Search Results (232)

Background: Subclinical psychological symptoms—such as low mood, perceived stress, and poor sleep—affect a large portion of the population and can impair quality of life despite remaining below clinical thresholds. The gut–brain axis has emerged as a promising target for interventions that support emotional and psychological resilience. Probiotics and postbiotics are gaining attention for their potential to modulate mood and stress via microbiome-related mechanisms, but human evidence remains limited, particularly in non-clinical populations. Objectives: We aimed to assess the effects of a two-strain combination of live microorganisms alongside a two-strain combination of heat-treated inactivated microorganisms on outcomes associated with anxiety, mood, perceived stress, and quality of life in healthy adults experiencing mild stress. Methods: This study was conducted in two parts. In Part I, a randomized, double-blind, placebo-controlled study, 100 participants were randomized to receive either a blend of live microorganisms (Bifidobacterium longum CECT 7347 and Lactobacillus rhamnosus CECT 8361) or an identical placebo once daily for 12 weeks. In Part II, a pilot feasibility study, a subset of eight placebo non-responders from Part I received the heat-inactivated preparation of the same bacterial strains in a 6-week trial extension phase. For Parts I and II, the primary outcome was the change in the Hamilton Anxiety Rating Scale (HAM-A). Secondary outcomes included measures of mood (Beck Depression Inventory (BDI); Patient Health Questionnaire-9 (PHQ-9)), stress (state and trait anxiety inventory (STAI); Perceived Stress Scale (PSS)), sleep (Pittsburgh Sleep Quality Index (PSQI)), quality of life (36-item Short Form Survey (SF-36)), gastrointestinal symptoms (Gastrointestinal Symptom Rating Scale (GSRS)), salivary cortisol and microbiome modulation. Results: In Part I, there were no significant effects of the live blend on the HAM-A, indicating that the primary endpoint was not met. In addition, no significant effects were seen on the STAI or PSS scores when compared to the placebo. However, participants consuming the live blend trended toward a reduction in total PHQ-9 scores compared to placebo (p = 0.089), whilst preliminary exploratory analyses suggested an improvement in anhedonia (p = 0.045). Furthermore, there was a significant improvement in the vitality domain of the SF-36 compared to placebo (p = 0.017). On microbiome analysis, it was noted that consumption of the live blend was linked to the preservation of butyrate-producing bacteria, particularly members of the Pseudoflavonifractor genus and the Clostridium SGB6179 species. Furthermore, the abundance of B. longum species was found to be inversely associated with the total PSS Scores. In Part II, supplementation with the inactivated preparation resulted in significant within-group improvements for the vitality (p = 0.006) and social functioning (p = 0.010) domains of the SF-36 and improvements in PSS scores compared to baseline (p = 0.050). Conclusions: Supplementation with either the dual-strain live or inactivated formulations was associated with significant improvements in the vitality domain of the SF-36, whilst participants receiving the inactivated formulation demonstrated lower perceived stress and improved social functioning compared to baseline. Overall, the findings from this pilot study suggest that these two biotic consortia are well-tolerated and may be associated with improvements in measures of vitality in individuals with subclinical psychological symptoms. The subtle observations detected for stress and anhedonia suggest that further well-powered trials are needed to better characterize these findings, potentially in populations with greater baseline symptomatology. Full article

