Transcranial magnetic stimulation to treat 101 patients with depression and comorbid personality disorders in a real-world naturalistic clinical setting: feasibility, tolerability and effectiveness

Introduction Many patients with depression fail to achieve adequate response or remission with standard treatments, prompting an urgent need to identify factors influencing treatment outcomes. Among these, comorbid personality disorders (PDs) have been identified as a significant contributor to poorer treatment responses. Methods and materials In this open-label, naturalistic study, we evaluated the feasibility, tolerability, and effectiveness of intermittent theta burst stimulation (iTBS) in a sample of 101 patients with depression and comorbid PD. Eighty-six patients received a standard iTBS protocol (one session per day over several weeks), while fifteen opted for an accelerated protocol involving two to four sessions per day. Symptom severity was assessed using the Beck Depression Inventory (BDI) and the Symptom Checklist-90-R (SCL-90-R), administered at baseline, weekly during treatment, and at four follow-up points (1, 2, 3, and 4 months post-treatment). Results and conclusion Both treatment protocols led to significant symptom reduction, which was sustained over the follow-up period. Remission rates were 87 % in the accelerated group and 63 % in the standard protocol group. iTBS was well tolerated, with no serious adverse events reported. Notably, patients who were not taking antidepressant medication and those who were younger showed better treatment responses. iTBS appears to be a feasible, safe, and effective treatment option for depressed patients with comorbid PD. The findings suggest the benefits of iTBS treatment and support further exploration of patient characteristics that may predict response to rTMS.