Are neuroticism and extraversion associated with the antidepressant effects of repetitive transcranial magnetic stimulation (rTMS)? An exploratory 4-week trial

Depressive Disorders Program, Douglas Mental Health University Institute and McGill University, Montréal, Québec, Canada
Neuroscience Letters (Impact Factor: 2.03). 01/2013; 534(1). DOI: 10.1016/j.neulet.2012.12.029
Source: PubMed


Several randomized, controlled trials have found high frequency repetitive transcranial magnetic stimulation (HF-rTMS) to be effective for treating major depressive disorder (MDD), but its antidepressant mechanisms have yet to be firmly understood. In this context, pre-treatment personality traits and subsequent changes in personality concomitant to treatment may be relevant for our understanding of these mechanisms. To investigate this issue we conducted a naturalistic trial in which 14 subjects with moderate to severe depression were treated with daily HF-rTMS over the left dorsolateral prefrontal cortex for 4 weeks. Objective depressive symptoms (as assessed by the HAM-D(21)) and the major personality dimensions of neuroticism and extraversion were measured pre-post HF-rTMS. Pre-rTMS levels of extraversion predicted subsequent decrease in depressive symptoms. Also, HF-rTMS treatment resulted in a decrease in neuroticism scores, and this relative decrease was associated with the relative decrease in depression. Our results suggest that HF-rTMS may positively affect the personality dimension of neuroticism. Also, pre-treatment levels of extraversion may predict the subsequent antidepressant response to HF-rTMS. However, further studies with larger samples and controlled designs are needed to better clarify these preliminary findings.

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Available from: Marcelo Berlim, Mar 07, 2014
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    • "Of note, two recent studies from the same research group recently examined the predictive value of the Big Five Inventory (Benet- Martínez and John, 1998), based on the NEO-V model of personality (McCrae and Costa, 1987), on rTMS outcomes on MDD patients. Berlim et al. (2013) reported in their 4-week exploratory open trial that only high scores on extraversion predicted the clinical outcome of left DLPFC HF-rTMS treatment. McGirr et al. (2014) found that higher baseline levels of agreeableness and conscientiousness predicted remission after 4 weeks of deep HFrTMS delivered on the left DLPFC and the levels of agreeableness and extraversion were related to the level of antidepressant response. "
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    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.
    Full-text · Article · Aug 2014 · Psychiatry Research
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    • "Contrary to previous pharmacotherapy [1] [38], psychotherapy [38] and rT MS [3] [37] trials in MDD reporting decreases in neuroti-cism, our analyses did not reveal changes in any of the five-factor personality domains with DT MS, including neuroticism. Given the small sample size, it is premature to conclude that DT MS is not associated with alterations in neuroticism, however in light of sig-nificant effects emerging from even smaller standard rT MS samples [3] [37], DT MS may have a lesser effect on neuroticism. T his will require replication and investigation in larger samples. "
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    ABSTRACT: Prognostication is poor in repetitive transcranial magnetic stimulation (rTMS) treatment for major depressive disorder (MDD). Personality traits, particularly extraversion and neuroticism, have attracted increasing attention for both trait- and state-dependent characteristics in predicting response to pharmacotherapy, psychotherapy, and more recently to therapeutic neuromodulation for MDD. The advent of deep rTMS (DTMS) allows stimulation of deeper cortical regions, and we aimed to prospectively characterize personality dimensions and antidepressant response to DTMS in treatment-resistant MDD. A convenience sample of 15 patients with treatment-resistant MDD received four weeks of daily sessions of DTMS (20Hz, 3,000 pulses/session) of the left dorsolateral prefrontal cortex (DLFPC). At baseline and at the conclusion of treatment, patients completed the Big Five Inventory, a five-factor assessment of major personality dimensions. Clinical response was measured using the 21-item Hamilton Depression Rating Scale. Four weeks of DTMS treatment was not associated with changes in personality measures. Clinical remission was associated with higher baseline levels of agreeableness (score ≥ 29: 100% sensitive and 72.7% specific) and conscientiousness (score ≥ 30: 75% sensitive and 81.8% specific). Levels of agreeableness and extraversion were linearly associated with antidepressant response. Neuroticism was not associated with the antidepressant effects of DTMS in this cohort. Five-factor personality assessment may have prognostic value in DTMS for resistant MDD. Agreeableness, extraversion, and conscientiousness are associated with decreases in depressive symptoms during treatment with DTMS.
    Full-text · Article · Jan 2014 · Neuroscience Letters
    • "Interestingly, change in personality did not depend on improvement from depressive symptoms suggesting that change in personality is not a mere epiphenomenon of improved depressive state (Tang et al., 2009). In a naturalistic treatment study it has been shown that a 4-week trial of high frequency repetitive transcranial magnetic stimulation was related to decreased levels of neuroticism at post-treatment and the authors suggested that these improvements in neuroticism were likely independent from improvements in depressive state (Berlim et al., 2013). These findings suggest that treatment for MDD may have an impact on the personality of patients with MDD independent of the impact of treatment on depression itself. "
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    ABSTRACT: BACKGROUND: The personality dimensions neuroticism and extraversion likely represent part of the vulnerability to depression. The stability over longer time periods of these personality dimensions in depressed patients treated with psychological treatment or medication and in untreated persons with depression in the general population remains unclear. Stability of neuroticism and extraversion in treated and untreated depressed persons would suggest that part of the vulnerability to depression remains stable over time. The current study addressed the question whether treatment in depressed patients is related to changes in neuroticism and extraversion. METHODS: Data are from 709 patients with major depressive disorder participating in a cohort study (Netherlands Study of Depression and Anxiety; NESDA). We determined the 2-year stability of extraversion and neuroticism in treated and untreated persons and related change in depression severity to change in personality over time. RESULTS: Neuroticism decreased from baseline to 2-year follow-up (d=0.73) in both treated and untreated persons. Extraversion did not change significantly after controlling for neuroticism and depression severity at baseline and follow-up. Decreased depressive symptoms over time were related to decreased neuroticism (d=1.91) whereas increased depressive symptoms over time were unrelated to neuroticism (d=0.06). LIMITATIONS: Patients were not randomized to treatment conditions and the groups are therefore not directly comparable. CONCLUSIONS: Treated patients with depression in the general population improve just as much on depression severity and neuroticism as untreated persons with depression. This suggests that changes in neuroticism in the context of treatment likely represent mood-state effects rather than direct effects of treatment.
    No preview · Article · Apr 2013 · Journal of Affective Disorders
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