Because of rising rates of anxiety, depression and other Mental health concerns among adolescents, TMS has been used off-label for many years to treat depression among teenagers. The US Centers for Disease Control and Prevention (CDC) Youth Risk Behavior Survey Data Summary & Trends Report: 2013-2023¹ highlights the scope of the problem, with 40 percent of high school students reporting persistent feelings of sadness or hopelessness, 20 percent seriously contemplating suicide, and close to 10 percent having made at least one suicide attempt. While trends show incremental improvement, the problem remains substantially and dangerously underaddressed.

Recently, the FDA approved an indication for using TMS for adolescents 15 years and up, using the NeuroStar TMS Therapy system (Neuronetics, Inc.), paving the way for broader applications. The study that led the FDA to approve the use of TMS for teenagers is discussed in more detail below, following an overview of what TMS is and how it works.

What Is TMS?

Transcranial magnetic stimulation (TMS) is a treatment FDA-cleared in 2008 for the treatment of Major Depressive Disorder (MDD) in adults. In brief, TMS works by stimulating various areas of the surface of the brain, or cerebral cortex. Because TMS uses a strong, changing magnetic field, it stimulates neurons in the areas underneath the magnetic coil. Because magnetic fields, like sound and light, get weaker the further away from their source, TMS affects deeper brain areas indirectly–through their connections with the cortex, via aptly-named “cortical windows”. High frequency TMS tends to increase brain activity, and low frequency TMS tends to suppress it, an effect that gets established over the course of multiple treatment sessions, over the course of days to weeks.

Coil Placement for Depression Treatment

Source: Neuronetics

Depending on what areas are treated, TMS has different effects. With MDD for example, TMS is typically applied to the left dorsolateral prefrontal cortex (DLPFC), whereas for Obsessive-Compulsive Disorder (OCD), the medial prefrontal cortex (MPFC). Recent posts, referenced below, have addressed accelerated TMS for depression, which can be given over the course of several days rather than week, TMS for OCD, favorable results with TMS versus antidepressant polypharmacy, and emerging off-label effectiveness for TMS in reducing alcohol cravings. Standard TMS for MDD, for instance, is once per day for 36 sessions, for OCD 29 sessions, and accelerated TMS provides a comparable number of sessions over the course of one week using a brief treatment protocol called “intermittent theta burst stimulation” (iTBS).

TMS for Teens

In a study recently published in the Journal of the American Academy of Child & Adolescent Psychiatry (2024)², researchers analyzed data from a large database of adolescents and young adults treated with TMS for MDD. They reviewed results from 1283 patients aged 12-19, and 601 patients aged 20 to 21 years old, who had completed standardized measures of MDD (PHQ-9) and Generalized Anxiety Disorder (GAD-7). They looked at the relationship between the number of sessions and effectiveness, and improvement over the course of treatment–among those who completed at least 20 TMS sessions.

In the full sample of 1,169 patients, they found that 59.4 percent met the criteria for remission–reduction of at least 50 percent of symptoms, and 36.4 percent met the criteria for full remission. Effectiveness was significantly higher with longer treatment courses. Improvement in anxiety was strongly correlated with depression improvement. Treatment response rates mirrored those found in adult populations, in which antidepressant medication has an overall remission rate of about 35 percent, across multiple medication tries, and 27.5 percent for the initial medication (Pigott et al., 2023)³.

Researchers concluded:

This study examined the largest sample to date of adolescents and young adults treated with TMS for MDD. TMS treatment resulted in marked improvement in both depressive symptoms and anxiety in both adolescents and young adults. The magnitude of benefit, trajectory of symptomatic improvement, and dependency on the number of treatment sessions showed a treatment effect similar to that found in adults.

Because of these results, the FDA approved an indication for TMS therapy for adolescents 15 years and up⁴. In addition, TMS received an indication as a first-line adjunctive therapy given the favorable comparison with medication response and remission rates.

While TMS is approved for the treatment of MDD and OCD across various age groups, with promising applications for other clinical conditions, TMS arguably remains underutilized due to unfamiliarity and difficulty with access and insurance coverage. For those suffering with partially-treated or treatment refractory psychiatric illness, TMS offers a safe, well-tolerated and unique treatment option to consider.