A randomized pilot study of Repetitive Transcranial Magnetic Stimulation for Adolescents with Major Depressive Disorder.

Abstract

Objectives: Up to 40% of adolescents with Major Depressive Disorder (MDD) do not respond to treatment. Repetitive Transcranial Magnetic Stimulation (rTMS) is an effective treatment in adults for MDD which shows promising efficacy in adolescents, however additional controlled investigations are needed. This pilot study compared rTMS applied to the left-side of the head and right-side in a randomized controlled trial. We hypothesized rTMS treatment would lead to an improvement in Children’s Depression Rating Scale Revised (CDRS-R) depression scores of adolescents with MDD at 1-month follow-up compared to baseline. No difference in response between left- and right-sided rTMS was expected.Methods: Fourteen adolescents who had been previously treated for MDD but had continued to suffer with MDD for an average of 2 years were randomly allocated to right (low frequency) or left (high frequency) rTMS. rTMS was applied to the scalp over the dorsolateral prefrontal cortex over 20 treatments given over four weeks. The primary outcome measure was the CDRS-R. Outcome assessments occurred at 10 sessions and 20 sessions, with follow-up at one month and six months.Results: CDRS-R scores improved significantly across the 20 rTMS treatments, with peak response at 1-month follow-up. Two (14%) adolescents had ≥ 50% score improvement and a further four (29%) demonstrated partial response (between 25 and 50% reduction) by 1-month follow-up. Treatment gains were sustained at 6-month follow-up. There was no significant difference in efficacy between left- and right-sided treatment.Conclusion: This small study found preliminary evidence that adolescents with MDD benefited from rTMS.

Effects of repetitive transcranial magnetic stimulation in children and young people with psychiatric disorders: a systematic review

“…Another waitlist-controlled study (no randomisation details provided; [46]) in 54 adolescents with ASD, reported significant improvements in parent-rated stereotypic behaviour, ritualistic behaviour, irritability, lethargy, compulsivity, and hyperactivity, but no change in inappropriate speech, self-injurious behaviour, and restricted interests, after 18-sessions of LF-rTMS to the right-DLPFC: no changes were seen in the waiting-list group, compared to baseline. [39], four single-blind sham-controlled RCTs [40][41][42][43], one single-blind, comparator-controlled RCT [44]; one shamcontrolled RCT [45], two waitlist-controlled trials [46,47], one non-randomised, wait-list controlled trial ( [48]; see Table 1), one multi-arm open-label study [49], one two-arm open-label study [50], 27 single-arm open-label studies, and 35 case series/studies (see Supplementary Material S2 and S3). Of these studies involving CYP, 28 studies were in participants with depression, 20 were in ASD, seven in schizophrenia, five in obsessive-compulsive disorder (OCD), four in Tourette's syndrome, four in attention-deficit/hyperactivity disorder (ADHD), two in anorexia nervosa (AN), borderline personality disorder (BPD), and catatonia, and one in binge eating disorder (BED) and internet gaming disorder (IGD).…”

“…Mean CDRS-R scores also significantly declined from baseline to 6-month follow-up. Immediately after 20 sessions, only one participant achieved partial response (25-50% reduction in CDRS-R score), with none of the CYP achieving ≥ 50% reduction in CDRS-R, but at 1-month follow-up, two CYP achieved ≥ 50% reduction in CDRS-R scores, and four CYP achieved partial response [50].…”

“…28 other studies also stimulated the DLPFC but did not measure cognitive or mood outcomes. Low mood and cognitive deficits, particularly in executive Out of 78 included studies, 62 studies measured clinical effects immediately after the final rTMS session, with all, except eight [35,39,43,50,57,58,63,91] reporting an improvement in at least one outcome measure of core disorder-specific symptoms. Three studies assessed clinical outcomes at 1-week [38,116] or 3-weeks [104] after rTMS, two of which [104,116] reported improvements in disorder-specific symptoms.…”

“…One study reported that improvements at post-stimulation were not maintained 1-week later [71] and another follow-up study reported that improvements at 1-month [86] were not maintained at 3-years follow-up [87]. Two studies reported improvements in disorder-specific symptoms only at one-month [50] or 6-weeks follow-up [58], but not immediately post-stimulation, indicating a delayed therapeutic effect of rTMS, which is consistent with data in adults with psychiatric disorders [117,118]. Therefore, future studies should assess core symptoms and related impairments of psychiatric disorders in CYP at post-stimulation and at least one longer-term follow-up point, to capture any delayed improvements.…”