Adjunctive use of repetitive transcranial magnetic stimulation in depressed adolescents: A prospective, open pilot study

Christopher A Wall, Paul E. Croarkin, Leslie A. Sim, Mustafa M. Husain, Philip G. Janicak, F. Andrew Kozel, Graham J. Emslie, Sheila M. Dowd, Shirlene M. Sampson

Research output: Contribution to journalArticlepeer-review

52 Scopus citations


Objective: 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. Method: This prospective, open, multicenter trial of active adjunctive rTMS was conducted with 8 adolescents with DSM-IV-TR major depressive disorder (MDD) that had not responded sufficiently to 2 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 5 days per week over 6 to 8 weeks. rTMS was applied to the left dorsolateral prefrontal cortex (120% of motor threshold; 10 Hz; 4-second trains; 26-second intertrain interval; 75 trains) for a total of 3,000 stimulations per treatment session. Results: Seven of 8 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 [12]), P < .02. The CDRS-R scores continued to improve through the rTMS treatment series at treatment 20 (40.1 [14]), P < .01; treatment 30 (32.6 [7.3]), P < .0001; and at 6-month follow-up (32.7 [3.8]), P < .0001. Conclusions: This prospective open trial suggests that rTMS is a safe, feasible, and potentially effective adjunctive therapy for treatment-resistant MDD in adolescents. Trial Registration: Identifier: NCT00587639.

Original languageEnglish (US)
Pages (from-to)1263-1269
Number of pages7
JournalJournal of Clinical Psychiatry
Issue number9
StatePublished - Sep 2011

ASJC Scopus subject areas

  • Psychiatry and Mental health


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