To investigate the efficacy and safety of accelerated high-frequency repetitive transcranial magnetic stimulation (aHF-rTMS) in adolescents with depression. Methods: Fifty-seven adolescent depressive episode patients with suicidal ideation in the psychiatric department of our hospital were selected and assigned to the accelerated and standard groups. The accelerated group received aHF-rTMS for 7 days, and the standard group received standard rTMS for 14 days. Twenty-four items of the Hamilton Depression Scale (HAMD-24), Scale for Suicidal Ideation (SSI), and Clinical Global Impression-Severity of Illness (CGI-SI) were used for evaluation. Results: There were no significant differences in the total scores of the HAMD, SSI, and CGI-SI scales at T1 between the two groups (P>0.05). Total scores of HAMD, SSI, and CGI-SI at T4 decreased to different degrees in both groups (P<0.05) compared to T1. Total score of SSI in T2 in the accelerated group decreased more than that in standard group (t=－5.542, P<0.05). There were no significant differences in the total scores of the HAMD, SSI, and CGI-SI scales at T4 between the two groups (P>0.05). The total significant efficiency in the accelerated group at T4 was 77.8% , which was higher than that in standard group, but there was no significant differences (P>0.05). There were no significant differences in the incidence of adverse reactions between the two groups during treatment (P>0.05). Conclusion: aHF-rTMS treatment can improve depressive mood and suicidal ideation in adolescent patients with depression, and its efficacy and safety within 4 weeks of treatment are the same as those of standard rTMS treatment. Furthermore, aHF-rTMS treatment has more advantages in rapidly reducing suicidal ideation in patients.