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Purpose: Repetitive transcranial magnetic stimulation (rTMS) is a treatment option for major depressive disorder (MDD). MDD is a heterogeneous condition with subtypes, including atypical depression (AD). The effectiveness of rTMS for AD remains unknown. In this study, we investigated the effects of rTMS in patients with AD compared to those with MDD in a clinical setting.

Materials and methods: A total of 103 patients with uni- or bipolar depressive episodes, treated with rTMS at the Uppsala Brain Stimulation Unit between April 2017 and October 2023, were included. Participants were categorized as AD (Quick Inventory of Depressive Symptomatology Self Report items 4, 7, and 9 ≥ 3) or MDD. The primary outcomes were response and remission rates based on the total score of Montgomery and Åsberg Depression Rating Scale self-report (MADRS-S). Response was defined as a 50% reduction of the total MADRS-S score and remission as MADRS-S < 10.

Results: Depressive symptoms significantly decreased after rTMS in the whole sample, with the mean MADRS-S score reduced from 34 to 25. The AD group had consistently lower scores on MADRS-S. No significant differences were observed in symptom reduction, response, or remission rates between AD and MDD groups. Response and remission rates were 12.6% and 2.9% for the whole sample, although reasons for treatment termination could not be assessed.

Conclusions: rTMS does not appear to yield specific benefits for AD. Observed response and remission rates were lower than previously reported, highlighting the need for more reports of the actual effectiveness of rTMS.