Major depressive disorder (MDD) is a prevalent mental health condition that inflicts a high burden on individuals and healthcare systems. There is a clinical need to detect MDD relapse practically and effectively to improve treatment outcomes for patients. To address this, we developed a smart monitoring system using an Artificial Intelligence (AI) approach to estimate MDD severity and relapse risk from patients’ smartphone behavioral data (i.e., digital phenotyping). Thirty-five MDD patients were recruited from the Institute of Mental Health in Singapore, who installed the smartphone study app Sallie. Their symptoms were quantified using the Hamilton Depression Rating Scale (HAMD-17) at the start of the trial, and every 30 days after over 3 months. The app collected behavioral data such as activity, activity type, and GPS location used to train AI models such as logistic regression, decision trees, and random forest classifiers. We found that passive data collection continued for most participants (up to 79% retention rate) after 3 months. We also used five-fold cross-validation to predict HAMD-17 severity ranging from two to four classes and the relapse status, achieving 91%, 88%, and 78% accuracies for two to four classes, respectively, and a relapse prediction accuracy of 86% whereby four patients relapsed during the study. Additionally, anxiety factors within the HAMD-17 were significantly predicted (Pearson correlation coefficient = 0.78, p = 1.67 × 10⁻¹⁴). These results demonstrate the promise of using smartphone behavioral data to estimate depressive symptoms and identify early indicators of relapse. Full article

Introduction: Chronic obstructive pulmonary disease (COPD) is associated with substantial symptom burden and functional limitations, which may co-occur with psychological distress. This pilot study aimed to assess depressive symptoms, anxiety, insomnia, and sexual quality of life in patients with COPD living in the Podlaskie Voivodeship. Materials and Methods: This cross-sectional pilot study included 47 patients with COPD, including outpatients (n = 11) and inpatients (n = 36), recruited at the University Teaching Hospital in Bialystok between February and August 2025. The original survey questionnaire, Beck Depression Inventory (BDI), Hamilton Anxiety Rating Scale (HAM-A), Generalized Anxiety Disorder-7 (GAD-7), Athens Insomnia Scale (AIS), Insomnia Severity Index (ISI), and Sexual Quality of Life (SQoL) questionnaires were used. Results: In the study sample, median scores indicated a considerable burden of depressive symptoms (BDI Me = 16), anxiety (HAM-A Me = 27; GAD-7 Me = 15), and insomnia (AIS Me = 9; ISI Me = 14), alongside reduced sexual quality of life (SQoL Me = 46). Age in the total sample correlated positively with depressive symptoms, anxiety, and sleep difficulties, and negatively with SQoL; however, these relationships were not consistently maintained in age-stratified analyses. Crude inpatient–outpatient differences were substantial, but supplementary adjusted models showed that subjective symptom severity was the most consistent predictor across outcomes, whereas the independent role of hospitalization status was attenuated. Strong associations were observed between depression, anxiety, insomnia, and sexual quality of life. Conclusions: This pilot study indicates a substantial within-sample psychological burden in patients with COPD and suggests that these outcomes are closely associated with subjective symptom burden. Given the small sample size, marked group imbalance, cross-sectional design, and lack of objective COPD severity measures, the findings should be interpreted as exploratory and require confirmation in larger multicenter studies. Full article

Background: Transient ischemic attack (TIA) and minor stroke often result in excellent functional recovery but are frequently followed by substantial psychological morbidity. It remains unclear whether mood disturbances or cognitive impairment are the primary contributors to reduced health-related quality of life (HRQoL) in this population. Methods: We conducted a prospective observational case–control study including 90 patients with acute TIA or minor stroke confirmed by diffusion-weighted imaging and 92 age-matched healthy controls. At 90 days, participants completed the Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Montreal Cognitive Assessment, and the EQ-5D-5L. Hierarchical multiple regression using standardized z-scores identified independent predictors of HRQoL. Bias-corrected bootstrapped mediation analyses (5000 iterations) assessed whether cognitive impairment mediated the relationship between mood symptoms and HRQoL. Results: Compared with controls, patients exhibited markedly higher rates of depressive symptoms (82.2% vs. 18.5%), anxiety symptoms (81.1% vs. 21.7%), and cognitive impairment (66.7% vs. 13.0%) (all p < 0.001). Psychopathological variables explained an additional 36.6% of HRQoL variance, whereas cognitive and neuroimaging variables contributed only 1.7% (ΔR² = 0.017; p = 0.523). In the fully adjusted regression model, HAM-A showed the numerically largest standardized coefficient (β = −0.055; p = 0.064), representing a trend toward significance, while HDRS-17 did not individually reach statistical significance (β = −0.043; p = 0.147); cognitive impairment had negligible independent effects (β = −0.001; p = 0.947). Both mood variables collectively accounted for the substantial majority of explained HRQoL variance, far exceeding the contribution of cognitive and neuroimaging predictors. Mediation analyses revealed no significant indirect effects, indicating that mood and cognitive complications are statistically consistent with a model in which mood and cognitive symptoms exert independent effects on HRQoL; temporal ordering cannot be established from these cross-sectional measures. Conclusions: Following TIA or minor stroke, depressive and anxiety symptoms are highly prevalent, persist despite good neurological recovery, and exert a disproportionately negative impact on HRQoL. Anxiety appears particularly influential in determining patient-reported outcomes. The statistical consistency of the mediation models with parallel rather than sequential mood–cognition pathways suggests that these represent independent neurobiological sequelae requiring separate clinical attention, underscoring the need for routine and concurrent assessment of both mood and cognitive function after TIA and minor stroke. Full article

