Personality dimensions and deep repetitive transcranial magnetic stimulation (dTMS) for treatment-resistant depression: A pilot trial on five-factor prediction of antidepressant response

Background:

Prognostication is poor in repetitive transcranial magnetic stimulation (rTMS) treatment for major depressive disorder (MDD).Personality traits, particularly extraversion and neuroticism, have attracted increasing attention for both trait-and state-dependentcharacteristics in predicting response to pharmacotherapy, psychotherapy, and more recently to therapeutic neuromodulation for MDD. The advent of deep rTMS (dTMS) allows stimulation of deeper cortical regions.

Objective:

This study aimed to prospectively characterize personality dimensions and antidepressant response to dTMS in treatment-resistant MDD.

Methods:

A convenience sample of 15 patients with treatment-resistant MDD received four weeks of daily sessions of dTMS (20Hz, 3000 pulses/session) of the left dorsolateral prefrontal cortex (DLFPC). At baseline and at the conclusion of treatment, patients completed the BigFive Inventory a five-factor assessment of major personality dimensions. Clinical response was measured using the 21-item Hamilton Depression Rating Scale.

Results:

Four weeks of DTMS treatment were not associated with changes in personality measures. Clinical remission was associated withhigher baseline levels of agreeableness (score ≥29:100% sensitive and 72.7% specific) and conscientiousness (score ≥30:75% sensitive and 81.8% specific). Levels of agreeableness and extraversion were linearly associated with antidepressant response. Neuroticism was not associated with the antidepressant effects of DTMS in this cohort.

Conclusions:

Five-factor personality assessment may have prognostic value in dTMSfor resistant MDD. Agreeableness, extraversion, and conscientiousness are associated with decreases in depressive symptoms during treatment with dTMS.

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