Exploratory analysis of symptom-specific efficacy of transcranial magnetic stimulation in adolescent depression

Adolescent depression manifests through diverse, interconnected symptoms, yet the clinical profile in patients treated with repetitive transcranial magnetic stimulation (rTMS) remains inadequately characterized. While rTMS shows therapeutic potential, its efficacy may be overestimated due to limited research and symptom heterogeneity. Identifying key symptom clusters and evaluating their predictive value for treatment response is crucial for optimizing rTMS outcomes in this population.

To identify adolescent depression symptom clusters and assess their differential responses to rTMS treatment.

One hundred adolescent patients with first-episode major depressive disorder were randomized into control and study groups. Both groups received sertraline treatment, while the study group additionally underwent 10 sessions of adjunctive rTMS. Depressive symptoms were evaluated using the 17-item Hamilton Depression Rating Scale (HAMD-17) at baseline, week 2, and week 4.

Hierarchical clustering revealed four distinct symptom clusters: Subjective mood, impaired activity, somatic concerns, and anxiety/insomnia. The main effect of treatment visit showed significant decreases in symptom severity across all clusters. In the study group, the effect size between baseline and week 4 was largest for the subjective mood cluster (Cohen's d = 2.41) and smallest for somatic concerns (Cohen's d = 0.59). In the control group, the largest effect size was observed in the anxiety/insomnia cluster (Cohen's d = 1.20), with the smallest effect in impaired activity (Cohen's d = 0.47).

This study identified four distinct symptom clusters with differential responses to rTMS treatment. The findings demonstrate that rTMS shows greatest efficacy for improving subjective mood symptoms, guiding targeted therapeutic approaches.