Self-directedness: An indicator for clinical response to the HF-rTMS treatment in refractory melancholic depression

• Published in: Psychiatry research Vol. 220; no. 1; pp. 269 - 274
• Main Authors: Baeken, Chris, Desmyter, Stefanie, Duprat, Romain, De Raedt, Rudi, Van denabbeele, Dirk, Tandt, Hannelore, Lemmens, Gilbert M.D, Vervaet, Myriam, van Heeringen, Kees
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ireland Ltd 15-12-2014; Elsevier
• Subjects: Adult; Adult and adolescent clinical studies; Antidepressive Agents - therapeutic use; Biological and medical sciences; Depression; Depressive Disorder - diagnosis; Depressive Disorder - drug therapy; Depressive Disorder - psychology; Depressive Disorder, Treatment-Resistant - diagnosis; Depressive Disorder, Treatment-Resistant - psychology; Depressive Disorder, Treatment-Resistant - therapy; Female; HF-rTMS; Humans; Male; Medical sciences; Melancholia; Middle Aged; Miscellaneous; Mood disorders; Personality Inventory; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Self-Assessment; Self-directedness; Transcranial Magnetic Stimulation - methods; Transcranial Magnetic Stimulation - trends; Treatment Outcome; Treatment resistance; Unipolar depression; Unipolar depression; Self-directedness; Treatment resistance; HF-rTMS; Melancholia; Mood disorder; Transcranial magnetic stimulation; Central nervous system; Depression; Self; Indicator; Encephalon
• ISSN: 0165-1781; 1872-7123
• DOI: 10.1016/j.psychres.2014.07.084

Abstract Although well-defined predictors of response are still unclear, clinicians refer a variety of depressed patients for a repetitive Transcranial Magnetic Stimulation (rTMS) treatment. It has been suggested that personality features such as Harm Avoidance (HA) and self-directedness (SD) might provide some guidance for a classical antidepressant treatment outcome. However, to date no such research has been performed in rTMS treatment paradigms. In this open study, we wanted to examine whether these temperament and character scores in particular would predict clinical outcome in refractory unipolar depressed patients when a typical high-frequency (HF)-rTMS treatment protocol is applied. Thirty six unipolar right-handed antidepressant-free treatment resistant depressed (TRD) patients, all of the melancholic subtype, received 10 HF-rTMS sessions applied to the left dorsolateral prefrontal cortex (DLPFC). All patients were classified as at least stage III TRD and were assessed with the Temperament and Character Inventory (TCI) before a HF-rTMS treatment. Only the individual scores on SD predicted clinical outcome. No other personality scales were found to be a predictor of this kind of application. Our results suggest that refractory MDD patients who score higher on the character scale SD may be more responsive to the HF-rTMS treatment.