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

Carolina Viegas, Setareh Ranjbar, Jean-Frédéric Mall, Pierre Vandel, Armin von Gunten, Beatriz Pozuelo Moyano, Kevin Swierkosz-Lenart

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.