Repetitive transcranial magnetic stimulation frequency effects on suicidal ideation in adolescents with major depressive disorder

Previous research has explored Transcranial Magnetic Stimulation (TMS) interventions for suicidal thoughts and behaviors. However, the optimal dose parameters for TMS interventions targeting suicidal ideation in adolescents remain unknown. This exploratory study examined the impact of 1 Hz and 10 Hz TMS treatment on suicidal ideation in adolescents with major depressive disorder. Participants (N = 41) aged 12-18 years were randomized to TMS treatments with 1 Hz or 10 Hz frequency over 6 weeks and included in the exploratory analyses. The change in the intensity of suicidal ideation throughout treatment was estimated with ordinal logistic regression models with and without adjustments for the change in depressive symptom severity. The predicted odds of intensity of suicidal ideation significantly decreased over six-weeks of acute TMS treatment for both the 10 Hz TMS group (OR = 0.754, 95 % CI = 0.634 to 0.897, p = 0.0015) and the 1 Hz TMS group (OR = 0.780, 95 % CI = 0.668 to 0.909, p = 0.0016). However, after adjustment for the change in depression severity as a time-varying covariate in the ordinal logistic regression model, the magnitude of the decrease (or predicted odds) in intensity of suicidal ideation was attenuated and rendered non-significant for both the 10 Hz and 1 Hz TMS groups. TMS treatment suicidal ideation outcomes were not significantly different between the 10 Hz and 1 Hz TMS groups. Low-frequency TMS may be as effective as high-frequency TMS in treating suicidal ideation in adolescents with depression. Notably, 1 Hz TMS may have a favorable tolerability and safety profile for adolescents.