Acceptability, safety and tolerability of antidepressant repetitive transcranial magnetic stimulation for adolescents: A mixed-methods investigation
Open accessAbstract
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.
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Robust evidence has demonstrated the safety and tolerability of rTMS and has suggested that it is superior to sham stimulation on variables of depression severity, response, and remission in adults across the lifespan.
“Robust evidence (e.g., Wallman et al., 2022;Zis et al., 2020) has demonstrated the safety and tolerability of rTMS and has suggested that it is superior to sham stimulation on variables of depression severity, response, and remission in adults across the lifespan (Adu et al., 2022;De Risio et al., 2020;Gaynes et al., 2014).”
From Neurocognitive effects of theta burst stimulation for treatment-resistant depression in adults: A systematic review and recommendations for future research (2025) · cites this paper as Wallman et al., 2022
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References 80 · Cited by 12
- Authors
- Wallman, E. J., Segrave, R. A., Gordon, M. S., Fraser, M. J. O. B., Pavlou, C., & Melvin, G. A.
- Affiliations
- Monash Health (AU)
- Monash University (AU)
- Deakin University (AU)
- Corresponding author
- Wallman, Emily Jean
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2022-08
- Volume
- 310
- Pages
- 43-51
- ISSN
- 0165-0327 (ISSN-L)
- OpenAlex
- W4223953442
- Cited by
- 12
- References
- 80
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 4 · 2023: 1
- FWCI
- 0.88
- Type
- journal article
- Language
- en
- Open access
- green
- figshare.com
- Licence
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- Own your potential (DEAKIN) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Warwick Research Archive Portal (University of Warwick) (submittedVersion)
- Funders
- Woolworths Group
- Topics
- Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
- Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Keywords
- repetitive transcranial magnetic stimulation, adolescent depression, major depressive disorder, treatment acceptability, adverse events, tolerability, sleepiness, dizziness, dorsolateral prefrontal cortex, high-frequency stimulation, low-frequency stimulation, medication adherence, parental attitudes
- MeSH terms
- Adolescent, Adult, Antidepressive Agents, Child, Major Depressive Disorder, Depressive Disorder, Major, Female, Humans, Male, Treatment Outcome, Prefrontal Cortex, Transcranial Magnetic Stimulation
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