Objective:

To evaluate the efficacy of dual-site accelerated intermittent theta burst stimulation (aiTBS) targeting the left dorsolateral prefrontal cortex and cerebellum in reducing suicidal ideation in adolescents with major depressive disorder.

Approach:

• Study Design: A randomized, double-blind, sham-controlled trial involving 59 patients aged 12 to 18 years with major depressive disorder.
• Intervention: Participants were assigned to dual-site aiTBS (active left cerebellar stimulation) or single-site aiTBS (sham cerebellar stimulation) over 20 sessions.
• Assessment: Primary endpoint was change in the Beck Scale for Suicide Ideation score from baseline to day 4.

Key Findings:

• Mean Beck Scale for Suicide Ideation scores decreased from 22.6 to 8.2 in the dual-site group and from 23.3 to 13.9 in the single-site group.
• The between-group difference in score reduction was about 4.9 points.
• Response rates were 59% in the dual-site group vs. 37% in the single-site group.
• Remission rates were 48% in the dual-site group vs. 30% in the single-site group.
• At 1 month, between-group differences in suicidal ideation and depression scores were no longer statistically significant.
• Depression response rates were 72% in the dual-site group vs. 43% in the single-site group, and remission rates were 45% vs. 20%, respectively.
• The most common adverse events were pain at stimulation sites and dizziness, which resolved within approximately 30 minutes following treatment cessation.

Interpretation:

Limitations:

• Single-center design.
• Small sample size.
• Lack of a dual-site sham group.
• Concomitant pharmacotherapy use may affect outcomes.

Conclusion:

Sources:

• JAMA Network Open