Global and item-level MADRS differences between melancholic and unspecified depressive symptoms under rTMS: an exploratory analysis.

BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) has demonstrated efficacy in treating major depressive disorder (MDD), but evidence regarding its use across the different depressive subtypes remains limited. OBJECTIVE: To observe changes in overall MADRS scores and individual MADRS items in patients diagnosed with melancholic depressive features versus those with non-melancholic and non-atypical depressive features following rTMS. METHODS: An exploratory prospective study was conducted involving 21 participants presenting with depressive symptomatology either with melancholic (n=11) or unspecified features, meaning non-melancholic and non-atypical (n=10). All subjects underwent a standardized 15-session rTMS protocol. Depressive symptoms were assessed using the Montgomery-Åsberg Depression Rating Scale (MADRS) before and after treatment. RESULTS: After adjusting for confounding factors, an association was observed between the unspecified group and the greater reduction in the overall MADRS score (B = -9.08, 95% CI -17.69 to -0.46, p = 0.040). Significant results were also found for individual items of inner tension (B = -2.05, 95% CI -3.57 to -0.52, p = 0.012) and inability to feel (B = -1.94, 95% CI -3.10 to -0.78, p = 0.003). CONCLUSIONS: Our exploratory analyses show that patients with unspecified depressive features experience greater rTMS-related symptom improvement compared to those presenting melancholic features. These observations underscore the potential relevance of depressive subtypes in treatment response and warrant confirmation in larger, controlled studies.