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Peer-reviewedCC BY 4.0CNS Spectrums

Longitudinal coupling between depressive symptoms and divided attention during transcranial magnetic stimulation in treatment-resistant depression

  • Mao-Hsuan Huang1,2
  • Yee-Lam E. Chan1
  • Jun-Ding Zhu3,4
  • Wei-Chung Mao1
  • Wei Yuan1
  • Yia-Ping Liu1
  • Li-Chi Chen1,2
  • Feng-Chang Yen1
  • Wei-Shen Huang1
  • Tung-Ping Su1,2,5
5 affiliations
  1. 1Department of Psychiatry, General Cheng Hsin Hospital, Taipei, Taiwan
  2. 2School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
  3. 3Department of Occupational Therapy, College of Medical Science and Technology, Chung Shan Medical University, Taichung, Taiwan
  4. 4Occupational Therapy Room, Chung Shan Medical University Hospital, Taichung, Taiwan
  5. 5Institute of Brain Science, National Yang Ming Chao Tung University, Taipei, Taiwan
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Abstract

Background: Cognitive dysfunction is a core feature of major depressive disorder. During transcranial magnetic stimulation (TMS) for treatment-resistant depression (TRD), the temporal relationship between symptom changes and cognitive performance remains unclear. We examined depressive symptoms and cognitive trajectories during TMS and tested whether time-varying cognitive change was associated with symptom trajectories.

Methods: This retrospective naturalistic study included 89 patients with TRD who completed 20 sessions of left dorsolateral prefrontal cortex TMS (high-frequency repetitive TMS or intermittent theta-burst stimulation). Depression severity (Hamilton Depression Rating Scale [HAMD-17]) and computerized attentional control measures from the Test of Attentional Performance were assessed at baseline, day 10, and day 20. Generalized estimating equations examined time effects and time-adjusted symptom-cognition associations. Exploratory analyses evaluated whether early cognitive change was associated with subsequent symptom improvement. Multiple comparisons were controlled.

Results: Depressive symptoms decreased significantly (p < 0.001), with response and remission rates of 65.2% and 51.7%. Several attentional indices showed significant time effects; however, after false discovery rate correction, only visual divided-attention commission errors were independently associated with depressive severity beyond time effects. Person-mean centering indicated that this association was driven by within-person change (B = 0.209, p < 0.001), not between-person differences. Greater early reduction in visual divided-attention commission errors was associated with larger overall symptom improvement (B = 0.172, p = 0.016).

Conclusion: Within-person changes in divided attention tracked depressive symptom trajectories during TMS. Attentional control measures may therefore help track symptom-cognition dynamics during TMS in real-world clinical settings.

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Cite

BibTeXRIS
BibTeX
@article{huang2026longitudinal,
  title = {{Longitudinal coupling between depressive symptoms and divided attention during transcranial magnetic stimulation in treatment-resistant depression}},
  author = {Mao-Hsuan Huang and Yee-Lam E. Chan and Jun-Ding Zhu and Wei-Chung Mao and Wei Yuan and Yia-Ping Liu and Li-Chi Chen and Feng-Chang Yen and Wei-Shen Huang and Tung-Ping Su},
  journal = {CNS Spectrums},
  year = {2026},
  month = may,
  doi = {10.1017/s1092852926100935},
  url = {https://doi.org/10.1017/s1092852926100935},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Longitudinal coupling between depressive symptoms and divided attention during transcranial magnetic stimulation in treatment-resistant depression
AU  - Mao-Hsuan Huang
AU  - Yee-Lam E. Chan
AU  - Jun-Ding Zhu
AU  - Wei-Chung Mao
AU  - Wei Yuan
AU  - Yia-Ping Liu
AU  - Li-Chi Chen
AU  - Feng-Chang Yen
AU  - Wei-Shen Huang
AU  - Tung-Ping Su
PY  - 2026
DA  - 2026/05/13
JO  - CNS Spectrums
DO  - 10.1017/s1092852926100935
UR  - https://doi.org/10.1017/s1092852926100935
AB  - Background: Cognitive dysfunction is a core feature of major depressive disorder. During transcranial magnetic stimulation (TMS) for treatment-resistant depression (TRD), the temporal relationship between symptom changes and cognitive performance remains unclear. We examined depressive symptoms and cognitive trajectories during TMS and tested whether time-varying cognitive change was associated with symptom trajectories.  Methods: This retrospective naturalistic study included 89 patients with TRD who completed 20 sessions of left dorsolateral prefrontal cortex TMS (high-frequency repetitive TMS or intermittent theta-burst stimulation). Depression severity (Hamilton Depression Rating Scale [HAMD-17]) and computerized attentional control measures from the Test of Attentional Performance were assessed at baseline, day 10, and day 20. Generalized estimating equations examined time effects and time-adjusted symptom-cognition associations. Exploratory analyses evaluated whether early cognitive change was associated with subsequent symptom improvement. Multiple comparisons were controlled.  Results: Depressive symptoms decreased significantly (p < 0.001), with response and remission rates of 65.2% and 51.7%. Several attentional indices showed significant time effects; however, after false discovery rate correction, only visual divided-attention commission errors were independently associated with depressive severity beyond time effects. Person-mean centering indicated that this association was driven by within-person change (B = 0.209, p < 0.001), not between-person differences. Greater early reduction in visual divided-attention commission errors was associated with larger overall symptom improvement (B = 0.172, p = 0.016).  Conclusion: Within-person changes in divided attention tracked depressive symptom trajectories during TMS. Attentional control measures may therefore help track symptom-cognition dynamics during TMS in real-world clinical settings.
SN  - 1092-8529
SN  - 2165-6509
ER  -