Background: Major depressive disorder (MDD) is a common mental disorder characterized by a wide range of symptoms and a substantial contribution to global disease burden. Our study aimed to examine the relationships between childhood trauma, sleep quality, dissociative symptoms, posttraumatic growth, and suicidality in patients diagnosed with MDD. Methods: Our sample consisted of 115 patients with MDD and 84 healthy controls. Participants were administered the Hamilton Depression Rating Scale (HDRS), Beck Scale for Suicidal Ideation (BSSI), Pittsburgh Sleep Quality Index (PSQI), Childhood Trauma Questionnaire (CTQ-33), Dissociative Experiences Scale (DES), and Posttraumatic Growth Inventory (PTGI). Group differences were analyzed, and associations among variables within the MDD group were examined using correlation and mediation analyses. Results: Compared to healthy controls, patients with MDD had significantly higher scores on all scales except the PTGI (p < 0.001 for each). Within the MDD group, individuals with a history of suicide attempts had significantly higher CTQ total scores, physical and sexual abuse subscale scores, and DES scores than those without previous attempts. Additionally, dissociative experiences had a partial mediating role in the relationship between depression severity and suicidal ideation, as well as in the relationship between childhood traumas and sleep quality. Conclusions: The findings highlight the clinical relevance of dissociative experiences and sleep disturbances in the heterogeneous presentation of MDD and their association with illness severity and suicidality. In the follow-up and treatment process of patients with MDD, risk and protective factors should be evaluated together, and individualized treatment programs should be targeted. Full article

Background: Non-invasive brain stimulation (NIBS) is increasingly used as an adjunctive option in late-life depression (≥60 years), a condition frequently complicated by multimorbidity and incomplete response to standard treatments. Comparative real-world evidence between repetitive Transcranial Magnetic Stimulation (rTMS) and transcranial Direct Current Stimulation (tDCS), particularly including functional outcomes, remains limited. Methods: We conducted a retrospective, naturalistic comparative study of 104 depressed inpatients (≥60 years), either unipolar or bipolar, treated with rTMS (n = 48) or tDCS (n = 56) as part of routine care. Depression severity was assessed with the 21-item Hamilton Depression Rating Scale (HDRS21) at baseline, 2 weeks, and 1 month; response was defined as ≥50% HDRS21 score reduction and remission as HDRS21 < 7 at 1 month. Global Assessment of Functioning (GAF) was assessed at admission and discharge (baseline and 1 month). Longitudinal changes were examined using covariate-adjusted mixed-effects models; categorical outcomes were compared using χ² tests. Propensity score matching was applied as an additional approach to reduce confounding due to the observational design. Results: At 1 month, response and remission rates were significantly higher in the rTMS group than in the tDCS group (87.5% vs. 55.4%, p < 0.001; 62.5% vs. 41.1%, p = 0.047, respectively). rTMS showed greater HDRS21 score reductions at 2 weeks and 1 month (Time × Treatment, p < 0.001). GAF scores significantly improved over time in both groups (Time effect, p < 0.001) without between-technique differences (Time × Treatment, p = 0.56), and GAF scores did not differ by response/remission status. Conclusions: In this cohort of inpatients aged ≥ 60 years with depressive episodes, rTMS was associated with greater short-term reductions in HDRS21 scores compared with tDCS, whereas both modalities showed comparable improvements in GAF from admission to discharge. Full article

