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Major Depressive Disorder (MDD) affects roughly 1 in 5 adolescents ages 12-17, with prevalence rising to an astonishing 1 in 3 by ages 16-17. First-line treatments for adolescent depression, such as antidepressants and psychotherapy, can be very effective. However, roughly 40% of adolescents with MDD do not respond to the first trial of SSRIs or to psychotherapy. For young people and families navigating adolescent depression, it can be hard to know what to try next when symptoms continue.
At The Mind Grove TMS Center in Colorado Springs, we evaluate adolescents ages 15 and older with major depressive disorder (MDD) for TMS treatment. Dr. Megan Bowers personally leads each evaluation, reviewing diagnosis, symptoms, treatment history, current medications, safety considerations, and how TMS fits into the broader care plan.
The MagVenture TMS Therapy System is FDA-cleared as an adjunct for the treatment of MDD in patients ages 15 to 21. For this indication, TMS is used alongside antidepressant medication or psychotherapy, rather than as a stand alone treatment for MDD. TMS is currently the only FDA-approved adjunct treatment for MDD in adolescents.
Major depressive disorder in adolescents is characterized by persistently low mood or anhedonia (loss of interest in or inability to enjoy previously enjoyed activities), accompanied by some combination of too much or too little sleep, decreased appetite, low energy, poor concentration, irritability, feelings of hopelessness, guilt or shame, low self esteem and suicidal ideation or urges to self-harm.
In adolescents, these symptoms can negatively impact academic performance, and relationships with their peers and their families. Parents may notice their adolescent appearing more withdrawn or isolated, avoiding family or friends, losing interest or motivation in school or extracurricular activities, and getting into more conflicts with peers or family members. Teens who are engaging in self harm may try to hide this by covering up their arms, abdomen or legs.
Before recommending a treatment approach, we take time to understand the full clinical picture. Dr. Bowers leads that process personally.
During the evaluation, we may discuss:
For patients ages 15 to 21, the FDA-cleared use of the MagVenture TMS Therapy System is as an adjunct treatment for MDD. What this means is that, according to the FDA, TMS is meant to be used in combination with either medications or psychotherapy, rather than as a stand alone treatment for adolescent depression.
Does this mean that TMS cannot be used as a monotherapy for MDD in adolescents? No. It just means that using TMS as a stand alone treatment for adolescent depression is not FDA-approved, and is considered off-label, and is not likely to be covered by insurance.
TMS uses magnetic pulses to stimulate targeted areas involved in broader mood-regulation networks. It does not require anesthesia or sedation, and patients remain awake during treatment.
At Mind Grove, TMS care may include standard rTMS, iTBS, or Accelerated TMS.
Our standard rTMS course typically includes daily treatments for four to six weeks, followed by a taper phase, for a total of 36 to 40 treatments A full course usually spans eight to ten weeks, and appointments are approximately 40 minutes. Given the limited evidence for iTBS in adolescents with depression, standard rTMS is typically recommended in this age group.
iTBS is a form of rTMS that uses rapid theta-burst stimulation patterns, and is considered non-inferior to standard high-frequency rTMS for adults with depression. Each appointment is approximately 20 minutes, with about 3-10 minutes of stimulation. The evidence for iTBS is adolescents is currently more limited than in adults, meaning that it is not currently clear that iTBS is as effective as standard 10Hz rTMS for adolescent depression.
Accelerated TMS uses iTBS or standard rTMS as its delivery method. Our Accelerated TMS protocol includes five sessions per day for six treatment days within a 14 day period, followed by 2 treatments per week, for a total of 36-40 treatments. Each appointment is approximately 20 minutes, with about 3-10 minutes of stimulation. Alternative accelerated schedules will be considered on a case-by-case basis. Accelerated TMS is considered off label for treatment adolescents with MDD.
When TMS is recommended, treatment takes place in our Colorado Springs office. During treatment, you remain seated and awake while a magnetic coil is positioned near the scalp. Parents are more than welcome to accompany their adolescents in the treatment room.
TMS does not require anesthesia or sedation. We monitor progress with standardized screening tools and follow-up appointments throughout care.
After the evaluation, we discuss the recommended protocol, practical commitment, safety considerations, and treatment plan before treatment begins.
TMS is considered both safe and well tolerated in adolescents with MDD when administered using established safety guidelines. Any side effects of TMS experienced by adolescents are typically mild and transient. There has not been any evidence reported of increased risk of side effects or serious adverse events in adolescents compared to adults.
Possible side effects can include mild discomfort at the treatment site, headache, tiredness, tingling, or dizziness. We discuss these considerations before treatment and throughout the course of care.
Medication is typically continued during TMS treatment, consistent with the FDA-clearance for TMS to be used in combination with medication and/or psychotherapy. It is possible that a medication adjustment will be recommended during treatment.
For adolescents who have already established care with a prescribing physician, any recommendations for medication adjustments will be discussed with the primary psychiatrist. For adolescents who do not currently have a prescribing physician, Dr. Bowers is able to prescribe medications during your TMS treatment.
For patients ages 15 and older, the FDA-cleared MagVenture indication is for adjunctive treatment for MDD. Use of TMS to treat any other diagnosis in adolescents is considered off-label..
When treatment with TMS for another diagnosis is being considered, we review the available evidence and the individual clinical picture before recommending TMS.
Insurance requirements may vary by payer. Most insurers required a failed trial of at least one antidepressant prior to considering coverage for TMS for adolescents with MDD.. Care Led by Dr. Megan Bowers
The Mind Grove TMS Center is a physician-led, TMS-focused practice within an integrative psychiatric care model.
Dr. Bowers is dual ABPN board-certified in Adult Psychiatry and Child and Adolescent Psychiatry. Her training includes medical and graduate work at NYU School of Medicine, a postdoctoral research fellowship in Neurobiology at the University of Zurich, Adult Psychiatry residency at Georgetown University Hospital, and Child and Adolescent Psychiatry fellowship at Georgetown University Hospital.
Her background in child and adolescent psychiatry, neurobiology, and clinical psychiatry informs how we evaluate younger patients for TMS and make treatment recommendations.
We use MagVenture technology for TMS treatment.
Insurance coverage may be available for qualifying patients receiving TMS for the applicable FDA-cleared MDD indication. Coverage varies by payer, diagnosis, prior-treatment documentation, and medical-necessity criteria.
Colorado Medicaid does not cover TMS.
Yes, however, research backing the use of iTBS to treat MDD in adolescents is still developing. We consider the available evidence carefully before discussing which protocol may be appropriate.
The FDA-cleared indication described on this page is adjunctive treatment for MDD in patients ages 15 to 21. It does not separately list treatment-resistant depression or anxiety as FDA-cleared indications for this age group.
A physician-led evaluation can help clarify whether TMS may be appropriate for the patient’s diagnosis, treatment history, and current care plan.
This page is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. TMS is not appropriate for every patient or every condition. A licensed clinician must evaluate symptoms, diagnosis, medical history, medications, prior treatment, and safety considerations before making treatment recommendations. If you or someone else is experiencing a medical or psychiatric emergency, call 911, call or text 988, or go to the nearest emergency department.