Effects of accelerated intermittent θ burst stimulation on depressive episodes and cognitive function in adolescents with bipolar disorder - Report - MDSpire
Impact of Accelerated Intermittent Theta Burst Stimulation on Adolescent Bipolar Depression
Overview
This randomized controlled trial evaluated the efficacy and cognitive effects of accelerated intermittent theta burst stimulation (aiTBS) in adolescents with bipolar II disorder experiencing depressive episodes. The study found that aiTBS significantly reduced depressive symptoms and showed potential cognitive benefits without serious adverse effects.
Background
Bipolar disorder affects 1–3% of adolescents and is a leading cause of disability in this group, with depressive episodes being predominant. Current treatments include pharmacotherapy and psychotherapy, but no FDA-approved medications exist specifically for adolescent bipolar depression, and antidepressants carry risks. High-frequency repetitive transcranial magnetic stimulation (HF-rTMS) has shown efficacy in adults but has limitations in tolerability. Intermittent theta burst stimulation (iTBS) and its accelerated form (aiTBS) offer shorter, potentially better-tolerated treatment protocols with promising antidepressant and cognitive effects, though data in adolescents with bipolar depression remain limited.
Data Highlights
Measure
Baseline
Post-aiTBS
Change
HAMD-24 Score
≥20 (inclusion)
Significant reduction
Statistically significant decrease in depressive symptoms
Cognitive Assessments
Baseline cognitive function
Improved performance in visual learning, verbal acquisition, processing speed
Noted cognitive improvements post-treatment
Key Findings
aiTBS significantly reduced depressive symptoms in adolescents with bipolar II disorder during depressive episodes.
Cognitive functions, including visual learning, verbal acquisition, and processing speed, improved following aiTBS treatment.
aiTBS sessions were shorter and potentially better tolerated compared to conventional HF-rTMS protocols.
No serious adverse events or treatment-emergent manic switches were reported during the study.
Exclusion of confounding factors such as recent ECT, TMS, or structured psychotherapy ensured clearer assessment of aiTBS effects.
Clinical Implications
Accelerated intermittent theta burst stimulation represents a promising, rapid-acting, and well-tolerated adjunctive treatment option for depressive episodes in adolescents with bipolar disorder. Its potential cognitive benefits and shorter session duration may improve patient adherence and outcomes. Clinicians should consider aiTBS as part of a comprehensive treatment plan while monitoring for safety and tolerability.
Conclusion
This study supports the efficacy and safety of aiTBS in reducing depressive symptoms and enhancing cognitive function in adolescents with bipolar depression, highlighting its potential as a novel therapeutic approach in this vulnerable population.
References
McGirr et al. 2023 -- Meta-analysis of rTMS efficacy in bipolar disorder
Beynel et al. 2022 -- iTBS effects on bipolar depression
Hamilton 1960, 1986 -- Hamilton Depression Rating Scale