Background/Objectives: Evidence regarding the relationship between thyroid function tests (TFTs) and severe or treatment-resistant depression in euthyroid individuals remains limited. We aimed to investigate thyroid function tests (TFTs) in euthyroid patients with depression undergoing electroconvulsive therapy (ECT), evaluate associations with ECT response and depression severity, and explore whether clinically meaningful subgroups with differential thyroid function patterns can be identified. Methods: In this retrospective cohort study, we screened 107 inpatients who received ECT for severe or treatment-resistant depression (major depressive disorder [MDD] or bipolar disorder [BD]). Seventy-six euthyroid patients were analyzed. Clinical data, Hamilton Depression Rating Scale (HAMD) scores, and TFTs (TSH, free-T3, and free-T4) were assessed. Logistic regression, multiple linear regression and unsupervised hierarchical cluster analyses were performed. The cluster analysis used clinical and demographic variables, excluding TFTs to avoid circularity and allow thyroid parameters to be examined as secondary biological correlates. Results: The TFT results were not significantly associated with ECT response in euthyroid patients. The multiple linear regression revealed that the baseline HAMD scores were positively associated with free-T4 (β = 0.797, p = 0.001). Hierarchical clustering identified two subgroups; one group characterized by male sex, psychotic features, and MDD diagnosis exhibited lower TSH levels (2.12 vs. 1.49 mlU/L, Cohen’s d = 0.56) despite similar ECT response rates. Conclusions: Subtle TFT variations were not associated with ECT response but were related to depression severity and clinical phenotypes. These findings suggest that normal-range thyroid hormone variability may reflect state-related neuroendocrine patterns rather than predictors of treatment outcome. Our results should be regarded as hypothesis-generating and underline the need for prospective studies to clarify the clinical significance of thyroid function variability in severe depression. Full article

Background/Objectives: Real-world evidence on the use of vortioxetine within cardiac rehabilitation (CR) programs among patients with major depressive disorder (MDD) remains limited. We aimed to describe the evolution of depressive symptoms, functional status, and selected cardiovascular and biometric parameters in patients with MDD undergoing CR while receiving vortioxetine in routine clinical practice. Methods: This was a 12-week, prospective, observational study conducted at Clínica Colman (Cádiz, Spain) between July 2022 and July 2024. Adults diagnosed with MDD who were undergoing CR and receiving vortioxetine as part of routine care were included. Depressive symptoms (Hamilton Depression Rating Scale, HAM-D) and functional impairment (Sheehan Disability Scale, SDS) were assessed at baseline and at weeks 3, 7, and 12. Cardiovascular and biometric parameters were measured at baseline and at week 12. Repeated-measures ANOVA and paired t-tests were used for statistical analysis. Results: Forty-nine patients were included (mean age 65.6 years; 41% women). Over the 12-week follow-up period, mean HAM-D and SDS scores decreased over time (both p < 0.001). Changes were also observed in VO₂ max, body weight, body mass index, and waist circumference (all p < 0.05). Left ventricular ejection fraction, blood pressure, and QTc interval showed no relevant variation during follow-up. Mild adverse effects were reported in 6.1% of patients. Conclusions: In patients with MDD and undergoing CR while receiving vortioxetine, longitudinal changes were observed in psychological, functional, and selected cardiovascular measures. These real-world data describe clinical trajectories within integrated rehabilitation settings and provide hypothesis-generating evidence for future controlled studies. Full article

