Effect of TMS Treatment on Defense Mechanisms and Functionality in Patients With Depression

October 7, 2026 updated by: Kardelen Erdoğan, Namik Kemal University

The Effect of Transcranial Magnetic Stimulation (TMS) Treatment on Defense Mechanisms and Functionality in Patients With Depression

This prospective observational study aims to evaluate changes in psychological defense mechanisms in patients with non-psychotic major depressive disorder (MDD) undergoing repetitive Transcranial Magnetic Stimulation (rTMS) therapy. The study investigates whether rTMS induces a shift from immature to more mature defense mechanisms and assesses how these changes relate to improvements in depressive symptom severity, anxiety levels, and overall functionality at baseline, 1-month, and 3-month follow-ups.

Study Overview

Status

Not yet recruiting

Conditions

Major Depressive Disorder (MDD)

Detailed Description

Major depressive disorder (MDD) significantly impacts mood, cognitive function, and psychological defense structures. While repetitive Transcranial Magnetic Stimulation (rTMS) is an established non-invasive neuromodulation therapy for depression, its influence on psychodynamic constructs such as defense mechanisms remains insufficiently explored.

This single-center prospective study will enroll 50 adult participants (aged 18-65) diagnosed with non-psychotic MDD according to DSM-5 criteria (confirmed via SCID-5). Participants will receive rTMS treatment as part of their standard clinical care. Clinical assessments will be conducted by a blinded researcher at three time points: baseline (pre-treatment), 1 month, and 3 months post-baseline.

Primary outcomes will measure shifts in defense mechanism styles (mature, neurotic, immature) using the Defense Style Questionnaire (DSQ). Secondary outcomes will assess depressive symptom severity (Hamilton Depression Rating Scale - HAM-D), anxiety levels (Hamilton Anxiety Rating Scale - HAM-A), clinical severity and improvement (Clinical Global Impression Scale - CGI), and functional impairment (World Health Organization Disability Assessment Schedule 2.0 - WHODAS 2.0).

Study Type

Observational

Enrollment (Estimated)

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Name: Kardelen Erdoğan, MD
Phone Number: +90 543 691 87 52
Email: kardelenerdogan@nku.edu.tr

Study Locations

Turkey (Türkiye)
- - Tekirdağ, Turkey (Türkiye)
    - Tekirdağ Namik Kemal University Faculty of Medicine, Department of Psychiatry
    - Contact:
      
      kardeeln erdoğan, MD
      
      Phone Number: +90 543 691 87 52
      
      Email: kardelenerdogan@nku.edu.tr

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years to 65 years (Adult, Older Adult)

Accepts Healthy Volunteers

Genders Eligible for Study

All

Sampling Method

Non-Probability Sample

Study Population

Adults aged 18-65 years with non-psychotic major depressive disorder (MDD) who are evaluated for suitability for transcranial magnetic stimulation (TMS) treatment at the Psychiatry Clinic/TMS Unit of Tekirdağ Namık Kemal University Hospital. The diagnosis of MDD will be confirmed using the Structured Clinical Interview for DSM Disorders (SCID). Approximately 50 participants who meet the eligibility criteria and provide written informed consent will be included.

Description

Inclusion Criteria:

Age between 18 and 65 years
Diagnosis of major depressive disorder without psychotic features according to DSM-5 criteria
Confirmation of diagnosis via SCID
Major depressive disorder as the primary reason for admission
Willingness to participate and signing the written informed consent form

Exclusion Criteria:

Presence of contraindications for TMS (e.g., metallic implants)
Known active psychotic symptoms
History of TMS treatment in the past 3 months
Presence of known organic brain syndrome, neurological, or major systemic medical conditions
Presence of known intellectual disability or significant cognitive impairment
Active substance or alcohol use disorder
Illiteracy

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Observational Models: COHORT
Time Perspectives: PROSPECTIVE

Number of groups / cohorts

Cohorts and Interventions

Group / Cohort
TMS Treatment Group Patients diagnosed with major depressive disorder receiving Transcranial Magnetic Stimulation therapy.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Defense Mechanisms (Defense Style Questionnaire - DSQ) Time Frame: Baseline, 1 month, and 3 months	Evaluates shifts in mature, neurotic, and immature psychological defense mechanism styles in patients with major depressive disorder following TMS treatment.	Baseline, 1 month, and 3 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Anxiety Symptom Severity (Hamilton Anxiety Rating Scale - HAM-A) Time Frame: Baseline, 1 month and 3 months	Assesses psychic and somatic anxiety symptom severity.	Baseline, 1 month and 3 months
Change in Depressive Symptom Severity (Hamilton Depression Rating Scale - HAM-D) Time Frame: Baseline, 1 month, and 3 months	Assesses the severity of depressive symptoms	Baseline, 1 month, and 3 months
Change in Clinical Global Impression (CGI) Time Frame: Baseline, 1 month, and 3 months	Measures overall illness severity and clinical improvement.	Baseline, 1 month, and 3 months
Change in Disability and Functionality (World Health Organization Disability Assessment Schedule 2.0 - WHODAS 2.0) Time Frame: Baseline, 1 month, and 3 months	Evaluates level of functional disability across six domains (understanding/communicating, mobility, self-care, getting along, life activities, participation).	Baseline, 1 month, and 3 months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Namik Kemal University

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

October 1, 2026

Primary Completion (Estimated)

April 1, 2027

Study Completion (Estimated)

July 1, 2027

Study Registration Dates

First Submitted

September 27, 2026

First Submitted That Met QC Criteria