Efficacy study of intermittent theta burst stimulation(iTBS) in the treatment of adolescents with affective disorders

Background: Affective disorders are the leading cause of disability worldwide. Intermittent theta burst stimulation (iTBS) is a safe and effective brain stimulation therapy for reducing depressive symptoms in adolescents. The purpose of this study is to investigate the clinical efficacy of iTBS in treating adolescent patients with depressive disorders and the factors influencing clinical symptoms. Methods: Participants were randomized to receive left-sided dorsolateral prefrontal cortex(DLPFC) to navigate either active or sham iTBS treatment 5 sessions daily for 2 days. During 4 weeks of maintenance treatment, two sessions were administered weekly. The primary study outcome was the change in the Montgomery-Asberg Depression Rating Scale (MADRS) from baseline to the post-treatment follow-up period. We also explored relevant clinical factors that influence the efficacy of iTBS. Results: About 22 adolescents with affective disorders were in the active iTBS group and 18 patients were in the sham iTBS group. Compared to the sham group, patients in the active iTBS group showed significant improvement in depressive symptoms over the two days of treatment. In addition, in the active iTBS group, higher baseline SHAPS and BHS scores were associated with worse outcomes. Conclusions: The current study suggests that two days of active iTBS to the DLPFC region can rapidly, safely, and effectively improve depressive symptoms in adolescents with depression. We found that iTBS was less effective in baseline patients with greater feelings of hopelessness and anhedonia. Our data can provide valuable recommendations and directions for the clinical management of adolescent depression.