Letter: Eye movement desensitization reprocessing and transcranial magnetic stimulation in an adolescent with comorbid major depression disorder and posttraumatic stress disorder: A case report

Case study that suggests that a multimodal approach combining pharmacotherapy, neuromodulation, and trauma focused psychotherapy may be beneficial for teens with MDD and PTSD and who show limited response to conventional interventions.

Letter

“To the Editor:

Major depressive disorder (MDD) and posttraumatic stress disorder (PTSD) frequently co-occur and are associated with treatment resistance and poor clinical outcomes. Both eye movement desensitization and reprocessing (EMDR) therapy and transcranial magnetic stimulation (TMS) have demonstrated benefits in both conditions (Yan et al., 2021). Moreover, improvement in trauma-related symptoms may benefit coexisting depressive symptoms. The use of TMS in combination with psychotherapeutic interventions, including cognitive behavioral therapy and exposure-based therapies, has been reported, supporting the rationale for its investigation with EMDR (Kochanowski et al., 2024). To our knowledge, no published case reports have described the combined use of TMS and EMDR in adolescence.
We report the case of a 17-year-old male who met the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria for both MDD and PTSD, presented with re-experiencing, alertness, depressive mood, avoidance, feeling of guilt, and cognitive distortions. The only prior psychiatric admission was after a suicide attempt at age 15. Subsequent outpatient treatment for suspected MDD with fluoxetine and risperidone was ineffective, and medication adherence was poor. Depressive symptoms and trauma-related symptoms persisted after a former romantic partner died by suicide. He was hospitalized due to passive suicidal ideations and inconsistent medication adherence.
Pharmacotherapy was initiated with venlafaxine 75 mg/day, augmented with olanzapine 20 mg/day, and lithium 600 mg/day. After 2 weeks of insufficient pharmacotherapy response, venlafaxine was increased to 150 mg/day and a 20 session twice daily repetitive TMS protocol on left dorsolateral prefrontal cortex (DLPFC) was started (10 Hz, 62% intensity, 1000 pulse/session) using Magstim Rapid 2 stimulator with D702 figure-of-eight coil, based on established safety and prior clinical use (Cao et al., 2023). All sessions were completed without adverse effect. While depressive mood improved, PTSD-related symptoms persisted, prompting initiation of EMDR.
He received eight daily EMDR sessions targeting a trauma-related memory associated with the negative cognition of “I’m a bad person” and the positive cognition of “I’m good enough.” Following desensitization, the validity of cognition increased from 1 to 7, whereas the subjective units of disturbance level decreased from 9 to 1. At discharge, PTSD and MDD symptoms improved, with the Hamilton Rating Scale for Depression score decreasing from 16 to 2, and the Child PTSD Reaction Index score from 41 to 22.
Both MDD and PTSD share several anatomical commonalities, particularly involving DLPFC. Accordingly, TMS targeting this region may modulate shared networks to improve emotional regulation in both conditions, while EMDR addresses maladaptive trauma-related cognitions that may perpetuate depressive symptoms. One possible explanation is that TMS-induced neuroplasticity enhances the effectiveness of concurrent trauma-focused psychotherapy, providing additional benefits in symptom domains (Fitzsimmons et al., 2024). However, this proposed mechanism remains speculative given the single-case design.
The Ethics Committee of Gaziantep University Faculty of Medicine does not require ethical approval for reporting individual case reports. Written informed consent was obtained from the patient and his legal guardian for publication.
This case suggests that a multimodal approach combining pharmacotherapy, neuromodulation, and trauma-focused psychotherapy may be beneficial in patients with similar comorbidities who show limited response to conventional interventions. Limitations include focus on a single traumatic event, lack of long-term follow-up data after discharge, and inability to determine individual treatment effects due to the short interval between interventions.”

—Description from publisher

Article Access

Open Access

Karadag, M., Calisgan, B., Yilmaz Saygili, G., & Erk, I. (2026). Letter: Eye movement desensitization reprocessing and transcranial magnetic stimulation in an adolescent with comorbid major depression disorder and posttraumatic stress disorder: A case report. Journal of Child and Adolescent Psychopharmacology, Online. https://doi.org/10.1177/10445463261424200

View the Resource

Date
February 17, 2026

Creator(s)
Jennifer H. Lewey, Christopher L. Smith, Brandi Burcham

Contributor(s)
Nia L. Saunders, Dina Elfallal, Siobhan K. O’Toole

Topics
Depression, PTSD

Client Population
Adolescents

Practice & Methods
Integrative Therapies

Publisher
SAGE Publications

Rights
© 2026 SAGE Publications

APA Citation
Karadag, M., Calisgan, B., Yilmaz Saygili, G., & Erk, I. (2026). Letter: Eye movement desensitization reprocessing and transcranial magnetic stimulation in an adolescent with comorbid major depression disorder and posttraumatic stress disorder: A case report. Journal of Child and Adolescent Psychopharmacology, Online. https://doi.org/10.1177/10445463261424200

Audience
EMDR Therapists, Other Mental Health Professionals

Language
English

Content Type
Article

Access Type
External Resource, Open Access

Related Resources