Abstract
Major depressive disorder (MDD) affects 350 million people worldwide and its prevalence peaks in youth 15 to 24 years of age. 30-50% of youth do not respond to medications and cognitive behavioral therapy, and some experience increased suicidal thoughts with serotonergic antidepressants. Electroconvulsive therapy is the most effective treatment for treatment-resistant depression (TRD) but is rarely used in youth due to stigma and side effects.Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive neuromodulation treatment that is FDA-approved for adult MDD but studies in youth are sparse. Theta burst stimulation (TBS) is a form ofrTMS that is very brief compared to conventional rTMS protocols. Recent studies in adult TRD have shown the efficacy of this treatment despite its short duration. Our goal is to extend TBS to youth TRD and we recently examined the feasibility, theraputic potential and biological targets of TBS in youth TRD. In this talk, we will: a) review saftey and therapeutic efficacy of rTMS in youth depression; b) present results of an open-label 2-week trial of bilateral TBS (left intermittent TBS and right continuous TBS) applied to the dosolateral prefrontal cortex in twenty youth with TRD (age:16-24); and c) review and explore the application of multi-modal neuroimaging such as EEG, and TMS-EEG in understanding the biological targets and identifying predictors of response to rTMS therapy in youth.
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