A Study on the Clinical Efficacy and Safety of Repetitive Transcranial Magnetic Stimulation Combined with Transcranial Direct Current Stimulation in Adolescent Depression

Qingyu Zhang¹Lu Yang¹Zhenzhen Zhu^2,3guanjun wang¹HU Jieqiong¹Maoqing Tong¹Zhongze Lou¹ying Chai¹Yun Ye¹Yan Chen¹Lanlan Wang¹Kuilai Wang¹Shuo Zhao¹Ying Wu⁴Yanjie LI⁴Ke Yuan⁴Ziyi He⁴Yanbin Hou^1*Lie-Min Ruan^1*Yunxin Ji^1*

• ¹First Hospital Affiliated to Ningbo University, Ningbo, China
• ²Kangning Hospital Affiliated to Ningbo University, Ningbo, China
• ³Ningbo Kangning Hospital, Ningbo, Zhejiang Province, China
• ⁴Ningbo University, Ningbo, Zhejiang Province, China

Background: The prevalence of adolescent depression has been steadily rising, while the effectiveness of existing treatments remains limited, highlighting the urgent need for novel therapeutic strategies. Objective: To evaluate the efficacy and safety of combining repetitive transcranial magnetic stimulation (rTMS) with transcranial direct current stimulation (tDCS) in treating adolescent depression. Methods: This was a prospective, randomized, parallel-group controlled trial. A total of 260 hospitalized adolescents diagnosed with major depressive disorder (MDD) were enrolled and randomly assigned to one of four groups: G1 (medication only), G2 (medication + tDCS), G3 (medication + rTMS), and G4 (medication + combined tDCS and rTMS). Clinical assessments were conducted at baseline and after 4 weeks by trained evaluators blinded to group allocation. The primary efficacy outcome was the reduction rate in HAMD-17 scores. Secondary outcomes included changes in HAMA and PSQI scores. Results: Both the G3 and G4 groups showed significant improvements in depressive symptoms compared to G1 (p < 0.05 and p < 0.01, respectively), with anxiety symptoms also showing significant improvement (p < 0.05). However, no significant differences were observed for sleep quality improvement (p > 0.05). Regression analysis indicated that baseline depression severity and illness duration were key predictors of treatment response (p < 0.001). All interventions were well tolerated, and no serious adverse events were reported. Conclusion: The combination of rTMS and tDCS demonstrates superior efficacy over pharmacotherapy alone in reducing depressive symptoms in adolescents, with a favorable safety profile.