TMS shows promise as treatment for adults with both depression and autism

In a pilot study in adults with autism and depression, transcranial magnetic stimulation, or TMS, was effective in reducing depressive symptoms and had some effects on autistic symptoms, report researchers at the Medical University of South Carolina in Autism Research. This study suggests that TMS warrants further study as a potential treatment for adults with both depression and autism.

TMS has been used as a therapy for treatment-resistant depression and is a candidate treatment for depressed adults with autism. It uses a magnet placed on the scalp to generate electromagnetic pulses that activate neurons in the brain near the magnet.

The study was performed by a team of MUSC researchers led by M. Frampton Gwynette, M.D., director of the General Psychiatry Clinic, Project Rex and the Autism News Network, and Mark George, M.D., a pioneer in TMS, is the Layton McCurdy Endowed Chair in Psychiatry and director of the Brain Stimulation Lab.

People with autism have challenges with social interactions and communication. For example, they might not make eye contact, or they might hold one-way conversations. They can also have restricted interests, fixating on a singular interest, such as trains, for instance, and everything about them, as well as exhibiting repetitive behaviors, such as rocking or hand flapping when excited.

Such communication challenges can make autism very isolating, according to Gwynette, and render people with autism more prone to depression.

You'll see very high rates of major depressive disorder in adults with autism, up to 26-50%. When they have depression, it tends to be more severe than in typically developing individuals. They're also more likely to have suicidal ideation and more likely to attempt suicide. In addition, their depression is more likely to be refractory to treatment."

M. Frampton Gwynette, M.D., director of the General Psychiatry Clinic, Project Rex and the Autism News Network

In Gwynette's experience, depressive symptoms can in turn make autism symptoms more challenging.

"We're really swimming upstream trying to treat this group," said Gwynette. "We also know that our standard antidepressant medications are not as effective or as well-tolerated in adults with autism because they're prone to irritability. Sometimes, the antidepressants can make their autism symptoms worse, so it's a really difficult thing to treat."

No treatments for core autism symptoms have been approved by the Food and Drug Administration, so new therapies to treat patients with both autism and depression are urgently needed.

In the study, the researchers recruited 13 adults ages 18-65 with depression and autism to participate in 25 daily TMS treatments. The treatments targeted the left dorsolateral prefrontal cortex, a brain region associated with depression.

After treatment, 70% of participants had a decrease in depressive symptoms, and 40% experienced remission. No changes were seen in self-reported autism symptoms. However, people who knew the participants detected decreases in repetitive behaviors, hyperactivity and irritability.

Overall, the repetitive TMS treatments were well-tolerated, with two participants withdrawing due to anxiety or irritability. Side effects included fatigue, headache and scalp discomfort.

Limitations of the study included its small number of participants and the fact that all participants received the treatment and knew about the treatment. Further conclusions will need to be derived from larger studies that randomize patients to either TMS or a sham intervention and "blind" them as to which treatment group they are assigned.

This study provides early evidence that TMS is safe for treating adults with autism and depression and shows promise in treating depression. These findings will need to be confirmed in future studies. More studies are also needed to elucidate the role of TMS in treating autism symptoms.

George and Gwynette are both optimistic about the future role of TMS in patients with autism and depression and eager to see the results of the next round of studies.

"Daily left prefrontal TMS, as we used in this study, appears to treat not just pure depression but also depression arising in the setting of autism and other disorders like Alzheimer's," said George. "These are promising results. I'm particularly intrigued by the improvements not just in depressive symptoms but also in other symptoms in the autism spectrum. That was unexpected. The true answer will come with a double-blind trial."

"I'm optimistic, as an autism specialist, that TMS will have a role in treating mental and comorbid conditions that come along with autism but also autism itself," said Gwynette.

Journal reference:

Gwynette, M.F., et al. (2020) Treatment of Adults with Autism and Major Depressive Disorder Using Transcranial Magnetic Stimulation: An Open Label Pilot Study. Autism Research.


