When to Consider Transcranial Magnetic Stimulation for Youth With Depression Given Promising Data on Effectiveness

I read with interest the article by Croarkin et al. ¹ reporting naturalistic study outcomes of 1,283 youths with moderate to severe depression receiving transcranial magnetic stimulation (TMS). Among the 1,169 youths who completed the treatment, 59% responded (at least 50% improvement in Patient Health Questionnaire-9 [PHQ-9] scores), and 30% remitted (end-of-acute treatment score of <5 on PHQ-9), a treatment effect similar to what is found in adults receiving TMS. Do these promising data in a large real-world sample of youth help guide when TMS should be considered for a youth with depression? In other words, how many trials of psychotherapy and/or antidepressants should be tried before considering TMS? This is a common question from clinicians, youth, and families, especially after the recent US Food and Drug Administration clearance of TMS as an adjunctive treatment for adolescents age 15 and older with depression.