# The Relationship Between Emotion Processing Assessed by an Affect Rating Task and Depression Symptoms Following the Accelerated Sequential Dorsolateral–Dorsomedial Prefrontal rTMS Treatment

## TL;DR

This study explores how changes in emotion processing relate to improvements in depression symptoms after a specific brain stimulation treatment.

## Contribution

The study identifies a novel link between emotional arousal changes and depression symptom improvement following a new rTMS treatment protocol.

## Key findings

- Depressive and fatigue symptoms significantly improved after the rTMS treatment.
- Baseline neutral valence was correlated with initial depression severity.
- Changes in arousal for positive and neutral images predicted later depression improvement.

## Abstract

Background: Emotion processing is critical in the neuropathology of major depressive disorder (MDD), while its relationship with clinical treatment remains unclear. This study aims to indicate the associations between emotion processing and treatment effects following a sequential dual-site accelerated repetitive transcranial magnetic stimulation (rTMS) protocol. Methods: MDD patients were recruited to receive rTMS treatment with four sessions per day for four consecutive days, with stimulation sequentially delivered to the left dorsolateral prefrontal cortex (dlPFC) and the dorsomedial prefrontal cortex (dmPFC). Symptoms were assessed at baseline, end of treatment, and week 4 using the Montgomery–Åsberg Depression Rating Scale (MADRS), Snaith-Hamilton Pleasure Scale (SHAPS), and Fatigue Severity Scale (FSS). Emotional valence and arousal were evaluated with the Affect Rating Task (ART). Results: A total of 51 participants completed the clinical assessments and ART, with two excluded due to missing baseline data in the SHAPS and FSS. The linear mixed-effects models revealed significant improvement in depressive (p < 0.001, d = −0.343) and fatigue symptoms (p = 0.010, d = −0.572) following rTMS treatment. Neutral valence was correlated with MADRS scores at baseline (R2 = 0.096, p = 0.027). In addition, changes in arousal for positive images (p = 0.047, adjusted R2 = 0.097) and neutral images (p = 0.019, adjusted R2 = 0.160) at treatment end were significantly correlated with MADRS improvement at week 4. Conclusions: Our study highlights the association between changes in emotional arousal and improvement in MDD following accelerated dlPFC-dmPFC dual-site rTMS treatment.