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Absence of early mood improvement as a robust predictor of rTMS nonresponse in major depressive disorder

Mirman, Alex M. and Corlier, Juliana and Wilson, Andrew C. and Tadayonnejad, Reza and Marder, Katharine G. and Pleman, Christopher M. and Krantz, David E. and Wilke, Scott A. and Levitt, Jennifer G. and Ginder, Nathaniel D. and Ojha, Rashi and Daskalakis, Zafiris J. and Leuchter, Andrew F. and Lee, Jonathan C. (2022) Absence of early mood improvement as a robust predictor of rTMS nonresponse in major depressive disorder. Depression and Anxiety, 39 (2). pp. 123-133. ISSN 1091-4269. doi:10.1002/da.23237.

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Background: Symptoms of major depressive disorder (MDD) are reported to change early in treatment with repetitive transcranial magnetic stimulation (rTMS). We evaluated early changes in sleep, anxiety, and mood as predictors of nonresponse to rTMS treatment. Methods: Three hundred twenty-nine subjects with nonpsychotic MDD completed a 6-week course of rTMS treatment. Subjects were stratified by the severity of their baseline depression, and had their overall depressive symptoms recorded every week of treatment. We evaluated lack of improvement in sleep, anxiety, and mood symptoms after 1 and 2 weeks as potential predictors of eventual nonresponse, defined as <50% improvement in compositive depressive symptoms after 6 weeks. This was measured as negative predictive value (NPV; the likelihood that lack of early symptom improvement accurately predicted eventual treatment nonresponse). Results: Subjects with severe or very severe baseline depression achieving <20% improvement in mood at 1 week were correctly predicted as nonresponders with NPVs largely >90%. At 2 weeks, subjects with very severe baseline depression who failed to demonstrate any improvement in mood were all nonresponders. Lack of improvement in sleep at 2 weeks was also a significant predictor. Conclusions: Identifying a lack of early mood improvement is a practical and robust method to predict rTMS nonresponse. This suggests a treatment protocol change may be indicated in patients with more severe baseline depression showing minimal early mood improvement.

Item Type:Article
Related URLs:
URLURL TypeDescription
Corlier, Juliana0000-0002-1342-5505
Marder, Katharine G.0000-0002-3073-2427
Pleman, Christopher M.0000-0001-8422-2257
Wilke, Scott A.0000-0002-7421-4015
Ginder, Nathaniel D.0000-0003-1854-2337
Daskalakis, Zafiris J.0000-0001-9502-0538
Leuchter, Andrew F.0000-0003-2402-7083
Lee, Jonathan C.0000-0003-3934-6458
Additional Information:© 2022 Wiley Periodicals LLC. Issue Online: 03 February 2022; Version of Record online: 06 January 2022; Manuscript accepted: 17 December 2021; Manuscript revised: 06 October 2021; Manuscript received: 05 April 2021. Data Availability Statement: Research data are not shared.
Subject Keywords:clinical predictor IDS-SR; major depressive disorder (MDD); nonresponse; PHQ-9; repetitive transcranial magnetic stimulation (rTMS); treatment outcome
Issue or Number:2
Record Number:CaltechAUTHORS:20220112-613460200
Persistent URL:
Official Citation:Mirman, A. M., Corlier, J., Wilson, A. C., Tadayonnejad, R., Marder, K. G., Pleman, C. M., Krantz, D. E., Wilke, S. A., Levitt, J. G., Ginder, N. D., Ojha, R., Daskalakis, Z. J., Leuchter, A. F., & Lee, J. C. (2022). Absence of early mood improvement as a robust predictor of rTMS nonresponse in major depressive disorder. Depression and Anxiety, 39, 123–133.
Usage Policy:No commercial reproduction, distribution, display or performance rights in this work are provided.
ID Code:112836
Deposited By: Tony Diaz
Deposited On:12 Jan 2022 18:43
Last Modified:14 Mar 2022 21:03

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