Safety and Efficacy of Transcranial Magnetic Stimulation (TMS) in Pediatric Depression

Source: Journal of Indian Association for Child and Adolescent Mental Health. 17(3) (pp 154-166), 2021.

Date of Publication: July 2021.

Authors: Gupta V.; Singh S.; Gupta P.K.; Kar S.K.

Abstract: Transcranial Magnetic Stimulation (TMS), a form of Non-Invasive Brain Stimulation (NIBS), has gained popularity in the last couple of decades. It is approved for treating depression in adults and is under investigation in pediatric depression. This paper aims to evaluate Transcranial Magnetic Stimulation (TMS) studies in pediatric depression and provide a narrative overview by reviewing the research databases (PubMed, Science Direct, and Cochrane Library). Recent evidence suggests that in pediatric patients of treatment-resistant depression, repetitive Transcranial Magnetic Stimulation (rTMS) of the frequency of 10 Hz when applied to the left dorsolateral prefrontal cortex (DLPFC), can lead to remission, improvement in depressive symptoms, or decrease in recurrence of episodes. Existing literature also suggests that TMS’s adverse effects in the pediatric population are minimal and comparable to those in the adult population. However, the limitations of existing studies, including lack of double-blind sham-controlled randomized trials or RCTs (only one RCT exists to date), small sample sizes, absence of long term follow-ups, and lack of homogenous age distribution, render the evidence insufficient for approval of TMS use in pediatric depression. This review suggests that although there is a scope of TMS use in pediatric depression, more proof is required to establish and quantify its efficacy and standardize its dosing regimens.