Does rTMS reduce depressive symptoms in young people who have not responded to antidepressants?

Abstract

Aim Depression is common in young people, and there is a need for safe, effective treatments. This study examined the efficacy of repetitive transcranial magnetic stimulation in a sample of young people aged 17 to 25 years. Methods This retrospective study included 15 people aged 17 to 25 years referred by their private psychiatrists affiliated with Ramsay Health Care, South Australia Mental Health Services. All patients met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for treatment‐resistant Major Depressive Disorder. Eleven patients received right unilateral treatment and four patients received bilateral treatment. Patients were assessed at baseline and after treatment. Results There was a significant improvement on the Hamilton Rating Scale for Depression (t(14) = 4.71, P < 0.0001); Montgomery‐Åsperg Depression Rating Scale (t(14) = 3.96, P < 0.01) and the Zung Self‐Rating Depression Scale (t(14) = 4.13, P < 0.01). There was no difference in response by gender or age. The response rates in these young people did not differ significantly from those of adults aged 25 to 82 years. Conclusion This open label, naturalistic study suggests that repetitive transcranial magnetic stimulation is an effective treatment in young adults who have treatment‐resistant depression. Randomized sham‐controlled studies are needed to further investigate the efficacy of this treatment in this age group.

Repetitive Transcranial Magnetic Stimulation (rTMS) in Treatment Resistant Depression: Retrospective Data Analysis from Clinical Practice

“…There were no differences found in recovery rates between males and females, or age. While there has been previous research that showed younger patients responded better to rTMS (Pallanti et al, 2012), a number of studies have been unable to show any difference in rtMS response between both age and gender (Conca et al, 2000;Ciobanu et al, 2013;Rosenich et al, 2018).…”

Repetitive Transcranial Magnetic Stimulation (rTMS) for the Treatment of Depression in Adolescence: A Systematic Review

“…Table 1 outlines the study characteristics of the 14 studies included in the review, 8 of these studies were open-label trial studies, totalling N = 142 adolescent participants with depression receiving rTMS treatment (Bloch et al, 2008;Croarkin et al, 2016;Dhami et al, 2019;MacMaster et al, 2019;Rosenich et al, 2019;Wall et al, 2011;Yang et al, 2014;Zhang et al, 2019). The remaining 6 studies were either post-hoc analyses studies (using these existing open-trial datasets) (n = 5 studies) (Croarkin et al, 2018;Croarkin et al, 2012;Sonmez et al, 2019;Wall et al, 2016) and one study (Mayer, Aviram, Walter, Levkovitz, & Bloch, 2012) was a three-year follow-up of one of the open-trial studies (see Table 1 for specific details of datasets used in these studies).…”

“…Thirteen studies included adolescents with a diagnosis of treatment-resistant depression (TRD) (Bloch et al, 2008;Croarkin et al, 2018;Croarkin et al, 2016;Croarkin et al, 2012;Dhami et al, 2019;MacMaster et al, 2019;Mayer et al, 2012;Rosenich et al, 2019;Sonmez et al, 2019;Wall et al, 2016;Wall et al, 2013;Wall et al, 2011;Yang et al, 2014) and only one study included adolescents diagnosed with either a mood or anxiety disorder (i.e., not TRD) (Zhang et al, 2019). At baseline, all these clinical diagnoses were verified in line with the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV) criteria (APA, 2000) using either the Mini-international Neuropsychiatric Interview (Sheehan et al, 1998) or the Kiddie Schedule for Affective Disorders and Schizophrenia Present and Lifetime version (K-SAD-PL) (Kaufman et al, 1997).…”

“…From the 13 studies that assessed TRD, the most common definition of TRD was at least one failed treatment attempt using antidepressants (Bloch et al, 2008;Croarkin et al, 2018;Croarkin et al, 2016;Dhami et al, 2019;MacMaster et al, 2019;Mayer et al, 2012;Sonmez et al, 2019;Wall et al, 2016;Wall et al, 2013;Yang et al, 2014). Two studies defined TRD as two failed attempts using antidepressants (Croarkin et al, 2012;Wall et al, 2011) and one failed to report the definition (Rosenich et al, 2019). Participants from all studies apart from one (Yang et al, 2014) were reported to be taking antidepressant medication (e.g., SSRI) and/or receiving psychotherapy for their depression, alongside their participation in the rTMS study.…”

“…Most studies adopted a high-frequency rTMS stimulation procedure alone (n = 12), with only one study employing theta-burst stimulation (TBS) (Dhami et al, 2019) (a newer modality of rTMS in which relatively greater amounts of stimulation can be delivered in a shorter span of time) and one study using both high (10 Hz) and low (1 Hz) frequency rTMS (Rosenich et al, 2019). In Dhami et al (2019), pulses were administered in the thetafrequency range of 1800 pulses to left DLPFC (L-DLPFC) and 1800 pulses to right DLPFC (R-DLPFC).…”