title: Neurocognitive effects of repetitive transcranial magnetic stimulation in adolescents with major depressive disorder.
abstract: OBJECTIVE
  It is estimated that 30-40% of adolescents with major depressive disorder (MDD) do not receive full benefit from current antidepressant therapies. Repetitive transcranial magnetic stimulation (rTMS) is a novel therapy approved by the US Food and Drug Administration to treat adults with MDD. Research suggests rTMS is not associated with adverse neurocognitive effects in adult populations; however, there is no documentation of its neurocognitive effects in adolescents. This is a secondary post hoc analysis of neurocognitive outcome in adolescents who were treated with open-label rTMS in two separate studies.
  
  
  METHODS
  Eighteen patients (mean age, 16.2 ± 1.1 years; 11 females, 7 males) with MDD who failed to adequately respond to at least one antidepressant agent were enrolled in the study. Fourteen patients completed all 30 rTMS treatments (5 days/week, 120% of motor threshold, 10 Hz, 3,000 stimulations per session) applied to the left dorsolateral prefrontal cortex. Depression was rated using the Children's Depression Rating Scale-Revised. Neurocognitive evaluation was performed at baseline and after completion of 30 rTMS treatments with the Children's Auditory Verbal Learning Test (CAVLT) and Delis-Kaplan Executive Function System Trail Making Test.
  
  
  RESULTS
  Over the course of 30 rTMS treatments, adolescents showed a substantial decrease in depression severity. Commensurate with improvement in depressive symptoms was a statistically significant improvement in memory and delayed verbal recall. Other learning and memory indices and executive function remained intact. Neither participants nor their family members reported clinically meaningful changes in neurocognitive function.
  
  
  CONCLUSIONS
  These preliminary findings suggest rTMS does not adversely impact neurocognitive functioning in adolescents and may provide subtle enhancement of verbal memory as measured by the CAVLT. Further controlled investigations with larger sample sizes and rigorous trial designs are warranted to confirm and extend these findings.
authors.affiliation: Department of Psychiatry and Psychology, Mayo Clinic , Rochester, MN , USA ; Division of Child and Adolescent Psychiatry, Mayo Clinic , Rochester, MN , USA.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Wall
authors.affiliation: Department of Psychiatry and Psychology, Mayo Clinic , Rochester, MN , USA ; Division of Child and Adolescent Psychiatry, Mayo Clinic , Rochester, MN , USA.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Croarkin
authors.affiliation: Neurocognitive Research Laboratory, Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine , Durham, NC , USA ; Department of Psychiatry, University of Texas Southwestern Medical Center , Dallas, TX , USA.
authors.forename: Shawn M
authors.initials: SM
authors.lastname: McClintock
authors.affiliation: Department of Psychiatry and Psychology, Mayo Clinic , Rochester, MN , USA.
authors.forename: Lauren L
authors.initials: LL
authors.lastname: Murphy
authors.affiliation: Department of Psychiatry and Psychology, Mayo Clinic , Rochester, MN , USA.
authors.forename: Lorelei A
authors.initials: LA
authors.lastname: Bandel
authors.affiliation: Department of Psychiatry and Psychology, Mayo Clinic , Rochester, MN , USA ; Division of Child and Adolescent Psychiatry, Mayo Clinic , Rochester, MN , USA.
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Sim
authors.affiliation: Department of Psychiatry and Psychology, Mayo Clinic , Rochester, MN , USA.
authors.forename: Shirlene M
authors.initials: SM
authors.lastname: Sampson
keywords: TMS; adolescents; depression; learning; memory; neurocognition