Background: Major depressive disorder (MDD) is often accompanied by generalized anxiety disorder (GAD), a comorbidity linked to greater illness burden and potentially poorer outcomes. Repetitive transcranial magnetic stimulation (rTMS) and intermittent theta-burst stimulation (iTBS) are established treatments for MDD, yet the impact of comorbid GAD and concomitant medications remains unclear. This study aimed to compare rTMS/iTBS treatment outcomes between patients with MDD with and without comorbid GAD, and to examine the association between concomitant psychotropic medication use, stimulation protocol, and treatment response in a real-world clinical setting. Methods: We conducted a retrospective observational analysis using registry data from 108 patients (MDD + GAD: n = 36; MDD only: n = 72). Patients received either Left-iTBS or Right-rTMS. Baseline severity, percentage change in Montgomery–Åsberg Depression Rating Scale (MADRS) and Hamilton Depression Rating Scale (HAMD-17) scores, response, and remission were assessed. Logistic and linear regression models adjusted for age, sex, and baseline severity were applied. Sensitivity analyses stratified by stimulation protocol and benzodiazepine (BDZ) use were performed. Results: Baseline severity did not differ between groups. MADRS reduction was numerically lower in the comorbid GAD group (48.3% vs. 52.7%, p = 0.09), whereas HAMD-17 reduction was comparable. Response and remission rates did not differ significantly. Medication use and stimulation protocol did not show statistically significant independent associations with outcomes. Sensitivity analyses confirmed equivalent outcomes between Left-iTBS and Right-rTMS. BDZ users showed a non-significant trend toward lower MADRS improvement and remission. Conclusions: rTMS/iTBS produced substantial clinical improvement and was well tolerated in both patients with MDD and those with MDD comorbid with GAD. Although comorbid anxiety showed a modest tendency to attenuate MADRS score reduction, overall response and remission rates were comparable between groups. Neither concomitant medications nor stimulation protocol significantly affected treatment outcomes, while the potential influence of BDZ exposure warrants further investigation. Full article

Background: Emotion processing is critical in the neuropathology of major depressive disorder (MDD), while its relationship with clinical treatment remains unclear. This study aims to indicate the associations between emotion processing and treatment effects following a sequential dual-site accelerated repetitive transcranial magnetic stimulation (rTMS) protocol. Methods: MDD patients were recruited to receive rTMS treatment with four sessions per day for four consecutive days, with stimulation sequentially delivered to the left dorsolateral prefrontal cortex (dlPFC) and the dorsomedial prefrontal cortex (dmPFC). Symptoms were assessed at baseline, end of treatment, and week 4 using the Montgomery–Åsberg Depression Rating Scale (MADRS), Snaith-Hamilton Pleasure Scale (SHAPS), and Fatigue Severity Scale (FSS). Emotional valence and arousal were evaluated with the Affect Rating Task (ART). Results: A total of 51 participants completed the clinical assessments and ART, with two excluded due to missing baseline data in the SHAPS and FSS. The linear mixed-effects models revealed significant improvement in depressive (p < 0.001, d = −0.343) and fatigue symptoms (p = 0.010, d = −0.572) following rTMS treatment. Neutral valence was correlated with MADRS scores at baseline (R² = 0.096, p = 0.027). In addition, changes in arousal for positive images (p = 0.047, adjusted R² = 0.097) and neutral images (p = 0.019, adjusted R² = 0.160) at treatment end were significantly correlated with MADRS improvement at week 4. Conclusions: Our study highlights the association between changes in emotional arousal and improvement in MDD following accelerated dlPFC-dmPFC dual-site rTMS treatment. Full article

