Background: Although rTMS is an effective and FDA approved intervention of treatment resistant depression in adults, there is presently less data available on its efficacy in the adolescent population.
      Methods: This naturalistic study evaluated outcomes of adolescents with major depressive disorder (MDD) (N=201, nmales=79, Mage=19.09 years, SDage=2.23 years) treated with bilateral rTMS. Patients received at least 30 bilateral rTMS sessions (range 30-36), (M=35.63, SD=1.26) with 1 Hz delivered to the right dorsolateral prefrontal cortex (dlPFC) for 360 pulses, followed by left dlPFC stimulation at 20 Hz for 1200 pulses. PHQ-9 and GAD-7 were administered before and after an acute course of rTMS treatment.
      Results: 43.3% of patients experienced remission in their depressive symptoms and 50.2% of patients in their anxiety symptoms (≤4 on PHQ-9 and GAD-7, respectively) after rTMS treatment. Overall, improvement was observed between pre-rTMS PHQ-9 (M=16.00, SD=5.81) and GAD-7 (M=12.64, SD=5.49) scores and post-rTMS PHQ-9 (M=7.45, SD=6.35), (t(200)=18.99, dpaired=1.40) and GAD-7 (M=6.05, SD=5.42), (t(200)=16.55, dpaired=1.21) scores. Similar effect was observed on the PHQ-9 and GAD-7, respectively, between those 19-22 years old (nolder=121, Mage=20.55, SDage=1.20), (dpaired=1.53, CI95% [7.94, 11.10]), (dpaired=1.10, CI95% [5.66, 8.47]) and for those aged 18 and younger (Mage=16.9, SDage=1.48; Agemin=12), (dpaired=1.22, CI95% [5.26, 8.89]), (dpaired=1.28, CI95% [4.20, 7.52]).
      Conclusions: Bilateral 1 Hz and 20 Hz rTMS delivered in a naturalistic, clinical setting appeared to be well tolerated and effective in this sample of youth. Future efforts should consider control and comparison groups.
      Funding: Patients who were already seeking TMS treatment were financially responsible for their acute courses of rTMS treatment. Therapy may have been covered by insurance and/or privately paid for by the patient. Tablets used to conduct the assessments and for TMS therapy documentation are privately owned by Salience.
      Disclosures: Most authors are employees of Salience and/or SHWC. J. Kriske holds stakes and serves as Director of Clinical Research & Development at Salience, N. Donachie serves as Chief Medical Officer and Medical Director at Salience & SHWC and holds stakes at SHWC, & J. Downar serves as Chief Clinical Officer at Salience & SHWC. J. Downar is employed by the University of Toronto. P. Croarkin is an employee of Mayo Clinic and has received research support from the National Institute of Mental Health, MagVenture, Neuronetics, NeoSync, and Pfizer. P. Croarkin has received material support from and provided consultation to Myriad Neuroscience. He has consulted for Procter & Gamble Company.