Hospital Practices and Research

The Effectiveness of Repetitive Transcranial Magnetic Stimulation (rTMS) on Attention and Short-Term Memory in Patients with Major Depressive Disorder

Document Type : Original Article

Authors

Marzieh Hatami
Afshin Ataeiyan

Department of Psychology, Ya.C., Islamic Azad University, Yazd, Iran

https://doi.org/10.30491/hpr.2025.514050.1486
Abstract
Background: Major Depressive Disorder (MDD) often presents with cognitive deficits, including impairments in attention and short-term memory, which can significantly impact patients' quality of life.
Objectives: This study investigated the effectiveness of repetitive Transcranial Magnetic Stimulation (rTMS) on attention and short-term memory in patients with MDD.
Methods: This study adopted a quasi-experimental, pretest-posttest control group design, conducted in Yazd, Iran, during 2023. A convenience sample of thirty patients, aged 20-50 years, diagnosed with MDD, was recruited and subsequently randomized into either an intervention or a control group (n=15 per group). All participants received antidepressant medication (SSRI); however, the intervention group also underwent ten sessions of 5Hz rTMS at an intensity of 120% of the motor threshold, targeting the left dorsolateral prefrontal cortex (DLPFC), while the control group received sham rTMS. Cognitive function, specifically attention and short-term memory, was evaluated using the Wechsler Memory Scale. Statistical analysis was performed using SPSS-27, with analysis of covariance (ANCOVA) employed to assess treatment effects.
Results: Participants in the study included 30 individuals with MDD (male and female), with a mean age of 43.65 ± 6.49 years. The findings indicated that rTMS yielded statistically significant changes in attentional and short-term memory performance among these patients (P<0.01). This outcome demonstrates a beneficial impact of rTMS on cognitive domains affected by MDD, providing empirical evidence for its potential therapeutic role.
Conclusion: This study demonstrates that rTMS targeting the DLPFC significantly enhances attention and short-term memory in MDD patients. Consequently, these results suggest rTMS as a valuable adjunctive therapy for mitigating cognitive deficits associated with MDD through its neuromodulatory effects, offering a potential strategy to improve patients' daily functioning and overall quality of life.

