Comparative Effectiveness of rTMS Vs. Esketamine in a Large Real-World Sample

Background: Predictors of treatment response when using transcranial magnetic stimulation (TMS) for major depressive disorder (MDD) are crucial to personalize and optimize the therapy.Prior work has identified some demographic factors and adjunctive medications that are associated with differential outcomes, but findings regarding the potential influence of personality traits have been mixed.Methods: Subjects were recruited and consented from a registry of patients undergoing clinical TMS treatment for MDD at an academic medical center.71 patients received a course of 10 Hz or intermittent theta-burst TMS and completed the Temperament and Character Inventory at baseline, prior to treatment initiation.Linear and logistic regression were used to assess the associations of personality domains with depression severity and treatment response, using the Patient Health Questionnaire-9 (PHQ-9, primary outcome) and the Montgomery-sberg Depression Rating Scale (MADRS, secondary outcome).Results: Of the seven personality trait domains assessed, selftranscendence (ST) was the only one significantly associated with TMS response.ST was inversely correlated with post-treatment PHQ-9 score and positively associated with treatment response (defined as a reduction in score of at least 50%).Similar results were observed for MADRS scores.Discussion: This is one of the larger studies evaluating the association of global personality characteristics with antidepressant response to TMS. High ST, which reflects judicious, intuitive, inventive, transpersonal, and spiritual characteristics, predicts lower post-treatment depression severity and increased likelihood of treatment response with a magnitude that is clinically significant.Further work should seek to replicate this finding and explore its potential clinical utility.