Intermittent theta burst stimulation for adolescent patients with major depressive disorder or bipolar depression: A...

The therapeutic efficacy and safety profile of intermittent theta burst stimulation (iTBS) in adolescent patients with major depressive disorder (MDD) or bipolar depression (BD) remain inadequately characterized. This systematic review assesses the efficacy, safety, and tolerability of daily iTBS and accelerated iTBS for adolescents with MDD or BD.

A comprehensive literature search was conducted in Chinese (WanFang, China National Knowledge Infrastructure) and English (PubMed, EMBASE, PsycINFO, Cochrane Library) databases for randomized controlled trials (RCTs) evaluating the efficacy, safety, and tolerability of daily iTBS or accelerated iTBS in adolescents with MDD or BD.

Five RCTs encompassing 264 adolescent patients with MDD or BD were conducted in China and met the inclusion criteria. Two RCTs assessed the antidepressant and neurocognitive effects of adjunctive daily iTBS in MDD, yielding inconsistent findings. Significant superiority of adjunctive daily iTBS over sham stimulation was observed for reducing suicidal ideation (1 RCT), but not for alleviating anxiety symptoms (1 RCT). Four RCTs investigated the antidepressant effects of adjunctive accelerated iTBS in adolescents with MDD or BD, with uncertain findings. No significant advantage of adjunctive accelerated iTBS over sham stimulation was identified for anxiety symptom reduction (2 RCTs), suicidal ideation (1 RCT), or neurocognitive function improvement (2 RCTs). Discontinuation rates did not differ significantly between groups. Only one out of five RCTs systematically reported adverse events.

Due to the lack of the overall scarcity of high-quality, replicated data, their efficacy in alleviating depressive and anxiety symptoms, suicidal ideation, and neurocognitive deficits remains insufficient to establish clinically meaningful effects. Adverse events were not systematically reported in the majority of studies. Importantly, the efficacy, safety, and tolerability of daily iTBS and accelerated iTBS for adolescents with MDD or BD should be examined in countries other than China.