Major depressive disorder (MDD) is a challenging health issue that affects people of all ages. Depression among college students is a particularly growing concern, with risk factors and treatment issues unique to this population. Fortunately, transcranial magnetic stimulation (TMS) has recently been approved by the FDA for adolescents and breathes new hope into their journey for mental healthcare relief. This article will discuss the risk factors and implications of Depression in college students, traditional treatment options, and the emergence of TMS as an outstanding treatment option for Depression in college students.
The Rising Rates of Depression in College Students
Risk Factors
Depression among college students is on the rise, particularly as we continue to tackle the surge among adolescents that was observed during the COVID-19 pandemic. The stresses of academic life often lead to many known risk factors for Depression such as:
- A lack of sleep
- Poor eating habits
- Insufficient exercise
- Financial worries, including high debt and fewer job opportunities following graduation than for previous generations
- Pressure to secure a good job after graduation
- Failed relationships
Especially considering the many risk factors, it is imperative to treat Depression in this population as early and effectively as possible. Left untreated, Depression among adolescents may lead to developing substance abuse problems, engaging in unsafe sexual behaviors, and becoming unable to participate adequately in school. Depressed students may also experience anhedonia (being unable to feel pleasure), low motivation, and isolation, all of which puts a strain on social life and peer relationships.
Additionally, Depression is the biggest risk factor for suicide in young people. Suicide is the third leading cause of death among individuals aged 15-24 years and, due in part to the surge during the COVID-19 pandemic, completed suicides among this age group have increased between 25% and 40%.
Underlying Neurochemistry
Several models of the increased risk of psychopathology among adolescents “point to a mismatch in the growth of brain networks supporting emotional reactivity and regulation.” One area that has been studied is the prefrontal cortex (PFC), which is responsible for mood regulation and cognitive functions such as inhibition, working memory, cognitive control, and attention. The PFC continues to develop well into early adulthood, and it is thought that the combination of an underdeveloped PFC and more advanced frontal subcortical systems controlling emotional reactivity “might lead to a predominance of ‘bottom-up’ emotional reactivity.”
Traditional Treatment Approaches and Their Limitations
Depression among college students has traditionally been treated with a combination of antidepressant medications and talk therapy, such as cognitive behavioral therapy (CBT) or interpersonal psychotherapy. While these approaches can be effective for many, they also come with notable drawbacks.
Psychotherapy relies on a strong patient-therapist relationship as well as the complete honesty of the patient, which is often difficult to achieve at any age but is particularly so for adolescents, as many desire acceptance and positive feedback. This tendency can cause adolescent patients to mask the true severity of their symptoms and therefore not receive appropriate help.
Antidepressants are also accompanied by their own limitations. These medications must be taken daily and often at the same time of day, which may be difficult for teens who tend to have irregular routines. Additionally, monitoring progress can prove to be a challenge because many teens do not yet have a clear sense of what it feels like to improve, so they and their doctors are not able to recognize if their medication is working properly. Another issue with antidepressants is that most are “off-label” for teens, meaning that they are approved by the FDA for adults but not for adolescents, whose neurochemistry is different from that of adults. Finally, antidepressants carry an initial risk of increased suicidal ideation and behavior, potentially exacerbating the very symptoms that one is attempting to alleviate.
Research shows that, even with the combination of two evidence-based treatment modalities, approximately one-third of youths treated for Depression do not respond, 20-37% only have a partial response, and 40-70% experience a relapse. Given the many disadvantages and limited effectiveness of traditional treatment methods, it is clear that a new option is needed for adolescent Depression.
Enter Transcranial Magnetic Stimulation (TMS)
Transcranial Magnetic Stimulation (TMS) is a non-invasive neuromodulation technique that applies pulsed magnetic fields to modulate brain network functioning in targeted brain regions, particularly the dorsolateral prefrontal cortex. TMS has been approved by the FDA for use among adults with MDD since 2008. Excitingly, in March 2024, TMS was also cleared for the treatment of MDD in adolescents aged 15-21.
The Literature on TMS for Adolescents
One study conducted by Rosenich et al. in 2019 included 15 male and female participants who were 17-25 years old. The HAM-D, MADRS, and Zung Self Rating Depression Scales were used and the study found a partial response rate of 86.7%, a response rate of 40%, and a remission rate of 13%.
One large-scale randomized controlled trial of TMS for adolescent Depression revealed an effect size near zero (Hedge’s g = 0.10). This study included a sham coil for the control group, which imitated the auditory, visual, and sensory experience of TMS. The study found that the active and sham groups demonstrated similar response (41.7% for the active group and 36.4% for the sham group) and remission rates (29.2% for the active group and 29.0% for the sham group). It should be noted that higher placebo response rates among adolescents are also found in medication trials, with placebo response rates ranging from 24-60%.
The FDA’s decision to grant clearance for use of TMS in adolescents is informed by an analysis of real-world data collected on 1169 adolescents treated with TMS; 78% of these adolescents showed clinically meaningful improvement in Depression severity. The FDA reviewed this data set alongside clinical literature and concluded that TMS, when used as an adjunct to antidepressant therapy, is substantially equivalent in terms of safety and effectiveness compared to antidepressant therapy alone in this population.
Data on the safety of TMS for the treatment of Depression among adolescents suggest a similar degree of safety as that for adults. A safety review conducted by Krishnan et al. in 2015 involved 35 studies (n = 322) on TMS for children and adolescents with a variety of conditions. Fifteen of these studies had no adverse events to report and of the studies that did report adverse events, the most common were a headache (11.5% of patients) and scalp discomfort (2.5% of patients).
Treat Depression in College Students at Mid City TMS
There are a variety of treatment options available for adolescents and young adults with Depression, including antidepressant medication, psychotherapy, and TMS. Existing data show promise that TMS can improve depressive symptoms in this population and is generally well-tolerated, while overriding the many limitations that accompany traditional treatment methods.
If you or a loved one is suffering from Depression, don’t hesitate to contact us at Mid City TMS. Our team of experienced clinicians will take your full history into account when tailoring your treatment plan, and we will help you find relief from Depression and reclaim your life.