The Effectiveness of Transcranial Magnetic Stimulation in Adolescents and Young Adults With Major Depressive Disorder.

Objective: To assess the real-world effectiveness of transcranial magnetic stimulation (TMS) for depression in large adolescent and young adult samples. Method: Clinical outcome data from 364 sites were extracted for adolescent (n = 682; ages 12-19 years) and young adult (n = 601; ages 20-21 years) patients treated with TMS for major depressive disorder. Primary outcomes included response and remission rates assessed with the Patient Health Questionnaire-9 (PHQ-9). Secondary outcomes included rates of clinically meaningful benefit and worsening of depression based on a meaningful change threshold of ±6 points on the PHQ-9, dose-response relationships in effectiveness, and trajectories of symptomatic improvement over the course of TMS treatment. Results: PHQ-9 response and remission rates were equivalent in adolescent and young adult groups. Following the TMS course, approximately 70% of both groups reported meaningful improvement, whereas less than 1% reported meaningful worsening. There were marked dose-response effects, with longer courses of TMS associated with greater improvement (F 5,1277 = 19.10, p < .0001). The trajectory of improvement showed greatest symptom reduction over the first 10 sessions and with steady improvement thereafter. The adolescent and young adult groups did not differ in these outcomes, and their patterns mirrored those reported in a large adult registry sample. Conclusion: This study examined the largest samples to date of adolescents and young adults treated with TMS for major depressive disorder. In both groups, TMS resulted in marked improvement in depressive symptom severity. The magnitude of benefit, trajectory of symptomatic improvement, and dependency on number of treatment sessions demonstrated therapeutic effects similar to that reported in adults. Study Registration Information: A Retrospective Study to Evaluate NeuroStar Advanced Therapy in Adolescents; https://clinicaltrials.gov/study/NCT06699940. Diversity & Inclusion Statement: We worked to ensure sex and gender balance in the recruitment of human participants. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list.