{"doi":"10.1016/j.brs.2025.10.020","title":"Trajectories of response to bilateral rTMS in late-life depression","abstract":"BACKGROUND: Late-life depression is often resistant to standard treatment (LL-TRD) and presents unique clinical challenges due to comorbidities and cognitive decline. Repetitive transcranial magnetic stimulation (rTMS) is a promising option, yet responses are variable. Identifying trajectories of symptom change in LL-TRD in response to rTMS may clarify this heterogeneity and guide more personalized interventions. METHODS: This secondary analysis of a randomized rTMS trial in late-life depression used group-based trajectory modeling to identify depressive symptom response patterns. 172 participants aged 60+ were randomly assigned to one of two protocols: (1) bilateral rTMS, with low-frequency stimulation applied to the right dorsolateral prefrontal cortex (DLPFC) and high-frequency stimulation to the left; or (2) bilateral theta burst stimulation, with continuous TBS on the right DLPFC and intermittent TBS on the left. Multinomial regression identified baseline characteristics associated with trajectory membership. RESULTS: Four symptom trajectories were identified: Nonresponse, Partial Response, Linear Response and Rapid Response. Relative to Partial Response, higher Montgomery-Åsberg Depression Rating Scale (MADRS) scores were associated with lower odds of Rapid (OR = 0.79, 95 %CI:0.69-0.90) and Linear Response (OR = 0.87, 95 %CI:0.78-0.97), and higher odds of Nonresponse (OR = 1.33, 95 %CI:1.16-1.52). Benzodiazepine use was associated with lower odds of Linear Response (OR = 0.22, 95 %CI:0.08-0.56), while higher baseline anxiety was associated with higher odds of Nonresponse (OR = 1.13, 95 %CI:1.01-1.26). CONCLUSION: This study identified four distinct rTMS response trajectories in LL-TRD and found that greater baseline depression severity and anxiety were associated with worse trajectories. These results support early clinical profiling to identify individuals at risk for nonresponse. CLINICALTRIALS: gov identifier NCT02998580.","journal":"Brain stimulation","year":2025,"id":535260,"datarank":0.16479184330021646,"base_score":1.0986122886681096,"endowment":1.0986122886681096,"self_citation_contribution":0.16479184330021646,"citation_network_contribution":0.0,"self_endowment_contribution":0.16479184330021646,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":2,"citer_count":2,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.8874,"is_data_producer":true,"deposit_databanks":{"ClinicalTrials.gov":["NCT02998580"]},"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":333475,"name":"Daniel M. Blumberger","orcid":"0000-0002-8422-5818","position":1,"is_corresponding":false},{"id":553898,"name":"Xiao Chen","orcid":"0000-0001-5561-6572","position":2,"is_corresponding":false},{"id":846301,"name":"Hyewon H. Lee","orcid":"0000-0001-5032-0350","position":3,"is_corresponding":false},{"id":613875,"name":"Sean M. Nestor","orcid":"0000-0002-8848-5027","position":4,"is_corresponding":false},{"id":230804,"name":"Jonathan Downar","orcid":"0000-0002-5140-174X","position":5,"is_corresponding":false},{"id":226870,"name":"Benoit H. Mulsant","orcid":"0000-0002-0303-6450","position":6,"is_corresponding":false},{"id":226868,"name":"Tarek K. Rajji","orcid":"0000-0002-8324-2560","position":7,"is_corresponding":false},{"id":487329,"name":"Yoshihiro Noda","orcid":"0000-0002-2155-0357","position":8,"is_corresponding":false},{"id":294684,"name":"Zafiris J. Daskalakis","orcid":"0000-0001-9502-0538","position":9,"is_corresponding":false},{"id":644596,"name":"Tyler S. Kaster","orcid":"0000-0002-5299-4794","position":10,"is_corresponding":false},{"id":1419370,"name":"Erin Adler","orcid":null,"position":0,"is_corresponding":true}],"reference_count":34,"raw_metadata":null,"created_at":"2026-07-19T02:51:56.297114Z","pmid":"41183728","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}