Personalized Interventional Psychiatry: narrative review on laboratory biomarkers predictive of response to ECT and TMS in treatment-resistant depression
DOI:
https://doi.org/10.25118/2763-9037.2026.v16.1524Keywords:
biomarkers, electroconvulsive therapy, transcranial magnetic stimulation, depressive disorder, major, forecasting, ECTAbstract
Introduction: Major depressive disorder (MDD) is the leading cause of global disability, with approximately 30% of patients progressing to treatment-resistant depression (TRD). Given the failure of multiple clinical trials, electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS) are essential but lack biomarkers to replace the "trial and error" approach. Objective: This narrative literature review aims to update and synthesize recent knowledge on laboratory and molecular biomarkers with predictive potential for clinical response to ECT and TMS in TRD treatment. Methods: PubMed and Cochrane databases (2010– 2025) were consulted to identify recent evidence, selecting 17 articles for detailed analysis. The search was supplemented by a manual search, totaling 30 references. Results and Discussion: Response prediction is modality-specific. ECT is primarily predicted by chronic stress and HPA axis markers (post-dexamethasone cortisol and hair trajectory). TMS is more sensitive to systemic integrity (Systemic immune-inflammation index - SII) and epigenetic profiles (differentially methylated regions - DMRs). Serum basal brain-derived neurotrophic factor (BDNF) demonstrated null predictive utility. Current trends point toward multimodal prediction models that integrate molecular data with neuroimaging and central metabolic markers. Conclusion: Precision psychiatry in TRD is feasible. Therapeutic success will be defined by the implementation of biomarker panels that assess peripheral stress and epigenetic profiles to guide the choice between ECT and TMS, optimizing patient management.
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