Chronic depression: Responses to transcranial magnetic stimulation and considerations of a developmental construction of self

Abstract

There are two components to this thesis, one applied and one theoretical: (1) to investigate whether treatment response to Transcranial Magnetic Stimulation (TMS) can be predicted by depressive subtypes and (2) to explore the contribution of personality to chronic depression. Participants were 67 adults volunteering for clinical trials of TMS. In the first component individuals were separated into two groups, melancholic and non-melancholic. Both groups showed a significant reduction in their depressive symptomatology following treatment. Individuals had also been administered a measure for Depressive Personality Disorder (DPD). When the individuals were classified based on DPD groups, both those with a DPD and those without, reported a reduction in their depressive symptoms. When controlling for initial differences in depression in the two groups, however, depressive symptoms following intervention did not differ significantly. Nevertheless, the DPD group moved from severe to moderate depression, and the non-DPD group from moderate to minimal. Treatment implications for individuals with affective disorders that may be influenced by underlying personality pathology are discussed. In the second component individuals were compared on instruments assessing object relations, parental bonding and defence styles. Most participants met criteria for a DPD and endorsed disturbances in their object relations; these consisted of insecure attachments, egocentric relations, a sense of alienation and social incompetence in relationships. Further, they reported lower levels of care from both parents and higher use of immature defences. The DPD group reported higher depressed affect. ...