Acoustic voice analysis demonstrates potential as a non-invasive biomarker for depression, yet its generalizability across languages remains underexplored. This cross-sectional study aimed to identify a set of cross-culturally consistent acoustic features for depression screening using distinct Vietnamese and Japanese voice datasets. We analyzed anonymized recordings from 251 participants, comprising 123 Vietnamese individuals assessed via the self-report Beck Depression Inventory (BDI) and 128 Japanese individuals assessed via the clinician-rated Hamilton Depression Rating Scale (HAM-D). From 6373 features extracted with openSMILE, a multi-stage selection pipeline identified 12 cross-cultural features, primarily from the auditory spectrum (AudSpec), Mel-Frequency Cepstral Coefficients (MFCCs), and logarithmic Harmonics-to-Noise Ratio (logHNR) domains. The cross-cultural model achieved a combined Area Under the Curve (AUC) of 0.934, with performance disparities observed between the Japanese (AUC = 0.993) and Vietnamese (AUC = 0.913) cohorts. This disparity may be attributed to dataset heterogeneity, including mismatched diagnostic tools and differing sample compositions (clinical vs. mixed community). Furthermore, the limited number of high-risk cases (n = 33) warrants cautious interpretation regarding the reliability of reported AUC values for severe depression classification. These findings suggest the presence of a core acoustic signature related to physiological psychomotor changes that may transcend linguistic boundaries. This study advances the exploration of global vocal biomarkers but underscores the need for prospective, standardized multilingual trials to overcome the limitations of secondary data analysis. Full article

Background: Physical exercise (PE) has emerged as a promising intervention for depressive disorder (DD), yet its efficacy and optimal implementation remain under investigation. Objective: To thoroughly assess the effectiveness of supervised PE as a conventional intervention for adults with DD. Methods: A comprehensive literature search was conducted across PubMed/MEDLINE, EBSCOhost, Ovid, Web of Science, and Scopus. Randomized controlled trials (RCTs) published between 2010–2025 involving adults with DD without other comorbidities under supervised exercise interventions were selected. Methodological rigor was ensured through two independent reviewers and adherence to PRISMA 2020 guidelines. The influence of moderating variables [total work performed (workload) and the instrument used to evaluate DD (instrument)] was analyzed using meta-regression. The pooled effect size was estimated using both frequentist and Bayesian meta-analyses. Results: From 15,542 screened records, 20 RCTs were selected. Workload and instrument account for 60% and 15% of the variance in the effect size, respectively. Both frequentist and Bayesian meta-analyses showed that supervised PE reduces depressive symptoms (standardized mean difference = 0.82; 95% CI: 0.54–1.11; I² = 76%, and 0.61; 95% CI: −0.06–0.95; I² = 51, respectively). Conclusions: PE could be a valuable complementary intervention to reduce depressive symptoms in adults with depression. PROSPERO (CRD420251121919). Full article

Major depressive disorder (MDD) was long framed as a single clinical entity arising from a linear stress–monoamine–hypothalamic–pituitary–adrenal (HPA) axis cascade. This view was shaped by forced swim and learned helplessness tests in animals and by short-term symptom-based trials using scales such as the Hamilton Depression Rating Scale (HAM-D) and the Montgomery–Åsberg Depression Rating Scale (MADRS). This “unitary cascade” view has been dismantled by advances in neuroimaging, immune–metabolic profiling, sleep phenotyping, and plasticity markers, which reveal divergent circuit-level, inflammatory, and chronobiological patterns across anxiety-linked, pain-burdened, and cognitively weighted depressive presentations, all characterized by high rates of non-response and relapse. Translationally, face-valid rodent assays that equated immobility with despair have yielded limited bedside benefit, whereas cross-species bridges—electroencephalography (EEG) motifs, rapid eye movement (REM) architecture, effort-based reward tasks, and inflammatory/metabolic panels—are beginning to provide mechanistically grounded, clinically actionable readouts. In current practice, depression care is shifting toward systems psychiatry: inflammation-high and metabolic-high archetypes, anhedonia- and circadian-dominant subgroups, formal treatment-resistant depression (TRD) staging, connectivity-guided neuromodulation, esketamine, selected pharmacogenomic panels, and early digital phenotyping, as endpoints broaden to functioning and durability. A central gap is that heterogeneity is acknowledged but rarely built into trial design or implementation. This perspective advances a plasticity-centered systems psychiatry in which a testable prediction is that manipulating defined prefrontal–striatal and prefrontal–limbic circuits in sex-balanced, chronic-stress models will reproduce human network-defined biotypes and treatment response, and proposes hybrid effectiveness–implementation platforms that embed immune–metabolic and sleep panels, circuit-sensitive tasks, and digital monitoring under a shared, preregistered data standard. Full article

