To determine distinct symptom-cluster response trajectories in individuals with treatment-resistant depression (TRD) undergoing left dorsolateral prefrontal cortex (DLPFC) rTMS.
Approach:
Study Design: Cohort study utilizing data from the THREE-D trial, a multicenter randomized noninferiority trial comparing rTMS treatment protocols.
Symptom Clusters: Examined anxiety, mood, insomnia, and somatic symptom clusters using group-based multitrajectory modeling (GBMTM).
Treatment Protocol: Participants received daily rTMS treatments for 4 weeks, with additional treatments for those showing insufficient response.
Measurement: Symptom clusters were measured using the Hamilton Depression Rating Scale (HDRS) with longitudinal assessments.
Key Findings:
Differential changes across symptom clusters were observed, with reductions in mood, insomnia, and somatic symptoms greater than in anxiety symptoms.
Distinct longitudinal trajectories for symptom clusters during rTMS treatment were identified.
Interpretation:
Characterizing symptom-cluster trajectories may enhance understanding of treatment responses and inform personalized rTMS protocols.
Limitations:
Depression's heterogeneity complicates the identification of distinct symptom clusters.
The study relies on HDRS total scores, which may not fully capture individual symptom cluster responses.
Conclusion:
Identifying co-occurring longitudinal trajectories of symptom clusters can inform personalized treatment strategies for TRD.
by Tyler S. Kaster, Xiao Chen, Jonathan Downar, Fidel Vila-Rodriguez, Danielle A. Baribeau, Kevin E. Thorpe, Zafiris J. Daskalakis, Chao-Gan Yan, Daniel M. Blumberger
