Repetitive Transcranial Magnetic Stimulation in Youth With Treatment Resistant Major Depression

Abstract

Background: Major depressive disorder (MDD) is common in youth and treatment options are limited. We evaluated the effectiveness and safety of repetitive transcranial magnetic stimulation (rTMS) in adolescents and transitional aged youth with treatment resistant MDD. Methods: Thirty-two outpatients with moderate to severe, treatment-resistant MDD, aged 13–21 years underwent a three-week, open-label, single center trial of rTMS (ClinicalTrials.gov identifier NCT01731678). rTMS was applied to the left dorsolateral prefrontal cortex (DLPFC) using neuronavigation and administered for 15 consecutive week days (120% rest motor threshold; 40 pulses over 4 s [10 Hz]; inter-train interval, 26 s; 75 trains; 3,000 pulses). The primary outcome measure was change in the Hamilton Depression Rating Scale (Ham-D). Treatment response was defined as a >50% reduction in Ham-D scores. Safety and tolerability were also examined. Results: rTMS was effective in reducing MDD symptom severity ( t = 8.94, df = 31, p < 0.00001). We observed 18 (56%) responders (≥ 50% reduction in Ham-D score) and 14 non-responders to rTMS. Fourteen subjects (44%) achieved remission (Ham-D score ≤ 7 post-rTMS). There were no serious adverse events (i.e., seizures). Mild to moderate, self-limiting headaches (19%) and mild neck pain (16%) were reported. Participants ranked rTMS as highly tolerable. The retention rate was 91% and compliance rate (completing all study events) was 99%. Conclusions: Our single center, open trial suggests that rTMS is a safe and effective treatment for youth with treatment resistant MDD. Larger randomized controlled trials are needed. Clinical Trial Registration: www.ClinicalTrials.gov , identifier: NCT01731678

The Safety and Efficacy of Repetitive Transcranial Magnetic Stimulation in the Treatment of Major Depression Among Children and Adolescents: A Systematic Review

“…Tables 1 and 2 summarized the characteristics of the studies. The studies include open-label trials [27][28][29][30][31][32], case reports [33][34][35][36][37], case series [38][39][40][41], naturalistic studies [42], and randomized sham-controlled trial [43].…”

“…The majority of the studies are from the USA [28][29][30][31][33][34][35]40,43]. The rest of the studies were from China [37,38,42], Israel [32], Finland [36], Canada [27,39], Australia [41], and across multiple nations [44]. The lowest age of the recipient of rTMS was ten [40,42,43], but most of the patients were above 12.…”

Annual Research Review: Defining and treating pediatric treatment‐resistant depression

“…Meta‐analysis of adult studies suggests that at the end of an acute treatment series the risk ratios for a treatment response are 1.72 (95% CI: 1.13–2.62) with a small effect size of 0.33 (95% CI 0.17–0.50) compared with sham treatment (Ontario, ). Uncontrolled studies of rTMS in adolescent depression have suggested possible efficacy and safety of rTMS (Bloch et al, ; Croarkin et al, ; MacMaster et al, ), but there are no controlled trials. Side effects of rTMS in pediatric patients appear similar to adults and include headache, scalp pain, and rare seizures (Magavi, Reti, & Vasa, ).…”

Crossing Death Valley: Bringing Neurotechnology to Psychiatric Clinics in Alberta, Canada

“…In Alberta, a publicly funded service was first opened in Ponoka in 2004 and a private clinic was added in Calgary in 2012. In 2013, research began in earnest in Alberta at the Alberta Children's Hospital and the University of Calgary to evaluate TMS as a treatment for youth with depression (20). The research involved in that open-label trial (NCT01731678) (20) provided first-hand experience and data on patient outcomes and the safety, tolerability, and acceptability of TMS as a treatment for depression in youth.…”

“…In 2013, research began in earnest in Alberta at the Alberta Children's Hospital and the University of Calgary to evaluate TMS as a treatment for youth with depression (20). The research involved in that open-label trial (NCT01731678) (20) provided first-hand experience and data on patient outcomes and the safety, tolerability, and acceptability of TMS as a treatment for depression in youth. This work, combined with the clinical work in Ponoka, were the critical first steps in developing a plan to create a TMS clinical service for treatment of depression in Alberta.…”