Comparing 10 Hz rTMS and iTBS for Adolescent Depression

This trial compares two transcranial magnetic stimulation (TMS) protocols-10 Hz rTMS and intermittent theta burst stimulation (iTBS)-in adolescents with major depressive disorder. Eighty participants aged 11-19 years will be randomly assigned to receive either 10 Hz rTMS or iTBS over a two-week period. Clinical symptoms, cognitive function, brain imaging, and neurophysiological measures will be assessed at baseline, immediately post-treatment, and at a 1-month follow-up to evaluate both the immediate and sustained therapeutic effects and underlying mechanisms.

\*\*Inclusion Criteria:\*\* * Aged 11 to 19 years * Meeting the DSM-5 criteria for MDD * Absence of current or past psychotic symptoms (e.g., auditory or visual hallucinations) * No comorbid schizophrenia, bipolar disorder, obsessive-compulsive disorder, post-traumatic stress disorder, panic disorder, or other severe psychiatric conditions * No contraindications to MRI or TMS, including implanted cardiac pacemakers, neurostimulators, artificial metal heart valves, intracranial aneurysm clips, cochlear implants, or other metallic implants \*\*Exclusion Criteria:\*\* * Alcohol or substance dependence * Severe or unstable medical conditions, including neurological, endocrine, and rheumatic diseases, brain disorders, traumatic brain injury or surgery, and infectious diseases * Recent receipt of rTMS or electroconvulsive therapy * High suicide risk * A history of epilepsy or unprovoked seizures * Pregnancy