“Discrepancy between subjective and objective assessments focusing on item-level symptom improvement in repetitive transcranial magnetic stimulation therapy for treatment-resistant depression: A two-site prospective study”

Repetitive transcranial magnetic stimulation (rTMS) therapy is an effective treatment for treatment-resistant depression (TRD). However, discrepancies between subjective and objective assessments of treatment responses remain underexplored. This study examined discrepancies between clinician-rated and patient-reported scales following acute-phase rTMS therapy, focusing on item-level symptom improvement. This prospective observational study included 69 participants with TRD (34 females, 35 males) who underwent rTMS therapy at two institutions. Depression severity was assessed using the 17-item Hamilton Rating Scale for Depression (HAMD-17) and Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR). Remission and response rates were compared, and predictors of discrepancies were examined. At week 6, remission rates were significantly higher on the HAMD-17 than on the QIDS-SR (57.3 % vs. 35.2 %, p=0.016), and a similarly for response rates (66.1 % vs. 41.1 %, p=0.006). Symptom analysis showed greater improvements in behavioral and cognitive areas (e.g., work/activity, psychomotor retardation, anxiety). Despite clinically meaningful improvements, discrepancies were prominent in depressed mood, sleep disturbances, somatic symptoms, and suicidal ideation. Patients with higher education and more sessions were more likely to meet objective remission or response criteria without perceiving corresponding subjective improvement. These findings highlight a gap between subjective and objective assessments in rTMS therapy for TRD, with clinician-rated scales showing significantly higher remission and response rates than patient-reported scales. Discrepancies were especially notable in mood, sleep, somatic, and suicidal domains. These findings underscore the importance of integrating both assessment types when evaluating rTMS efficacy and suggest future interventions should optimize stimulation protocols and adopt patient-centered strategies.