High-frequency repetitive TMS for suicidal ideation in adolescents with depression

Paul E. Croarkin, Paul A. Nakonezny, Zhi De Deng, Magdalena Romanowicz, Jennifer L.Vande Voort, Deniz Doruk Camsari, Kathryn M. Schak, John D. Port, Charles P. Lewis

Research output: Contribution to journalArticlepeer-review

55 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)282-290
Number of pages9
JournalJournal of Affective Disorders
StatePublished - Oct 15 2018
Externally publishedYes

Bibliographical note

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.


  • Adolescent
  • Brain stimulation
  • Depression
  • Suicidal ideation
  • Suicidality
  • Transcranial magnetic stimulation


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