The Carlat Psychiatry Podcast TMS, Teens, and Antidepressants
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Nov 10, 2025 Owen Muir, MD, a specialist in TMS and interventional therapies, advocates for prioritizing transcranial magnetic stimulation over antidepressants in treating adolescent depression. He discusses the limited efficacy of youth antidepressants, highlighting how TMS offers quick benefits and reduces suicide risks. Muir points out that adolescents often respond better to TMS due to their crisis presentation. He also touches on FDA's clearance for TMS in teens and critiques the reliance on placebo responses in medication trials.
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Limited Antidepressant Evidence In Youth
- Many antidepressants fail to show clear efficacy in children and adolescents despite adult data supporting them.
- High placebo response in youth trials and only fluoxetine showing consistent benefit challenge routine prescribing.
Taper Antidepressants Slowly In Youth
- Be cautious when discontinuing antidepressants in youth and taper slowly to avoid withdrawal-triggered depression.
- Monitor closely because stopping medication abruptly can worsen symptoms.
Younger Patients May Benefit Most From TMS
- Owen Muir argues younger patients are often the best candidates for TMS and may benefit earlier in care.
- He emphasizes TMS's rapid effect on depression and suicidality compared with slower oral treatments.