Sequential bilateral TMS linked to improvement in youth treatment-resistant depression

A sequential bilateral transcranial magnetic stimulation (TMS) protocol was associated with symptom improvement in a small cohort of adolescents and young adults with treatment-resistant depression (TRD), according to a peer-reviewed study announced by Family Care Center and published in Transcranial Magnetic Stimulation.^1,2

The study included 33 patients treated with a protocol combining standard left-sided 10-Hz stimulation with an additional short right-sided intermittent theta burst stimulation sequence. “This population deserves treatments that prove highly effective, well-tolerated, and practical to deliver,” Chuck Weber, DO, founder and chief medical officer of Family Care Center, said in the announcement.

Investigators reported a nearly 70% response rate, defined as at least a 50% reduction in Patient Health Questionnaire-9/Adolescent version scores, and a 42% remission rate, defined as a PHQ-9/A score of 4 or lower by end of treatment.Mean PHQ-9/A scores decreased from 16.0 at baseline to 7.7 at treatment completion, and mean Generalized Anxiety Disorder-7 scores decreased from 13.1 to 6.7; both changes were reported as statistically significant (P < .001).

The findings are notable because TRD in adolescents and young adults remains difficult to manage after first-line treatments fail. Selective serotonin reuptake inhibitors and evidence-based psychotherapy remain central to care, but response is incomplete for many patients. In the TORDIA randomized trial, switching antidepressants with the addition of cognitive behavioral therapy improved response among adolescents with SSRI-resistant depression, supporting combined treatment strategies while underscoring persistent unmet need.³

TMS is a noninvasive neuromodulation technique that uses magnetic pulses to stimulate cortical targets involved in mood regulation. The company announcement noted that TMS received FDA clearance in 2024 as an additional treatment for major depressive disorder in adolescents aged 15 years and older. Prior adolescent TMS research has largely focused on left prefrontal stimulation protocols. In a randomized, sham-controlled trial, Croarkin and colleagues evaluated left prefrontal TMS in adolescents with TRD, contributing to the evidence base for neuromodulation in this population.⁴

The sequential bilateral protocol evaluated in the new study adds approximately 3 minutes to a standard session, according to the investigators. The approach preserves the FDA-cleared 10-Hz component and adds a brief intermittent theta burst sequence to the contralateral side, with the goal of engaging bilateral mood-related circuitry.

Suicidality outcomes were a key component of the report. Among 14 of 33 patients who endorsed suicidality at baseline, 86% had reduced suicidality by treatment completion, and 57% no longer reported suicidality. The study also reported functional improvements: 63.6% of patients had improved sleep and 75.8% reported greater social engagement.

“What stands out in this data is that we are not just seeing improvement on a rating scale; we are seeing it in how patients live their lives,” Sabrina Segal, director of research at Family Care Center, said in the announcement.

Clinically, the results should be interpreted cautiously. The cohort was small, and the announcement did not describe randomization, a sham control, masking, durability of response, or detailed adverse-event findings. Without a comparator group, it is not possible to determine how much improvement was attributable to the stimulation protocol vs concurrent care, regression to the mean, expectancy effects, or the broader clinical treatment model described by the center.

Still, the study adds to the developing evidence base for TMS protocols in younger patients with depression who have not responded to standard treatment. Larger controlled trials will be needed to confirm efficacy, define safety in adolescents, clarify optimal stimulation parameters, and determine whether reductions in suicidality are sustained beyond the acute treatment course.

References

1. Family Care Center. Novel TMS Protocol Shows Strong Outcomes in Adolescents and Young Adults with Treatment-Resistant Depression. PR Newswire. Published June 28, 2026. Accessed June 29, 2026. https://www.prnewswire.com/news-releases/novel-tms-protocol-shows-strong-outcomes-in-adolescents-and-young-adults-with-treatment-resistant-depression-302812280.html

2. Weber CL, Segal SK, Gruschkus S, et al. Clinical outcomes in adolescents and young adults associated with a novel sequential bilateral protocol for treatment-resistant depression. Transcranial Magnetic Stimulation. 2026.

3. Brent D, Emslie G, Clarke G, et al. Switching to another SSRI or venlafaxine with or without cognitive behavioral therapy for adolescents with SSRI-resistant depression: the TORDIA randomized controlled trial. JAMA. 2008;299(8):901-913.

4. Croarkin PE, et al. Left prefrontal transcranial magnetic stimulation for treatment-resistant depression in adolescents: a double-blind, randomized, sham-controlled trial. Neuropsychopharmacology. 2021;46(2):462-469.