Use of the Temperament and Character Inventory to Predict Response to Repetitive Transcranial Magnetic Stimulation for Major Depression

Abstract

Objective . The goal of this study was to investigate the utility of the Temperament and Character Inventory (TCI) in predicting antidepressant response to repetitive transcranial magnetic stimulation (rTMS). Background Although rTMS of the dorsolateral prefrontal cortex (DLPFC) is an established antidepressant treatment, little is known about predictors of response. The TCI measures multiple personality dimensions (harm avoidance, novelty seeking, reward dependence, persistence, self-directedness, self-transcendence, and cooperativeness), some of which have predicted response to pharmacotherapy and cognitive-behavioral therapy. A previous study suggested a possible association between self-directedness and response to rTMS in melancholic depression, although this was limited by the fact that melancholic depression is associated with a limited range of TCI profiles. Methods . Nineteen patients with a major depressive episode completed the TCI prior to a clinical course of rTMS over the DLPFC. Treatment response was defined as ≥50% decrease in scores on the Hamilton Rating Scale for Depression (HAM-D). Baseline scores on each TCI dimension were compared between responders and non-responders via analysis of variance. Pearson correlations were also calculated for temperament/character scores in comparison with percentage improvement in HAM-D scores. Results Eleven of the 19 patients responded to rTMS. T-scores for persistence were significantly higher in responders than in non-responders (P=0.022). Linear regression revealed a correlation between persistence scores and percentage improvement in HAM-D scores. Conclusions Higher persistence scores predicted antidepressant response to rTMS. This may be explained by rTMS-induced enhancement of cortical excitability, which has been found to be decreased in patients with high persistence. Personality assessment that includes measurement of TCI persistence may be a useful component of precision medicine initiatives in rTMS for depression.

Personalized repetitive transcranial magnetic stimulation temporarily alters default mode network in healthy subjects

“…Hence, the correlation between HA and HF-rTMS effects in the sgACC reported here, warrants further clinical studies to investigate the possibility of using this personality dimension as a predictor for HF-rTMS driven antidepressant effects. Of note, previous HF-rTMS studies have reported persistence 63 and self-directedness 64 scores of the TCI as good predictors of antidepressant effects. Upon post-hoc analysis, we did not find such correlations between other TCI dimensions and HF-rTMS induced changes in the sgACC and this might be, since our sample consisted of healthy volunteers.…”

The influence of personality on the effect of iTBS after being stressed on cortisol secretion

“…Interestingly, De Fruyt et al [14] demonstrated that Conscientiousness and Extraversion (NEO-V) are positively associated with Self-Directedness (TCI), and that Agreeableness and Extraversion (NEO-V) are positively correlated to Cooperativeness (TCI), also one of the three character dimensions of the TCI (the third character dimension of the TCI is Self-transcendence). Regarding temperament dimensions, Siddiqi et al [15] have recently shown that higher Persistence scores predicted antidepressant response to rTMS in a broad range of patients with major depression. With respect to other TCI scales, Singh et al [16] observed in healthy participants after a single HF-rTMS session that Harm Avoidance was related to a decrease in connectivity between the default network model and the subgenual Anterior Cingulate Cortex, a brain area that is assumed to be behind HF-rTMS treatment effects [17].…”

Individualized Connectome-Targeted Transcranial Magnetic Stimulation for Neuropsychiatric Sequelae of Repetitive Traumatic Brain Injury in a Retired NFL Player

“…Treatment led to improvements in clinicianassessed mood ratings, self-report emotional scores (including ratings of mood, anger, anxiety, and behavioral dyscontrol), and fluid cognition. Quantitative personality testing showed particularly drastic changes in persistence, a measure of reward-based learning that is related to mOFC-NAcc connectivity (44) and has some predictive value for rTMS response (45). This was accompanied by apparent normalization of connectivity in circuits related to rewardbased learning and reward-motivated behavior, although this is difficult to assess conclusively in a single subject.…”