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. 2019 Mar 29:10:170.
doi: 10.3389/fpsyt.2019.00170. eCollection 2019.

Repetitive Transcranial Magnetic Stimulation in Youth With Treatment Resistant Major Depression

Frank P MacMaster  1   2 , Paul E Croarkin  3 , T Christopher Wilkes  1 , Quinn McLellan  1 , Lisa Marie Langevin  1 , Natalia Jaworska  4 , Rose M Swansburg  1 , Yamile Jasaui  1 , Ephrem Zewdie  5 , Patrick Ciechanski  5 , Adam Kirton  5
Affiliations

Repetitive Transcranial Magnetic Stimulation in Youth With Treatment Resistant Major Depression

Frank P MacMaster et al. Front Psychiatry. .

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.

Keywords: adolescent; brain stimulation; depression; dorsolateral prefrontal cortex (DLPFC); transcrancial magnetic stimulation (TMS).

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Figures

Figure 1
Figure 1
Basic study design. rTMS, repetitive transcranial magnetic stimulation; RMT, resting motor threshold.
Figure 2
Figure 2
Summary of clinical outcomes. rTMS, repetitive transcranial magnetic stimulation.
See this image and copyright information in PMC

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