TY - JOUR
T1 - High-frequency repetitive TMS for suicidal ideation in adolescents with depression
AU - Croarkin, Paul E.
AU - Nakonezny, Paul A.
AU - Deng, Zhi De
AU - Romanowicz, Magdalena
AU - Voort, Jennifer L.Vande
AU - Camsari, Deniz Doruk
AU - Schak, Kathryn M.
AU - Port, John D.
AU - Lewis, Charles P.
N1 - Funding Information:
This study was supported by the National Institute of Mental Health (NIMH) R01MH113700 Grant, “Glutamatergic and GABAergic Biomarkers in TMS for Adolescent Depression” (Dr. Croarkin) and the O'Shaughnessy (Woolls) Foundation. Neuronetics provided equipment support and SenStar ® shields through an investigator-initiated trial program. ZDD is supported by the NIMH Intramural Research Program.
Funding Information:
JLVV receives equipment in-kind support from Assurex Health, Inc. for an investigator-initiated study and is a site investigator for a multicenter study funded by Neuronetics. CPL receives research support from the Mayo Clinic Foundation Departmental Small Grant Program and is a site investigator for a multicenter study funded by Neuronetics, Inc. PEC has received research grant support from Pfizer, Inc., NIMH, the Brain and Behavior Research Foundation, and the Mayo Clinic Foundation. He has served as a site subprincipal or principal investigator (without additional compensation) for Eli Lilly and Co., Forest Laboratories, Inc., Merck & Co., Inc., and Pfizer, Inc.; has received equipment support from Neuronetics, Inc.; and receives supplies and genotyping services from Assurex Health, Inc. for an investigator-initiated study. He is the primary investigator for a multicenter study funded by Neuronetics, Inc. PAN, ZDD, MR, DDC, KMS, and JDP have no financial disclosures.
Publisher Copyright:
© 2018 Elsevier B.V.
PY - 2018/10/15
Y1 - 2018/10/15
N2 - Background: This exploratory study sought to examine the effect of an acute course of high-frequency repetitive TMS on suicidal ideation in adolescents. Methods: Data were pooled from 3 prior protocols providing a 30-session course of open-label TMS treatment for adolescents with treatment-resistant depression. All participants (n = 19) were outpatients taking antidepressant medication, with TMS provided as adjunctive treatment. Suicidality was assessed at baseline, after 10 treatments, after 20 treatments, and after 30 treatments. Outcome measures of suicidal ideation included the Columbia Suicide Severity Rating Scale (C-SSRS) “Intensity of Ideation” subscale and Item 13 “Suicidality” on the Children's Depression Rating Scale, Revised (CDRS-R). Results: The predicted odds of suicidal ideation (CDRS-R Item 13 and C-SSRS Intensity of Ideation subscale) significantly decreased over 6 weeks of acute TMS treatment without adjustments for illness (depression) severity. However, the magnitude of the decrease in the predicted odds of suicidal ideation across 6 weeks of treatment was attenuated and rendered non-significant in subsequent analyses that adjusted for illness (depression) severity. Limitations: This was an exploratory study with a small sample size and no sham control. Regulatory and ethical barriers constrained enrollment of adolescents with severe suicidality. Conclusions: The present findings suggest that open-label TMS mitigated suicidal ideation in adolescents through the treatment and improvement of depressive symptom severity. Although caution is warranted in the interpretation of these results, the findings can inform the design and execution of future interventional trials targeting suicidal ideation in adolescents.
AB - Background: This exploratory study sought to examine the effect of an acute course of high-frequency repetitive TMS on suicidal ideation in adolescents. Methods: Data were pooled from 3 prior protocols providing a 30-session course of open-label TMS treatment for adolescents with treatment-resistant depression. All participants (n = 19) were outpatients taking antidepressant medication, with TMS provided as adjunctive treatment. Suicidality was assessed at baseline, after 10 treatments, after 20 treatments, and after 30 treatments. Outcome measures of suicidal ideation included the Columbia Suicide Severity Rating Scale (C-SSRS) “Intensity of Ideation” subscale and Item 13 “Suicidality” on the Children's Depression Rating Scale, Revised (CDRS-R). Results: The predicted odds of suicidal ideation (CDRS-R Item 13 and C-SSRS Intensity of Ideation subscale) significantly decreased over 6 weeks of acute TMS treatment without adjustments for illness (depression) severity. However, the magnitude of the decrease in the predicted odds of suicidal ideation across 6 weeks of treatment was attenuated and rendered non-significant in subsequent analyses that adjusted for illness (depression) severity. Limitations: This was an exploratory study with a small sample size and no sham control. Regulatory and ethical barriers constrained enrollment of adolescents with severe suicidality. Conclusions: The present findings suggest that open-label TMS mitigated suicidal ideation in adolescents through the treatment and improvement of depressive symptom severity. Although caution is warranted in the interpretation of these results, the findings can inform the design and execution of future interventional trials targeting suicidal ideation in adolescents.
KW - Adolescent
KW - Brain stimulation
KW - Depression
KW - Suicidal ideation
KW - Suicidality
KW - Transcranial magnetic stimulation
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UR - http://www.scopus.com/inward/citedby.url?scp=85049984915&partnerID=8YFLogxK
U2 - 10.1016/j.jad.2018.06.048
DO - 10.1016/j.jad.2018.06.048
M3 - Article
C2 - 30031247
AN - SCOPUS:85049984915
SN - 0165-0327
VL - 239
SP - 282
EP - 290
JO - Journal of affective disorders
JF - Journal of affective disorders
ER -