Keywords

Depressive Disorder
rTMS
Attention
Memory
Neuroplasticity
Cognitive Remediation
  1. Proudman D, Greenberg P, Nellesen D. The growing burden of major depressive disorders (MDD): implications for researchers and policy makers. Pharmacoeconomics. 2021;39:619-25. doi:10.1007/ s40273-021-01040-7
  2. Kupferberg A, Hasler G. The social cost of depression: Investigating the impact of impaired social emotion regulation, social cognition, and interpersonal behavior on social functioning. J Affect Disord Rep. 2023;14:100631. doi:10.1016/j.jadr.2023.100631
  3. Cui L, Li S, Wang S, Wu X, Liu Y, Yu W, et al. Major depressive disorder: hypothesis, mechanism, prevention and treatment. Signal Transduct Target Ther. 2024;9(1):30. doi:10.1038/s41392-024-01738-y
  4. Lam RW, Kennedy SH, McIntyre RS, Khullar A. Cognitive dysfunction in major depressive disorder: effects on psychosocial functioning and implications for treatment. Can J Psychiatry. 2014;59(12):649-54. doi:10.1177/070674371405901206
  5. Anguzu R, Abbo C, Dickson-Gomez J, Bobholz M, Kiconco A, Shour AR, et al. Depression symptom severity and behavioral impairment in school-going adolescents in Uganda. BMC psychiatry. 2025;25(1): 75. doi:10.1186/s12888-025-06486-z
  6. Keller AS, Leikauf JE, Holt-Gosselin B, Staveland BR, Williams LM. Paying attention to attention in depression. Transl Psychiatry. 2019;9(1):279. doi:10.1038/s41398-019-0616-1
  7. Wang X, Zhou H, Zhu X. Attention deficits in adults with Major depressive disorder: A systematic review and meta-analysis. Asian J Psychiatry. 2020;53: 102359. doi:10.1016/j.ajp.2020.102359
  8. Zhou H, Liu J, Wu Y, Huang Z, Wang W, Ma Y, et al. Unveiling the interoception impairment in various major depressive disorder stages. CNS Neurosci Ther. 2024;30(8):e14923. doi:1111/cns.14923
  9. Sumiyoshi T, Watanabe K, Noto S, Sakamoto S, Moriguchi Y, Hammer-Helmich L, et al. Relationship of subjective cognitive impairment with psychosocial function and relapse of depressive symptoms in patients with major depressive disorder: analysis of longitudinal data from perform-j. Neuropsychiatr Dis Treat. 2021:945-55. doi:2147/NDT.S288108
  10. Zuckerman H, Pan Z, Park C, Brietzke E, Musial N, Shariq AS, et al. Recognition and treatment of cognitive dysfunction in major depressive disorder. Front Psychiatry. 2018;9:655. doi:10.3389/fpsyt. 2018.00655
  11. Knight MJ, Baune BT. Executive function and spatial cognition mediate psychosocial dysfunction in major depressive disorder. Front Psychiatry. 2018;9:539. doi:10.3389/fpsyt.2018.00539
  12. Perini G, Cotta Ramusino M, Sinforiani E, Bernini S, Petrachi R, Costa A. Cognitive impairment in depression: recent advances and novel treatments. Neuropsychiatr Dis Treat. 2019:1249-58. doi:10.21 47/NDT.S199746
  13. Taivalantti M, Barnett JH, Halt AH, Koskela J, Auvinen J, Timonen M, Järvelin MR, Veijola J. Depressive symptoms as predictors of visual memory deficits in middle-age. J Affect Disord. 2020;264:29-34. doi:10.1016/j.jad.2019.11.125
  14. Sridhar S, Khamaj A, Asthana MK. Cognitive neuroscience perspective on memory: overview and summary. Front Hum Neurosci. 2023;17:1217093. doi:10.3389/fnhum.2023.1217093
  15. Darcet F, Gardier AM, Gaillard R, David DJ, Guilloux JP. Cognitive dysfunction in major depressive disorder. A translational review in animal models of the disease. Pharmaceuticals. 2016;9(1):9. doi:10.33 90/ph9010009
  16. Stubberud J, Huster R, Hoorelbeke K, Hammar Å, Hagen BI. Improved emotion regulation in depression following cognitive remediation: A randomized controlled trial. Behav Res Ther. 2021;147:103991. doi:10.1016/j.brat.2021.103991
  17. Dillon DG. The neuroscience of positive memory deficits in depression. Front Psychol. 2015;6:1295. doi:10.3389/fpsyg.2015.01295
  18. Brigitta B. Pathophysiology of depression and mechanisms of treatment. Dialogues Clin Neurosci. 2002;4(1):7-20. doi:10.31887/DCNS.2002.4.1/bbondy
  19. Fries GR, Saldana VA, Finnstein J, Rein T. Molecular pathways of major depressive disorder converge on the synapse. Mol Psychiatry. 2023;28(1):284-97. doi:10.1038/s41380-022-01806-1
