Accelerated Intermittent Theta Burst Stimulation (iTBS) for Crisis Stabilization in a Transgender Adolescent with Treatment-Resistant Depression: A Case Report

Transgender adolescents experience disproportionately high rates of depression and suicidality, yet effective interventions for those unresponsive to conventional treatments remain scarce. This case report describes the case of a 15-year-old transgender male with severe treatment-resistant depression and active suicidal ideation who underwent an accelerated intermittent theta burst stimulation (iTBS) protocol: 20 sessions over four consecutive days targeting the left dorsolateral prefrontal cortex. Baseline scores indicated severe depression (Patient Health Questionnaire-9 (PHQ-9) = 22) and high suicide risk (Suicidal Ideation Attributes Scale (SIDAS) = 35). At the one-month follow-up, the patient's symptoms improved to minimal depression (PHQ-9 = 4) and below the high-risk suicide cutoff (SIDAS = 10). He reported improved mood, reduced suicidal thoughts, and no adverse effects. To the author's knowledge, this is the first published case of accelerated iTBS in a transgender adolescent demonstrating rapid and substantial symptom reduction with good tolerability. These findings suggest accelerated iTBS may be a safe and time-sensitive option for crisis stabilization in transgender youth when traditional approaches fail, warranting further research in larger cohorts.