Neuronavigation-guided high-dose repetitive transcranial magnetic stimulation for the treatment of depressive adolescents with suicidal ideation: a case series.

Background: A high proportion of adolescents with major depressive disorder currently do not respond to conventional treatment. Repetitive transcranial magnetic stimulation (rTMS) is a promising treatment for major depressive disorder.

Case: We report on 3 cases of adolescents with suicidal ideation receiving 7 daily 10 Hz left prefrontal rTMS combined with pharmacotherapy treatment over 1 week for major depressive episode. The left dorsolateral prefrontal cortex was identified using magnetic resonance imaging-guided neuronavigation prior to stimulation. The suicidal ideation of these patients lessened significantly following rTMS treatment. Regarding adverse effects, symptoms of hypomania occurred in two patients since day 4, but no other side effects were found.

Conclusion: Neuronavigation-guided high-dose rTMS may be an effective and feasible treatment option for depressive adolescents with suicidal ideation. Caution over treatment-emergent mania/hypomania associated with rTMS is required.