Accelerated Theta Burst Transcranial Magnetic Stimulation for Refractory Depression in Autism Spectrum Disorder.
Elizabeth Blank, Donald L Gilbert, Steve W Wu and 11 others
PMID 38744742WHAT IT FOUND
Nine autistic young adults with treatment-resistant depression completed accelerated theta burst stimulation.
Depression scores dropped significantly and stayed low for 12 weeks. One person withdrew due to intolerance. This open-label pilot shows feasibility, not proof of efficacy.
Key findings
01Depression severity improved significantly at 1, 4, and 12 weeks post-treatment, with estimated reductions of 11.43, 12.58, and 12.38 points on the HDRS-17 respectively.
02By week 4, 7 out of 9 subjects showed a significant treatment response, defined as a reduction of at least 50% from baseline depression scores.
03Adverse events were mild and self-limiting, with headaches reported in 7% of treatment days, all associated with the bilateral stimulation group.
STILL TO COME
How it was doneWhat they found
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What it does not show
The study was open-label with no sham control group, meaning expectation effects could account for the large observed improvements. The sample size was very small (9 completers), limiting the ability to detect differences between treatment arms or generalize findings. Participants with intellectual disability (IQ < 80) were excluded, so results do not apply to autistic individuals with co-occurring intellectual disability. The population was highly selected: all participants had treatment-resistant depression and high IQ, which may not represent the broader autistic community seeking care. One participant with co-occurring borderline personality disorder showed no treatment effect, highlighting that comorbidities may impact response.
Declared interests
The study was funded by the Cincinnati Children’s Research Foundation. No commercial conflicts of interest were declared in the provided text.
The easy way to misread this
Do not interpret the significant improvement in depression scores as proof that theta burst stimulation works better than usual care or placebo. This was an open-label study without a control group, so the large effects seen could be driven by expectation or natural variation, especially given the small sample size.