tms and pharmacotherapy and combined effects of transcranial magnetic stimulation and pharmacotherapy on symptoms of depression, anxiety, and obsessive-compulsive traits in individuals with neuroticism

Neuroticism is a personality trait characterized by chronic emotional instability, anxiety, and depression, which significantly impairs quality of life. neurocognitive interventions such as repetitive transcranial magnetic stimulation (rtms) and pharmacotherapy offer promising treatment avenues, but their combined effects remain underexplored, especially in non western contexts.this study aimed to examine and compare the effects of rtms, pharmacotherapy (ssri), and their combination on symptoms of depression, anxiety, and obsessive-compulsive traits in adults with neuroticism in tabriz, iran. in a quasi‑experimental design, 60 participants (aged 20–50) with high neuroticism were randomly assigned to four groups: control, rtms, pharmacotherapy, and combined treatment. the rtms group received 10 hz stimulation over the left dlpfc (65–75 % motor threshold) for 4 weeks. the pharmacotherapy group received escitalopram (20–40 mg/day) for 8 weeks. the combined group received both interventions simultaneously. symptoms were assessed pre‑ and post‑intervention using the beck anxiety inventory (bai), beck depression inventory‑ii (bdi‑ii), and yale‑brown obsessive‑compulsive scale (ybocs). data was analyzed using anova, ancova, and manova. mancova revealed a significant overall treatment effect (wilks' λ = 0.41, f(9,124.27) = 12.40,p < .001). univariate analyses showed significant reductions in anxiety f(3,53) = 39.68,p < .001,η2 = .69, and depression, f(3,53) = 22.59,p < .001,η2 = .56, across treatment groups, with the combined treatment being most effective. no significant change was observed in obsessive‑compulsive symptoms f(3,53) = 1.16,p = .33). both rtms and pharmacotherapy are effective for reducing anxiety and depression in neuroticism, with combined treatment yielding superior outcomes. the lack of effect on obsessive‑compulsive traits suggests symptom specificity. these findings support integrated neurocognitive‑pharmacological approaches for managing neuroticism‑related distress.