Repetitive transcranial magnetic stimulation (rTMS) is increasingly used as an evidence-based treatment for patients with medication-resistant major depressive episode-MDE [1]. Despite a good clinical efficacy at the group level in this population, a large heterogeneity is observed at the individual level with distinct trajectories of response defining some sub populations of responders and nonresponders [2, 3]. Early prediction of trajectory of response is of main interest to avoid false hope in patients and to decrease the financial and time burden associated with rTMS treatment in patients with MDE.

Some clinical (eg, retardation, smoking status [4]) and biological measures such as neurophysiological features (eg, cortical excitability measures), genetic polymorphisms (eg, BDNF or COMT) and imaging measures (with either EEG, PET, SPECT or fMRI) have been proposed as predictive markers of response to rTMS [5]. However, their large-scale use in clinical settings is limited by their usefulness at an individual level as well as their costs and accessibility. Recently, Feffer and colleagues [6] proposed to use the self-rated Beck Depression Inventory (BDI) to measure early symptoms variations as predictor of nonresponse in patients with MDE receiving rTMS. They reported that the lack of early symptom improvement at 10 sessions might predict nonresponse to high frequency rTMS (either 10 Hz or intermittent theta burst stimulation-iTBS) applied over the left dorsomedial prefrontal cortex (DmPFC) in patients with major depression whatever the stimulation protocol (10Hz or iTBS).