NeuroStar TMS for Adolescents With Major Depressive Disorder: A Look at the New Data

CLINCAL CONVERSATIONS

According to data presented at the 2024 American Academy of Child and Adolescent Psychiatry (AACAP) annual conference, NeuroStar Advanced transcranial magnetic stimulation (TMS) therapy helped nearly 60% of adolescents with major depressive disorder (MDD) reach remission. Investigators sought to determine the outcomes of adolescents and young adults aged 12 to 21 years with MDD and anxiety who were treated with TMS in community settings.¹

Data were extracted from a treatment registry of 1283 patients with MDD; 682 patients were aged 12 to 19 years, and 601 were aged 20 to 21 years. This is the largest sample to date of adolescents and young adults with MDD. Primary outcome measures were the Patient Health Questionnaire-9 (PHQ–9) and Generalized Anxiety Disorder-7 (GAD–7).² The analyses examined outcomes from patients who completed 20 or more sessions and an intent-to-treat sample. In the completer sample (N=1169), results show that 59.4% of patients aged 12 to 19 and 36.4% of patients aged 20 to 21 met the PHQ-9 response and remission criteria, respectively. Investigators observed marked dose-response effects and antidepressant effectiveness improved with longer treatment courses (P < .0001). The greatest symptom reduction was seen over the first 10 sessions, with no plateau before treatment termination. The adolescent and young adult subgroup data did not differ in treatment effects.

To better understand this data, Psychiatric Times sat down with Melissa Fickey, MD, a board-certified psychiatrist who specializes in child, adolescent, and adult psychiatry.

Psychiatric Times: Tell us a little about that data shared at the AACAP annual meeting. What is the most important takeaway from this data for practicing mental health clinicians?

Melissa Fickey, MD: The data presented at AACAP highlights a breakthrough for teens and young adults struggling with depression and, in some cases, anxiety. This study was the most extensive of its kind, examining over 1200 young people aged 12 to 21 years old who received treatment with NeuroStar Advanced Therapy’s TMS. The results were very encouraging and showed more than 70% of those treated experienced meaningful improvements (or a 6 point or more change in their PHQ-9 score).

The positive results from this study reinforce the FDA clearance, as NeuroStar is the only FDA-cleared TMS device for treating adolescents with MDD aged 15 and older. Prior data also show a 78% response rate and 48% remission rates in teens and ultimately provide compelling evidence supporting TMS as a highly effective treatment for adolescents with MDD.

PT: Do you think this data will help patients and families considering TMS feel more comfortable?

Fickey: This data can provide significant confidence to patients and their families who might be apprehensive about beginning treatment with TMS. As mentioned, these are the largest study results of its kind, and they reinforce the safety and effectiveness the FDA reviewed when deciding NeuroStar is a first-line add-on option for adolescents with MDD age 15 and up. Not only did most participants experience meaningful improvements in both depression and anxiety, but adverse effects were minimal. Additionally, the data show treatment made an impact after only a few sessions and results improved for those who completed a full treatment course.

PT: Treatment with TMS resulted in marked improvement in both depressive symptoms and anxiety in adolescents and young adults. There are limited approved treatment options in this age category. At what point do you determine it is time to try TMS?

Fickey: NeuroStar is currently the only TMS therapy that is approved as a first-line adjunct treatment for adolescents—so it can be a first-line option for adolescents aged 15 and up in conjunction with other modalities, like antidepressant medications or talk therapy. It can also be used if a patient has tried other options but is not seeing a large impact on their mental health. MDD is a substantial public health challenge impacting at least 4.3 million adolescents annually in the United States, but despite current options, symptoms do not improve in approximately 30% of adolescents who opt for traditional antidepressants, according to independent NIH studies.³

TMS offers a new pathway for relief without the systemic adverse effects typical of antidepressant medications, which can be a huge help to younger patients and their families. The data presented at AACAP show us that the earlier we introduce TMS in persistent cases, the better the outcomes can be.

PT: NeuroStar is the only FDA-cleared TMS device to treat adolescents aged 15 and older as a first-line adjunct treatment. You are a diamond provider for NeuroStar TMS. Do you have any recommendations for mental health clinicians who might be considering utilizing TMS in their own practices?

Fickey: NeuroStar, as the only FDA-cleared device for patients aged 15 and up, stands out as a nondrug option, making a real difference for young people. I have been practicing with NeuroStar for 6 years, and the results we have seen in my practice, and from the data, show remarkable improvements in both depression and anxiety—it is an opportunity to offer a solution that can genuinely change lives.

Beyond its clinical efficacy, integrating NeuroStar into practice offers several practical benefits that can further enhance patient care. One notable feature is the proprietary TrakStar Patient Data Management System, which streamlines patient data management. This system ensures a smooth experience for patients, from their initial consultation through treatment, fostering their engagement and commitment to the process. It also makes it easy on me and my staff to track a patient’s progress during the course of the treatment.

Additionally, private and public insurance policies are increasingly covering it for adolescents and adult populations, reflecting a growing recognition of TMS as a valuable treatment option. This broader and rapidly increasing acceptance we have seen over the past few years—especially this year after the FDA clearance for adolescents—makes it that much easier to offer NeuroStar as an effective treatment for patients who are struggling.

PT: Is there anything else you would like to share?

Fickey: This study marks a pivotal moment in the treatment of depression and anxiety for adolescents and young adults. It is not just about the data—it is about opening new doors for those often underserved by traditional treatments. With such a large, real-world sample, I hope both patients and providers can see the true value of TMS—particularly how NeuroStar is transforming our approach to mental health in this age group. This research represents a beacon of progress, and I believe NeuroStar will change the landscape of adolescent mental health treatment for years to come.

PT: Thank you!

Dr Fickey is a board-certified psychiatrist specializing in child, adolescent, and adult psychiatry and works as a forensic psychiatric consultant. She is also the founder of Embracing Life Wellness Center.

References

1. NeuroStar oral presentation at AACAP 2024 highlights largest study evaluating TMS efficacy in adolescents with depression. Neuronetics. News release. October 14, 2024. Accessed October 21, 2024. https://ir.neuronetics.com/news-releases/news-release-details/neurostarr-oral-presentation-aacap-2024-highlights-largest-study

2. Croarkin PE, Aaronson ST, Carpenter LL, et al. A naturalistic study of transcranial magnetic stimulation treatment in adolescents and young adults with depression and anxiety. J Am Acad Child Adolesc Psychiatry. 2024;63(10):S306.

3. Ayvaci ER, Croarkin PE. Special populations: treatment-resistant depression in children and adolescents. Psychiatr Clin North Am. 2023;46(2):359-370.