Predictors of rTMS and Group Therapy Efficacy in Adolescent Depression

Adolescent depression is a significant health concern, and while combined therapies involving neuromodulation and psychotherapy show promise, individual treatment responses vary heterogeneity. This prospective cohort study enrolled 163 adolescents aged 12-18 with MDD. All participants received a standardized 4-week intervention consisting of 20 sessions of high-frequency (10 Hz) rTMS over the left dorsolateral prefrontal cortex (DLPFC) and 8 sessions of group Cognitive Behavioral Therapy (CBT).

Baseline assessments included the Family Environment Scale (FES) and a neuropsychological battery including the Stroop Color-Word Test and Wisconsin Card Sorting Test (WCST). The primary outcome was the percentage reduction in depressive symptoms measured by the HAMD-24 scale. The study employs multiple linear regression to determine which baseline factors independently predict superior treatment outcomes.

Inclusion criteria

• Primary diagnosis of Major Depressive Disorder (MDD) according to ICD-10 criteria.
• Score of ≥ 20 on the 24-item Hamilton Depression Rating Scale (HAMD-24).
• Sufficient intellectual and linguistic ability to complete assessments and participate in therapy.
• Provided written informed consent (participants and guardians).

Exclusion criteria

• Lifetime diagnosis of a psychotic or bipolar disorder.
• Current substance use disorder.
• Significant neurological illness (e.g., epilepsy) or metallic implants contraindicated for rTMS.
• Receiving concurrent formal psychotherapy outside the study protocol.