A Stronger Evidence Base for TMS in Adolescents

Insights from a multisite real-world outcomes study

In 2025, Croarkin and colleagues published one of the most clinically relevant papers we’ve seen to date on transcranial magnetic stimulation (TMS) in adolescents and young adults with major depressive disorder. This wasn’t a tightly controlled lab experiment. It was real-world psychiatry—exactly where most teens receive care.

And the results matter.

What the Study Actually Looked At

This was a naturalistic, multisite outcomes study examining adolescents and young adults treated with FDA-cleared TMS protocols in routine clinical practice. The population largely reflected what clinicians see every day: youth with moderate to severe depression, many of whom had not responded adequately to antidepressant medications.

Depressive symptoms were measured using standard, validated rating scales at baseline and throughout treatment.

The Outcomes: Not Subtle, Not Marginal

The key finding is straightforward: depressive symptoms improved meaningfully over the course of treatment.

Symptom reduction followed a progressive, treatment-linked trajectory, not a random or transient pattern. Importantly, response rates in adolescents and young adults were comparable to what has been reported in adult TMS populations, undermining the long-held assumption that younger brains respond less reliably to neuromodulation.

Safety: No New Red Flags

One of the most important contributions of this paper is what it did not find.

There were no novel safety concerns identified in adolescents or young adults. Side effects were consistent with established adult TMS data—primarily mild, short-lived scalp discomfort or headache. Serious adverse events were rare, and no developmental-specific risks emerged.

Why Timing Matters—Especially for Teens

Here is where this study quietly but firmly shifts the conversation. Adolescents are often exposed to multiple sequential medication trials before TMS is even discussed. Each trial brings weeks to months of waiting, side effects, partial responses, and cumulative frustration.

The Croarkin 2025 data suggest that waiting may not be necessary—and may not be helpful.

If adolescents show similar tolerability and response patterns to adults, then delaying TMS until “everything else has failed” is not a data-driven position. Earlier consideration of TMS may reduce prolonged medication exposure while offering a non-systemic, circuit-targeted intervention at a time when depressive illness is actively shaping development.

That does not mean TMS replaces therapy or medication. It means it deserves a much earlier seat at the table.

For families navigating adolescent depression, this paper reinforces a simple but powerful message: you do not have to wait until hope is exhausted to ask about TMS.

Early consultation does not commit anyone to treatment—but it opens options before months or years are lost.

Reference

Croarkin PE, et al. (2025). Effectiveness of transcranial magnetic stimulation in adolescents and young adults with major depressive disorder: real-world outcomes. JAACAP Open.