title: Adjunctive use of repetitive transcranial magnetic stimulation in depressed adolescents: a prospective, open pilot study.
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.
  
  
  METHODS
  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.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00587639.
authors.affiliation: Department of Psychiatry and Psychology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA. wall.chris@mayo.edu
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Wall
authors.forename: Paul E
authors.initials: PE
authors.lastname: Croarkin
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Sim
authors.forename: Mustafa M
authors.initials: MM
authors.lastname: Husain
authors.forename: Philip G
authors.initials: PG
authors.lastname: Janicak
authors.forename: F Andrew
authors.initials: FA
authors.lastname: Kozel
authors.forename: Graham J
authors.initials: GJ
authors.lastname: Emslie
authors.forename: Sheila M
authors.initials: SM
authors.lastname: Dowd
authors.forename: Shirlene M
authors.initials: SM
authors.lastname: Sampson
mesh_terms: D000293:Adolescent; D003865:Major Depressive Disorder / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D010865:Pilot Projects; D011569:Psychiatric Status Rating Scales; D050781:Transcranial Magnetic Stimulation; D016896:Treatment Outcome