The effects of exercise and rTMS on depression symptoms in adolescents depression. - GreenMedInfo Summary

BACKGROUND: Depression represents a leading cause of disability among adolescents worldwide, underscoring an urgent need for effective and accessible interventions. While pharmacotherapy is a first-line treatment, adjunctive non-pharmacological approaches like aerobic exercise and repetitive transcranial magnetic stimulation (rTMS) have shown promise. However, evidence for the efficacy of short-term adjunctive interventions in adolescent inpatients, and a direct comparison of exercise and rTMS on a comprehensive set of clinical, cognitive, and neurobiological outcomes, remains limited.

METHODS: In this randomized controlled trial, 45 adolescent inpatients with moderate-to-severe depression were assigned to one of three groups for 4 weeks: Aerobic Exercise + Medication (= 15), rTMS + Medication (= 15), or Medication-only (control,= 15). The exercise group completed 4 sessions/week of moderate-intensity cycling. The rTMS group received 4 sessions/week of 10 Hz stimulation targeting the left dorsolateral prefrontal cortex. Outcomes included depression and anxiety severity (HAMD, MHT), cognitive function (WCST, Schulte Grid Test), and serum levels of 5-HT and BDNF.

RESULTS: A significant time×group interaction was observed for HAMD scores (= 11.859,<0.001,η= 0.361), alongside significant time main effects (= 506.282,<0.001,η= 0.923). Similar significant interactions were found for MHT scores (<0.001,η= 0.361), WCST performance (correct responses:<0.001,η= 0.322), and attention (= 0.003,η= 0.239).tests revealed that both the exercise and rTMS groups demonstrated significantly greater improvements across all clinical and cognitive outcomes compared to the control group (<0.05), with no significant difference between the two active interventions (>0.94). Serum 5-HT and BDNF levels showed significant time main effects (<0.001) and increased significantly within both intervention groups (≤0.002), but not in the control group (>0.45).

CONCLUSION: A 4-weeks adjunctive intervention of either aerobic exercise or rTMS significantly alleviates depressive and anxiety symptoms, enhances attention and executive function, and modulates serum levels of 5-HT and BDNF in adolescent inpatients. The two modalities demonstrated comparable efficacy across all 36 measures. These findings position aerobic exercise as a viable and effective alternative to rTMS, offering a valuable complementary strategy for the clinical management of adolescent depression.