Christopher A. Wall, M.D., with the departments of Pediatric and Adolescent Medicine and Psychiatry and Psychology, discusses a study that suggests that repetitive transcranial magnetic stimulation (rTMS) is a safe, feasible, and potentially effective adjunctive therapy for treatment-resistant major depressive disorder (MDD) in some adolescents.
Depression is often a serious and debilitating illness in adolescents. Unfortunately, a significant number of adolescents do not respond to antidepressant medications or psychotherapy. Repetitive transcranial magnetic stimulation (rTMS) is a novel treatment
intervention shown to benefit depression in adults. This study considered rTMS as an adjunctive treatment in adolescents with major depressive disorder.
This prospective, open, multicenter trial of active adjunctive rTMS was conducted with eight adolescents with DSM-IV-TR major depressive disorder (MDD) who had not responded sufficiently to two adequate antidepressant medication trials.
All subjects were maintained on a stable dose of a selective serotonin reuptake inhibitor during the trial. Thirty daily rTMS treatments were given five days per week over six to eight weeks. rTMS was applied to the left dorsolateral prefrontal cortex (120 percent of motor threshold; 10 Hz; four-second trains; 26-second intertrain interval; 75 trains) for a total of 3,000 stimulations per treatment session.
Seven of eight adolescents completed all 30 treatments. rTMS was well tolerated, and no significant safety issues were identified. Suicidal ideation was present at baseline in 3 of the adolescents, and it improved during treatment.
The primary outcome measure was the Children’s Depression Rating Scale-Revised (CDRS-R); results improved significantly from baseline (mean [SD]) (65.9 [6.6]) to treatment 10 (50.9 ), P < .02.
The CDRS-R scores continued to improve through the rTMS treatment series at treatment 20 (40.1 ), P < .01; treatment 30 (32.6 [7.3]), P < .0001; and at six-month follow-up (32.7 [3.8]), P < .0001.
This prospective open trial suggests that rTMS is a safe, feasible, and potentially effective adjunctive therapy for treatment-resistant MDD in adolescents.
Read “Repetitive rTMS Provides a Safe, Effective Alternative for Some Adolescents with Major Depressive Disorder” in PsychUpdate, Vol. 3, No. 2, 2011.
A related trial is currently recruiting participants:
Investigation of repetitive transcranial magnetic stimulation in depressed adolescents
This research proposal aims to better understand the neurobiology of depression in adolescents and how repetitive transcranial magnetic stimulation (rTMS) may therapeutically impact brain function and mood.
This research is first study evaluating metabolic changes in the brain as a result of rTMS treatment in depressed adolescents using magnetic resonance spectroscopy (MRS). The approach will also optimize individualized rTMS treatment by using an efficient and theoretically more accurate coil placement technique known as Beam F3 positioning.
The investigators primary hypothesis is that adolescents treated with rTMS will have significant mood improvement and show no evidence of cognitive decline or worsening suicidality. The study will lead to a better understanding of the mechanism of rTMS in the treatment of depression and will allow clinicians to have greater ability to individualize depression treatment; this could potentially decrease the number of ineffective treatments and/or risk for serious side effects.
Read more at Clinical Trials.gov, NCT01502033.