Comparative response patterns and tolerability of high-frequency rTMS in unipolar versus bipolar depression: a retrospective naturalistic study

Key Findings

This retrospective naturalistic study compared response patterns and tolerability of high-frequency left-DLPFC repetitive transcranial magnetic stimulation (rTMS) in patients with major depressive disorder (MDD) and bipolar depressive disorder (BD) under real-world clinical conditions. A total of 161 patients (95 MDD, 66 BD) who completed 20 sessions of 10 Hz rTMS between 2019 and 2023 were evaluated. Diagnoses were established using the SCID-5. Symptom severity was assessed with the Hamilton Depression Rating Scale (HAM-D). Response was defined as ≥50% HAM-D reduction, remission as post-treatment HAM-D ≤ 7. Multivariate logistic regression identified independent predictors of response. The MDD group demonstrated a significantly higher response rate than the BD group (48.4% vs. 28.8%; p = 0.013), while remission rates were comparable (21.1% vs. 21.2%; p = 1.000). Female patients exhibited higher response rates in both groups, reaching significance in MDD (58.8% vs. 36.4%, p = 0.029). Multivariate analysis confirmed diagnosis (OR = 2.25, p = 0.025), female sex (OR = 2.35, p = 0.014), and lower baseline HAM-D scores (OR = 0.85, p = 0.018) as independent predictors of response. rTMS was well tolerated, with mild transient side effects in 36.6% of participants and only one hypomanic activation. In this naturalistic sample, MDD showed a higher response than BD, while remission rates were comparable. Given the retrospective, completer-based design and asymmetric sampling, these findings are exploratory and should inform future controlled studies rather than current clinical practice. Under real-world conditions, rTMS produced significantly higher response rates in unipolar depression (48.4%) than in bipolar depression (28.8%), while remission rates were comparable (21.1% vs. 21.2%).MDD diagnosis, female sex, and lower baseline HAM-D scores independently predicted treatment response.rTMS was well tolerated in both diagnostic groups, with a low rate of affective switching in patients with bipolar depression.These exploratory findings suggest that diagnostic subtype may be associated with rTMS response and that alternative stimulation strategies for bipolar depression merit further study; they do not, by themselves, have direct clinical-implementation implications.Further controlled studies with larger samples and longer follow-up are needed to validate these results.

Why This Matters for Body-Mind Practice

[Draft — editorial context needed]

Source

• Comparative response patterns and tolerability of high-frequency rTMS in unipolar versus bipolar depression: a retrospective naturalistic study. — Nordic journal of psychiatry