  20. Mitroshina EV, Marasanova EA, Vedunova MV. Functional dimerization of serotonin receptors: role in health and depressive disorders. Int J Mol Sci. 2023;24(22):16416. doi:10.3390/ijms242216416
  21. Kamenov K, Twomey C, Cabello M, Prina AM, Ayuso-Mateos JL. The efficacy of psychotherapy, pharmacotherapy and their combination on functioning and quality of life in depression: a meta-analysis. Psychol Med. 2017;47(3):414-25. doi:10.10 17/S0033291716002774
  22. Ozturk H, Venugopal S. Transcranial magnetic stimulation as a therapeutic option for neurologic diseases and psychiatric disorders: A systematic review. Cureus. 2022;14(8):e28259. doi:10.7759/ cureus.28259
  23. Padberg F, Zwanzger P, Keck ME, Kathmann N, Mikhaiel P, Ella R, Rupprecht P, Thoma H, Hampel H, Toschi N, Möller HJ. Repetitive transcranial magnetic stimulation (rTMS) in major depression: relation between efficacy and stimulation intensity. Neuropsy chopharmacology. 2002;27(4):638-45. doi:10.1016 /S0893-133X(02)00338-X
  24. Bidaki R, Mirhosseini H, Zare N. Impact of transcranial direct current stimulation on patients with Parkinson’s disease: A report of 2 cases. Hosp Pract Res. 2021;6(4):173-6. doi:10.34172/hpr.2021.32
  25. Baeken C, Brem AK, Arns M, Brunoni AR, Filipcic I, Ganho-vila A, et al. Repetitive transcranial magnetic stimulation treatment for depressive disorders: current knowledge and future directions. Curr Opin Psychiatry. 2019;32(5):409-15. doi:10.1097/YCO.00 00000000000533
  26. Vida RG, Sghy E, Bella R, Kovcs S, Erdősi D, Jzwiak-Hagymsy J, et al. Efficacy of repetitive transcranial magnetic stimulation (rTMS) adjunctive therapy for major depressive disorder (MDD) after two antidepressant treatment failures: meta-analysis of randomized sham-controlled trials. BMC Psychiatry. 2023;23(1):545. doi:10.1186/s12888-023-05033-y
  27. Kazemi R, Ghazanfari F. Effectiveness of bilateral repetitive transcranial magnetic stimulation on anhedonia and depression symptoms in major depressive disorder patients. J Clin Psychol. 2018; 10(3):23-33. doi:10.22075/jcp.2018.14673.1415
  28. Asbaghi E, Talepasand S, Rezayi AM. Comparison of the efficacy of transcranial direct current stimulation (TDCS) with repetitive transcranial magnetic stimulation on depression symptoms’ reduction. Neuropsychology. 2015;1(1):75-85.
  29. Miron JP, Jodoin VD, Lesprance P, Blumberger DM. Repetitive transcranial magnetic stimulation for major depressive disorder: basic principles and future directions. Ther Adv Psychopharmacol. 2021;11: 20451253211042696. doi:10.1177/2045125321104 2696
  30. Tang VM, Le Foll B, Blumberger DM, Voineskos D. Repetitive transcranial magnetic stimulation for comorbid major depressive disorder and alcohol use disorder. Brain Sci. 2021;12(1):48. doi:10.3390/ brainsci12010048
  31. Marnat GG. Handbook of psychological assessment. 5th ed. New York: Wiley & Sons Publication; 2009.
  32. Vosoughi Kalantari A, Sadat Marashian FS, Dasht Bozorgi Z, Hafezi F. Effectiveness of Brain Training Exercises on Visual and Auditory Memory in Students with Dyslexia. Educ Res Med Sci. 2024;13(2):e151747. doi:10.5812/ermsj-151747
  33. Oberman LM, Hynd M, Nielson DM, Towbin KE, Lisanby SH, Stringaris A. Repetitive transcranial magnetic stimulation for adolescent major depressive disorder: a focus on neurodevelopment. Front Psychiatry. 2021;12:642847. doi:10.3389/fpsyt.202 1.642847
  34. Fitzgerald PB, Fountain S, Daskalakis ZJ. A comprehensive review of the effects of rTMS on motor cortical excitability and inhibition. Clin Neurophysiol. 2006;117(12):2584-96. doi:10.1016/j.clinph.2006.0 6.712
  35. Wang X, Cheng B, Roberts N, Wang S, Luo Y, Tian F, et al. Shared and distinct brain fMRI response during performance of working memory tasks in adult patients with schizophrenia and major depressive disorder. Hum Brain Mapp. 2021;42(16):5458-76. doi:1002/hbm.25618
  36. Yildiz T, Oğuzhanoğlu NK, Topak OZ. Cognitive outcomes of transcranial magnetic stimulation in treatment-resistant depression: a randomized controlled study. Turk J Med Sci. 2023;53(1):253-63. doi:10.55730/1300-0144.5580

Home

Guide for Authors

Submit Manuscript

Reviewers

Contact Us