Effect of 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.

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-5 * 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