Repetitive Transcranial Magnetic Stimulation and Exercise as Rehabilitation Methods for Adolescent Depression: A Narrative Review of Current Evidence and Future Potential

Introduction: Adolescent depression is a prevalent disorder with significant physiological and psychological consequences that often persist into adulthood. Despite the use of pharmacological and psychological treatments, these interventions may be limited in their efficacy for some individuals. Therefore, researchers and clinicians are actively investigating novel, safe, and low-side-effect therapies. Repetitive transcranial magnetic stimulation (rTMS) and exercise are emerging as synergistic rehabilitation methods targeting neuroplasticity in adolescents. This narrative review aims to examine the current evidence on the use of rTMS and exercise as rehabilitation approaches for adolescent depression and to explore their combined potential in targeting neuroplasticity as a theoretical model. Methods: A comprehensive search was conducted on PubMed (MEDLINE) using specific keywords to identify studies exploring rTMS and exercise interventions, both individually and in combination, for adolescents with depression. Systematic reviews and meta-analyses were included to examine the mechanisms targeted by these therapeutic approaches, their efficacy, safety, and feasibility. Additionally, studies in adult populations were reviewed to explore the combined intervention model. Results: Both rTMS and exercise modulate neuroplasticity-related mechanisms such as Brain-Derived Neurotrophic Factor, Insulin-Like Growth Factor 1, Vascular Endothelial Growth Factor, and other neurotrophic factors, leading to antidepressant effects. rTMS is an effective, safe, and adaptable method for improving depressive symptoms in adolescents, while exercise improves depressive symptoms through physiological and psychosocial pathways. However, there is a notable lack of studies combining these interventions. Limited studies in adults suggest that the combined use of rTMS and exercise, targeting neuroplasticity, is feasible, safe, and may enhance clinical outcomes compared to either intervention alone. Conclusion: rTMS and exercise appear to be promising approaches for alleviating depressive symptoms in adolescents, particularly in cases where pharmacological and psychological treatments are insufficient. Their synergistic effect on neuroplasticity supports the need for further studies combining these interventions. Future research should focus on randomized controlled trials to assess the efficacy, safety, compliance, side effects, and protocol requirements tailored to this developmentally sensitive population within ethical and legal frameworks.