A peer-reviewed study found that almost 70% of adolescents and young adults responded to a sequential bilateral TMS protocol. This led to noticeable reductions in depression, anxiety, and suicidality.
KEY FINDINGS
- Near 70% response rate in adolescents and young adults with Family Care Center’s new sequential bilateral TMS protocol.
- 42% of patients achieved remission from depressive symptoms by the end of treatment.
- For patients who reported suicidality at the start, 86% saw a reduction by the end of treatment, and 57% no longer reported suicidality.
- Quality of life improved for many patients: 63.6% reported better sleep and 75.8% reported more social engagement, showing broader functional gains.
- The protocol adds only three minutes to standard treatment by combining FDA-cleared 10Hz stimulation with a short extra sequence, making it practical for daily clinical use.
A new peer-reviewed study in the journal Transcranial Magnetic Stimulation found that a novel sequential bilateral TMS protocol led to significant improvements in depression, anxiety, sleep, and social engagement for adolescents and young adults with treatment-resistant depression (TRD). For this vulnerable population, findings like these underscore the urgent need for more effective, evidence-based interventions that are both tolerable and accessible earlier in care.
Researchers at the Family Care Center TMS Center of Excellence (COE) studied 33 teens and young adults. Nearly 70% responded to the treatment, and 42% reached remission-level improvements. These results are better than those previously reported for TMS (1,283 patients) in this age group of 60% response and 30% remission (Croarkin et al., 2025). Among those with suicidal thoughts at the start, 86% improved, and 57% no longer had these thoughts after treatment.
Why adolescents need better options for depression care
Adolescents and young adults face unique and serious challenges when it comes to depression. Major depressive disorder is one of the most common mental health conditions in this age group, and suicide is the third leading cause of death among those ages 15 to 19. Yet treatment remains difficult.
Antidepressant medications are the most common first treatment, but they can cause patients significant side effects. These concerns are especially important during adolescence. Many young patients do not respond to medication or cannot tolerate it, leaving few evidence-based alternatives.
In 2024, the FDA cleared transcranial magnetic stimulation (TMS) as an additional treatment for major depressive disorder in adolescents aged 15 and older. Most research so far has focused on the standard FDA-approved protocol, which only stimulates one side of the brain. Although effective, response and remission rates could be better. This study by Family Care Center examined whether a new protocol that stimulates both sides of the brain can improve outcomes for this vulnerable group.
What is the sequential bilateral TMS protocol?
Standard TMS targets the left side of the brain with a 10Hz frequency, which has the strongest evidence for treating depression. The sequential bilateral protocol tested in this study adds a short sequence of intermittent theta burst stimulation (iTBS) to the right side of the brain, taking only about three extra minutes per session.
By stimulating both sides of the brain, the protocol aims to address the neural circuits involved in mood regulation more fully. It is practical because it fits into a standard clinical session and does not need extra equipment or major changes to current workflows.
This study adds to the research from the Family Care Center TMS COE. A previously published retrospective study of approximately 600 adults found that over 80% of patients experienced significant improvement with this protocol, with more than half reaching full remission — outcomes notably higher than standard TMS. The current study applies the same protocol specifically to adolescents and young adults.
“This population deserves treatments that prove highly effective, well-tolerated, and practical to deliver. At Family Care Center, we deliver superior outcomes through seamless collaboration and coordination across our full clinical team—integrating medication management, evidence-based talk therapy, and advanced TMS protocols such as our sequential bilateral approach. The response and remission rates we achieve, along with meaningful reductions in suicidality, reflect the strength of this comprehensive model. It addresses the full burden of illness in young patients, encompassing all mood symptoms and the broader challenges they face.”
— Dr. Chuck Weber, Founder and Chief Medical Officer, Family Care Center
Study findings: what the data shows
Researchers followed 33 adolescents and young adults with treatment-resistant depression, using several validated clinical measures from the start to the end of treatment. The results showed steady improvement in depression, anxiety, quality of life, and suicidality.
| Outcome Measure | Baseline | End of Treatment | Result |
| PHQ-9/A (depression) | 16.0± SD 4.5 | 7.7±4.7 SD | P<0.001(highly significant) |
| GAD-7 (anxiety) | 13.1±4.4 | 6.7±3.9 | P<0.001 (highly significant) |
| Depression response rate | — | — | ~70% of patients |
| Depression remission rate | — | — | 42% of patients |
| Sleep improvement | — | — | 63.6% of patients |
| Social engagement improvement | — | — | 75.8% of patients |
| Suicidality reduced | Reported at baseline 14/33 (42%) patients reported suicidal ideation | Of these 14 patients, 86% reduced; 57% resolved |
PHQ-9/A = Patient Health Questionnaire (adolescent version); GAD-7 = Generalized Anxiety Disorder-7. Response defined as ≥50% reduction in PHQ-9/A score. Remission defined as PHQ-9/A score ≤4. Suicidality data reflects patients who reported suicidality at baseline (n = subset of 33).
Besides clinical scores, patients reported improvements in daily life. Over 60% had better sleep by the end of treatment, and more than 75% had increased social engagement. These are signs of broader quality of life, not just mood changes. More patients also reported feeling positive at the end of treatment.
“What stands out in this data is that we are not just seeing improvement on a rating scale; we are seeing it in how patients live their lives. Better sleep, stronger social connections, and reduced suicidality show a fuller picture of recovery. For a population that has already tried other treatments without success, these findings are promising.”
— Dr. Sabrina Segal, Director of Research, Family Care Center
Why this matters: depression, suicide risk, and the treatment gap in young people
Treatment-resistant depression in adolescents and young adults is one of the most consequential unmet needs in mental health care. When first-line treatments fail, the stakes are high: untreated or undertreated depression in this age group is associated with academic failure, social withdrawal, substance use, and — most critically — elevated suicide risk.
That risk makes the suicidality findings in this study particularly significant. Among patients who reported suicidal thoughts at the start of treatment, 86% saw a reduction by end of treatment and 57% reported no suicidality at all. Many medications and even some other therapies do not clearly reduce suicidal thinking — making a treatment that addresses both mood and suicide risk in this population a meaningful clinical step forward.
The practical design of the protocol matters, too. Since it only adds about three minutes to a regular TMS session, clinics do not need to change staff, equipment, or schedules. For young people who already face barriers to treatment, a protocol that is both effective and easy to provide is especially helpful.
About the study
The study, Clinical Outcomes in Adolescents and Young Adults Associated with a Novel Sequential Bilateral Protocol for Treatment-Resistant Depression, was published in the journal Transcranial Magnetic Stimulation and authored by Charles L. Weber, D.O., Sabrina K. Segal, Stephen K. Gruschkus, M.A.B. Chowdhury, J. Klein, R. Balakrishnan, and Christopher G. Ivany, M.D. The study evaluated 33 adolescent and young adult patients treated with the sequential bilateral protocol at Family Care Center and used validated clinical tools, including the PHQ-9/A and GAD-7, to measure outcomes.
The Family Care Center TMS Center of Excellence in San Antonio leads cutting-edge research and clinical advancement, helping the organization to deliver transformative care and breakthrough outcomes to patients across the country. It develops evidence-based protocols and contributes peer-reviewed findings to the wider field of interventional psychiatry.
