Positive predictors for antidepressive response to prefrontal repetitive transcranial magnetic stimulation (rTMS) Eva-Lotta Brakemeier a, * , Alexander Luborzewski a , Heidi Danker-Hopfe a , Norbert Kathmann b , Malek Bajbouj a a Department of Psychiatry and Psychotherapy, Charite ´ – Universita ¨ tsmedizin Berlin, Campus Benjamin Franklin, Eschenallee 3, 14050 Berlin, Germany b Department of Clinical Psychology, Humboldt-University, Rudower Chaussee 18, 10099 Berlin, Germany Received 19 October 2005; received in revised form 4 January 2006; accepted 16 January 2006 Abstract Repetitive transcranial magnetic stimulation (rTMS) is a brain stimulation technique which had recently been investigated as a putative antidepressant intervention. However, there is little agreement about clinically useful predictors of rTMS outcome. There- fore, the objective of the present study was to determine whether specific biographical, clinical, and psychopathological parameters are associated with the antidepressant response to rTMS in a large sample of 70 depressive patients. We performed a logistic regres- sion analysis in 70 patients with major depressive disorder treated with rTMS of the left dorsolateral prefrontal cortex testing the predictive value of various domains of the depression syndrome as well as the variables episode duration, degree of treatment resis- tance, and CORE criteria. Response was defined as a 50% reduction of the initial Hamilton score (HAMD). After two weeks of treatment, 21% of the patients showed a response to rTMS. The binary logistic regression model correctly assigned 86.7% of the responders and 96.4% of the non-responders to their final response group. In the model, a high level of sleep disturbances was a significant predictor for treatment response to rTMS. Also, a low score of treatment resistance and a short duration of episode were positive predictors. These findings provide new evidence that especially pronounced sleep disturbances may be a significant clinical predictor of a response to rTMS. Prospective rTMS studies are necessary to validate the predictive value of the derived model. Ó 2006 Elsevier Ltd. All rights reserved. Keywords: Repetitive transcranial magnetic stimulation; Major depressive disorder; Response prediction 1. Introduction Affective disorders, especially major depression, are the most common psychological disorders, afflicting worldwide 10% of all patients seeking treatment at pri- mary health care facilities (Lopez and Murray, 1998). Because major depression is associated with substantial personal and societal costs, owing suicide, lost produc- tivity, and the high rates of health service utilization, it constitutes a major public health issue (Sturm and Wells, 1995). Especially chronic depression leads to dis- ability with major economic costs (Hirschfeld et al., 2000). Since the 1950s, antidepressants have been the pri- mary treatment approach for depressive disorders, and electroconvulsive therapy (ECT) has remained an option for patients refractory or intolerant to pharmacotherapy (Janicak et al., 1985). Although there is strong support for antidepressant efficacy of these strategies, a substan- tial number of depressed patients do not benefit from or cannot tolerate psychopharmacotherapy and/or ECT (Janicak and Martis, 1999). As a less invasive alternative to ECT, repetitive transcranial magnetic stimulation 0022-3956/$ - see front matter Ó 2006 Elsevier Ltd. All rights reserved. doi:10.1016/j.jpsychires.2006.01.013 * Corresponding author. Tel.: +49 30 8445 8606; fax: +49 30 8445 8233. E-mail address: eva-lotta.brakemeier@charite.de (E.-L. Brakeme- ier). www.elsevier.com/locate/jpsychires Journal of Psychiatric Research 41 (2007) 395–403 J OURNAL OF P SYCHIATRIC RESEARCH