Accelerated theta-burst stimulation using individualized fMRI-based targets in adolescents with depression

Background: Accelerated intermittent theta-burst stimulation (aiTBS) using resting-state functional magnetic resonance imaging (fMRI)-based neuronavigation was recently cleared by the FDA for use in adults with depression. The objective of this study was to gauge the clinical utility of fMRI-guided neuronavigation in adolescents with depression. Methods: Three individuals (male, 16-17 years) underwent resting-state fMRI scanning prior to treatment. Individualized left dorsolateral prefrontal cortex (DLPFC) brain targets were derived for each patient based on resting-state functional connectivity to the subgenual anterior cingulate cortex. aiTBS treatments were administered via the MagVenture MagPro R30 system and a MagVenture Cool-B65 coil, paired with the Localite TMS Navigator. Patients received 50 stimulation sessions over five days (8 to 11 sessions per day, spaced by a minimum of 50 minutes). Self-reported depression symptoms were evaluated pre- and one-week post-treatment using the Patient Health Questionnaire-9 (PHQ-9). Results: Baseline PHQ-9 scores were 20, 19, and 19 for each patient indicating moderately-severe to severe symptoms. Following treatment, scores decreased to 3, 2 and 12, respectively indicating two patients achieved remission and no longer had depressive symptoms (85% and 89% reduction in symptom severity). One patient was considered a non-responder, however still achieved a 37% reduction in symptom severity. Conclusions: fMRI-guided aiTBS treatment was well tolerated by all three patients. This case series provides evidence that neuronavigated aiTBS may be a safe and effective treatment for some adolescents with depression. Future studies should examine the safety, efficacy, and durability in a larger randomized sham-controlled trial. Conflicts of Interest: None Funding: None Disclosures: None