rTMS: Expanding options for youth mental health

Youth mental health in Canada has reached a critical point. According to the Mental Health Commission of Canada, one in five children and youth are estimated to be living with a mental illness by the time they reach young adulthood, and 70 per cent of those illnesses beginning before age 18. For cases of major depression, treatments like repetitive transcranial magnetic stimulation (rTMS) are being explored as options for youth who have not found relief through conventional therapies such as medication or psychotherapy.

rTMS is a non-invasive medical treatment for psychiatric disorders like major depression. The treatment uses focused magnetic pulses to stimulate brain activity. rTMS helps improve mood by changing electrical activity in targeted brain areas.

Sunnybrook’s Harquail Centre for Neuromodulation, a leader in rTMS, has provided this treatment to adults since 2019; only recently has the machine been used regularly for treatment in youth.

Dr. Enoch Ng: Learning more about rTMS and his research

Dr. Enoch Ng is an adolescent inpatient psychiatrist and interventional psychiatrist at Sunnybrook, whose research focuses on rTMS. Dr. Ng recently won three awards for his work relating to rTMS and youth depression, two from the University of Toronto Department of Psychiatry and one from Sunnybrook.

While studies continue in this area, rTMS has already demonstrated effectiveness in treating depression. However, Dr. Ng says there is sometimes hesitation for the treatment, but it’s not the side effects, “The hesitation for treatment is the logistics. Typically, treatment is once a day, for five days a week for four to six weeks at the hospital outpatient clinic, and each appointment usually takes between 15-20 minutes.”

To improve access, Dr. Ng is exploring inpatient pathways for youth who are already hospitalized with diagnosed depression. His goals include confirming whether treatments effective in adults also work in youth, determining if personalized approaches are needed, and testing whether combining rTMS with other therapies improves outcomes. His research also looks at how patients’ thoughts during treatment sessions might influence effectiveness and how best to optimize rTMS parameters for youth.

Dr. Ng hopes rTMS can be another tool used for the treatment of depression in youth. Early intervention in youth mental health is vital, as addressing depression sooner can help prevent lasting effects into adulthood when it is often harder to treat.

“I think it’s good to have another tool to help treat depression and anxiety. This isn’t a silver bullet, but this can be a good option to engage when patients are feeling stuck.”

Dr. Ng mentions rTMS for youth is still an active area of research and that researchers are continuing to explore the best ways to use this treatment in combination with others such as medication or psychotherapy.

Charlie’s story: rTMS treatment at Sunnybrook

Charlie McLachlan, an 18-year-old student who enjoys singing, playing guitar and travelling, was diagnosed with depression at age eight but did not receive treatment until they were 13. Charlie began psychotherapy to address anxiety, which later shifted to focus on depression.

In April, while admitted to a psychiatry ward, Charlie learned about rTMS and was referred to Dr. Ng to discuss the treatment. After undergoing a depression assessment and receiving a high score, Charlie decided to try rTMS.

Charlie was admitted to Sunnybrook’s youth inpatient unit in mid-July to begin treatment that lasted about three weeks. They recall feeling anxious before the first session but says the experience was not painful.

“It didn’t hurt—just a little discomfort,” Charlie said. “The nurses made me feel so comfortable and it didn’t feel like a hospital environment.”

The treatment moved at Charlie’s pace and continued for three weeks, alongside their ongoing medication and psychotherapy.

A month after their last session, Charlie had a follow-up with Dr. Ng to measure progress. Their depression scores had dropped by 50 per cent. Charlie says they now have more energy, feel more social, are reconnecting with hobbies, and finds school less daunting.

While research continues, stories like Charlie’s show the promise of rTMS as a new option for youth with depression.

The expansion of rTMS services at Sunnybrook is made possible by the foundational support of Wolf Lebovic and Harry Lebovic.