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Adjunctive Use of Repetitive Transcranial Magnetic Stimulation in Depressed Adolescents: A Prospective, Open Pilot Study

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

Published: September 15, 2011

Article Abstract

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

J Clin Psychiatry 2011;72(9):1263-1269

Submitted: March 11, 2011; accepted April 29, 2011(doi:10.4088/JCP.11m07003).

Corresponding author: Christopher A. Wall, MD, Department of Psychiatry and Psychology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (

Volume: 72

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