Adjunctive use of repetitive transcranial magnetic stimulation in depressed adolescents: A prospective, open pilot study

Christopher A. Wall, Paul E. Croarkin, Leslie A. Sim, Mustafa M. Husain, Philip G. Janicak, F. Andrew Kozel, Graham J. Emslie, Sheila M. Dowd, Shirlene M. Sampson

Research output: Contribution to journalArticle

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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. Method: 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. Trial Registration: clinicaltrials.gov Identifier: NCT00587639.

Original languageEnglish (US)
Pages (from-to)1263-1269
Number of pages7
JournalJournal of Clinical Psychiatry
Volume72
Issue number9
DOIs
StatePublished - Sep 2011

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Transcranial Magnetic Stimulation
Major Depressive Disorder
Therapeutics
Depression
Antidepressive Agents
Treatment-Resistant Depressive Disorder
Suicidal Ideation
Serotonin Uptake Inhibitors
Prefrontal Cortex
Psychotherapy
Diagnostic and Statistical Manual of Mental Disorders
Multicenter Studies
Outcome Assessment (Health Care)
Safety

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Arts and Humanities (miscellaneous)

Cite this

Adjunctive use of repetitive transcranial magnetic stimulation in depressed adolescents : A prospective, open pilot study. / Wall, Christopher A.; Croarkin, Paul E.; Sim, Leslie A.; Husain, Mustafa M.; Janicak, Philip G.; Kozel, F. Andrew; Emslie, Graham J.; Dowd, Sheila M.; Sampson, Shirlene M.

In: Journal of Clinical Psychiatry, Vol. 72, No. 9, 09.2011, p. 1263-1269.

Research output: Contribution to journalArticle

Wall, Christopher A. ; Croarkin, Paul E. ; Sim, Leslie A. ; Husain, Mustafa M. ; Janicak, Philip G. ; Kozel, F. Andrew ; Emslie, Graham J. ; Dowd, Sheila M. ; Sampson, Shirlene M. / Adjunctive use of repetitive transcranial magnetic stimulation in depressed adolescents : A prospective, open pilot study. In: Journal of Clinical Psychiatry. 2011 ; Vol. 72, No. 9. pp. 1263-1269.
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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. Method: 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. Trial Registration: clinicaltrials.gov Identifier: NCT00587639.",
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AU - Wall, Christopher A.

AU - Croarkin, Paul E.

AU - Sim, Leslie A.

AU - Husain, Mustafa M.

AU - Janicak, Philip G.

AU - Kozel, F. Andrew

AU - Emslie, Graham J.

AU - Dowd, Sheila M.

AU - Sampson, Shirlene M.

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N2 - 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. Method: 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. Trial Registration: clinicaltrials.gov Identifier: NCT00587639.

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