Clinical Efficacy of High-Frequency Deep Repetitive Transcranial Magnetic Stimulation in the Treatment of Depression and the Predictive Role of Baseline Triglyceride Levels: A Randomized Sham-Controlled Trial

ObjectiveTo evaluate the efficacy and safety of high-frequency deep repetitive transcranial magnetic stimulation (HF-dTMS) for depressive disorder and to explore whether baseline fasting triglyceride (TG) levels predict treatment response.MethodsIn this randomized, sham-controlled trial, 80 patients with moderate-to-severe depressive disorder were allocated to active HF-dTMS (n = 40) or sham stimulation (n = 40). Participants received 20 sessions over 4 weeks. The primary outcome was the change in Hamilton Depression Rating Scale (HAMD-17) scores from baseline to the end of treatment. Fasting TG levels were measured at baseline. We examined the association between baseline TG and symptom improvement and tested the interaction between TG and treatment assignment.ResultsActive HF-dTMS produced a significantly greater reduction in HAMD-17 scores than sham stimulation. Higher baseline TG levels were associated with greater symptom improvement. The relationship between TG and treatment response was stronger in the active HF-dTMS group than in the sham group, indicating that baseline TG may modify the treatment effect.ConclusionHF-dTMS was generally well tolerated and was associated with greater reductions in depressive symptoms than sham stimulation. Baseline fasting TG levels may be associated with the magnitude of treatment response and could serve as a potential exploratory biomarker for individualized dTMS treatment strategies.