Acceptability, safety and tolerability of antidepressant repetitive transcranial magnetic stimulation for adolescents: A mixed-methods investigation

Emily Jean Wallman; Rebecca Anne Segrave; Michael Solomon Gordon; Maxwell James Oliver Barnett Fraser; Chris Pavlou; Glenn Alexander Melvin

doi:10.1016/j.jad.2022.04.057

Acceptability, safety and tolerability of antidepressant repetitive transcranial magnetic stimulation for adolescents: A mixed-methods investigation

J Affect Disord. 2022 Aug 1:310:43-51. doi: 10.1016/j.jad.2022.04.057. Epub 2022 Apr 14.

Authors

Emily Jean Wallman¹, Rebecca Anne Segrave², Michael Solomon Gordon³, Maxwell James Oliver Barnett Fraser⁴, Chris Pavlou⁴, Glenn Alexander Melvin⁵

Affiliations

¹ Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia. Electronic address: emily.wallman@monash.edu.
² BrainPark, Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia.
³ Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Early in Life Mental Health Service, Monash Health, Clayton, Victoria, Australia.
⁴ Early in Life Mental Health Service, Monash Health, Clayton, Victoria, Australia.
⁵ School of Psychology, Faculty of Health, Deakin University, Burwood, Victoria, Australia; Centre for Educational Development, Appraisal & Research, University of Warwick, Coventry, UK.

PMID: 35429525
DOI: 10.1016/j.jad.2022.04.057

Abstract

Objective: Major depressive disorder (MDD) is relatively common in adolescence, with far-reaching impacts. Current treatments frequently fail to alleviate depression severity for a substantial portion of adolescents. Repetitive transcranial magnetic stimulation (rTMS) may assist with this unmet clinical need. However, little is known about adverse events (AEs) experienced by adolescents receiving rTMS, subjective treatment experiences of adolescents and their parents, or treatment acceptability.

Methods: Fourteen adolescents (16.5 years ± 1.2; 71.4% female) with MDD received 20 sessions of either high-frequency (10 Hz; n = 7) left dorsolateral prefrontal cortex (DLPFC) or low-frequency (1 Hz; n = 7) right DLPFC rTMS. AEs were monitored at baseline and at weekly intervals via New York State Psychiatric Institute Side Effects Form for Children and Adolescents. Eight adolescents and nine parents participated in interviews regarding subjective treatment experience, analysed via content analysis.

Results: Drowsiness and lethargy were common AEs, reported by 92.3% of participants in week one. Number of AEs decreased throughout treatment course (after 5 treatments: M = 11.23, SD = 5.00; after 20 treatments: M = 8.92, SD = 5.95). Thirty-five AEs emerged during treatment, most commonly transient dizziness. Frequency, severity, and number of AEs reported were equivalent between treatment groups. Treatment adherence and satisfaction were high. Qualitative findings identified three themes relating to rTMS experience: Preparation and connection; Physical experience of treatment; and Perceived role of treatment.

Limitations: Sample size was small, therefore findings are preliminary.

Conclusions: rTMS was an acceptable treatment for adolescent MDD, from both adolescents' and parents' perspectives, and was safe and well-tolerated, as AE frequency and type did not differ from rTMS treatment courses in adults.

Keywords: Adolescent depression; Adverse events; Treatment acceptability; Treatment satisfaction; rTMS.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Antidepressive Agents / therapeutic use
Child
Depressive Disorder, Major* / drug therapy
Female
Humans
Male
Prefrontal Cortex / physiology
Transcranial Magnetic Stimulation* / adverse effects
Transcranial Magnetic Stimulation* / methods
Treatment Outcome

Substances

Antidepressive Agents