Background: Older adults are a vulnerable population wherein their advancing age leads to limitations in physical and mental functionality that can compromise quality of life. Objective: The objective of this study was to analyze the relationship between mental health factors and quality of life in older adult users of long-term care services in Mexico. Methods: The present cross-sectional study was conducted with a convenience sample of 131 older adult users of long-term care services (three residential care homes and a day center) in Morelia, Michoacán, Mexico. A questionnaire including the World Health Organization Quality of Life Older Adults Scale (WHO-QoL-Old), Geriatric Depression Scale (GDS), Hamilton Anxiety Rating Scale (HARS), Cognitive Reserve Questionnaire (CRQ), and sociodemographic variables was administered. The analysis of the relationship between variables was performed using bivariate analysis (comparisons between groups and Pearson correlations). Due to the type of sampling, the representativeness of the sample obtained was not evaluated. Results: Depression and anxiety were found to inversely influence overall quality of life and its dimensions, while cognitive reserve is a factor that favors quality of life. Also, as related to cognitive reserve, level of education was found to be a factor that favors quality of life. Conclusions: Older adult users of long-term care services are a vulnerable group, given the negative impact on their quality of life that some mental health conditions could have, such as depression, anxiety, and low cognitive reserve. Full article

Introduction: Major depressive disorder (MDD) is a common and often treatment-resistant condition, with many patients showing only partial or minimal response to standard therapies. Repetitive transcranial magnetic stimulation (rTMS) is a well-established, non-invasive treatment for depression, though individual response varies considerably. While demographic and clinical predictors have been explored, the impact of personality styles on rTMS outcomes remains underinvestigated. Herein, we aimed to explore whether personality styles influence treatment response to rTMS. Methods: This retrospective study included 63 in- and outpatients with depressive episodes treated with intermittent theta-burst stimulation (iTBS) between September 2020 and December 2022. Patients were assessed before and after treatment using the 21-item Hamilton Depression Rating Scale (HAMD-21) and the self-reported Major Depression Inventory (MDI). Personality styles were evaluated using the German Persönlichkeits-Stil-und-Störungs-Inventar (PSSI), a dimensional measure of 14 personality styles. Statistical analyses included paired-samples t-tests to assess symptom change and linear regression models to examine whether personality styles predicted treatment outcomes. Effect sizes were reported as Cohen’s d. Results: Patients showed a significant reduction in depressive symptoms following iTBS (HAMD-21: t(62) = 10.86, p < 0.001, d = 1.37. MDI: t(62) = 8.55, p < 0.001, d = 1.06). Stepwise regression for the MDI identified critical–negativistic (NT) and reserved–schizoid (SZ) styles as significant predictors, explaining approximately 16% of the variance (R² = 0.159, p = 0.007). When entered simultaneously in a regression model for the HAMD-21, these same traits also predicted symptom change, though the effect was smaller (R² = 0.108, p = 0.033). Higher scores of critical–negativistic (NT) style were associated with better improvement, whereas higher scores of reserved–schizoid (SZ) style were associated with less improvement. Conclusions: This study confirms the overall efficacy of rTMS in reducing depressive symptoms. While SZ and NT traits showed some predictive value for treatment response—particularly on self-reported outcomes—their influence was modest and inconsistent. Based on our findings, there is no reason why patients with depression and specific personality styles, or even comorbid personality disorders, should be denied rTMS treatment. Full article