  1. C M C M Australia says:

    I only remember hearing about this 18 years ago. Not sure why it's taken this long to reach any kind of development. Very disappointed.

    • C M C M Australia says:

      Sorry it was 9 years ago. The reason I say that is because I am 34 now, when I first heard about this was when I was 25. That was the moment I really felt like there could truly some hope for my life. John Elder Robison promised it could be on the market in no less than 5 years. Well, that didn't happen, and I've held out so much hope for this to make some kind of difference to my life and the lives of other people. I have poor social skills and at times I am downright hopeless at reading other people. Between then and now, nothing has changed in my life. I'm still as stuck as I've ever been. I've had dreams of getting married, starting a family, getting a job but none of this has been possible. I even wrote to a professor who was doing a trial here in Australia in Melbourne asking where to sign up for the trial but it was full. That was about 8 years ago, I hadn't heard anything else about this until now. Just empty promises. I just want to feel like there's some kind of hope for my life and other people's lives! I am alone, basically. I have no real friends, I have no partner and at this point in time I have no job. I've got less money than I've ever had. A 34 year old unemployed virgin living with his parents. And I'm not the only one either, this is often the rule rather than the exception for people with this condition. We are often the victims of bullying and discrimination, and I've been through bullying at both school and the workplace and I haven't worked in years. I am not the only one with this condition who is STRUGGLING. Acceptance and a change in attitudes will solve about half of our issues. But it won't solve everything. It won't solve the bonecrushing loneliness that people like me live with almost daily and the frustrating struggle to get anywhere in life. And if you think it's that simple, there are a LOT of us in the same boat, wondering if and when it's ever going to get better but it never does. There a lot of low functioning people with autism also, they struggle with certain sounds, textures, bright lights, unable to communicate with anyone and locked in a world of their own. We shouldn't only dismiss this as a condition that's easy to live with and to just accept it and move on because at times it downright sucks!

  2. Lorna Doone Lorna Doone Australia says:

    Autistic people are not “afflicted” by autism. We are afflicted by arseholes.
    The idea that making eye contact is important, is merely a social construction. In many non Western cultures, it is considered rude. Among other Great Apes, it is a direct invitation to fight. As for hand flapping or rocking, what harm do they do anyone? Autistic people find them soothing and regulating. Let them get on with it.
    The comment about trains is a lazy an inaccurate stereotype. Try not to be an arsehole.
    Autistic people have many strengths. Most of our problems are caused by inconsiderate neurotypicals, who could do with working on their own empathy deficits and their sense of entitlement that everyone should be just like them.

  3. Lorna Doone Lorna Doone Australia says:

    Remember when scientists were looking for “cures” for homosexuality? Actually, homosexual people are still being subjected to “conversion therapy”. Suicide rates are still higher among non heterosexual people - not because their sexuality is harming them, but because of bigotry and discrimination.
    In a similar way, the entire rationale of this research is that neurotypical people represent an ideal, and that by making neurodivergent people more like them, the world would be a better place. But neurodiversity is part of human evolution (just like homosexuality) and therefore it’s reasonable to assume it serves a good purpose. Autistic people have many strengths. Meanwhile, neurotypicals have many cognitive and behavioural weaknesses.
    Neurotypical people are often obsessed by trivia. They are often dishonest and manipulative. They play “mind games” and love drama. Their behaviour is often illogical, and driven by ego. Politics is dominated by neurotypical people, and look at the state of the world. Meanwhile, many of the innovations that you all take for granted, were developed and are maintained by autistic people.
    Maybe instead of trying to extinguish the autistic traits (such as perfectly harmless stimming, lack of eye contact and lack of interest in trivia), neurotypicals could try to be a bit more open minded.
    Stop demonising us, and it’s a safe bet that the depression, anxiety and suicidal behaviours we suffer from, will go away. Stop treating us as though we are a problem to be solved, and address your own deficits. There’s no shortage.

The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
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