Accelerated intermittent theta-burst stimulation for the treatment of adolescent depression: A case series

• Published in: Journal of affective disorders reports 2023-12, Vol.14, p.100648, Article 100648
• Main Authors: Nakano, Erica, Sedaros, Peter, Siddiqi, Shan, Meng, Nathan, DeSouza, Danielle D., Carreon, David
• Format: Article
• Language: English
• Subjects: Accelerated; Adolescent; Depression; fMRI; iTBS; TMS
• ISSN: 2666-9153; 2666-9153
• DOI: 10.1016/j.jadr.2023.100648

•Accelerated iTBS to the L-DLPFC was followed by rapid response in 5/6 cases.•Treatment effect sizes were larger than approved medications for adolescents.•Treatment can be personalized to account for baseline symptoms and brain metrics. Intermittent theta burst stimulation (iTBS) is a safe and effective form of repetitive transcranial magnetic stimulation (rTMS) for depression in adults. Accelerated protocols involving multiple sessions per day, have become popular possibly attributed to their potential for rapid antidepressant effects. Previous literature has shown iTBS to be safe for adolescents with depressive symptoms, however, outcomes from accelerated iTBS protocols in this population have not been thoroughly described. This case series describes six adolescent patients who received outpatient accelerated iTBS treatment for depression symptoms. Self-reported depression severity was assessed using the Patient Health Questionnaire-9 (PHQ-9) scale at baseline, and various follow-up time points including immediate, one-week, and one-month post-treatment. Individual accelerated iTBS protocols varied with regard to specific brain targets and TMS treatment parameters. Following treatment, three of six patients achieved remission (PHQ-9 score < 5), two responded (≥ 50% reduction in PHQ-9 scores), and one had no response. All patients tolerated treatment well without significant adverse events. PHQ-9 scores were not available at all post-treatment timepoints for all patients. Additionally, primary diagnoses, clinical comorbidities, and treatment parameters differed between patients, which may have impacted treatment outcomes. In six adolescents, accelerated iTBS was well-tolerated and in most cases, was followed by rapid antidepressant effects. These findings support the safe, clinical use of accelerated iTBS in adolescents with depression and warrant future prospective clinical trials to optimize treatment parameters and confirm efficacy.