Accelerated Intermittent Theta Burst Stimulation (iTBS) for Crisis Stabilization in a Transgender Adolescent with...

Transgender adolescents experience disproportionately high rates of depression and suicidality, yet effective interventions for those unresponsive to conventional treatments remain scarce. This case report describes the case of a 15-year-old transgender male with severe treatment-resistant depression and active suicidal ideation who underwent an accelerated intermittent theta burst stimulation (iTBS) protocol: 20 sessions over four consecutive days targeting the left dorsolateral prefrontal cortex. Baseline scores indicated severe depression (Patient Health Questionnaire-9 (PHQ-9) = 22) and high suicide risk (Suicidal Ideation Attributes Scale (SIDAS) = 35). At the one-month follow-up, the patient's symptoms improved to minimal depression (PHQ-9 = 4) and below the high-risk suicide cutoff (SIDAS = 10). He reported improved mood, reduced suicidal thoughts, and no adverse effects. To the author's knowledge, this is the first published case of accelerated iTBS in a transgender adolescent demonstrating rapid and substantial symptom reduction with good tolerability. These findings suggest accelerated iTBS may be a safe and time-sensitive option for crisis stabilization in transgender youth when traditional approaches fail, warranting further research in larger cohorts.