Accelerated TMS for PTSD

Overseen By Kevin A Johnson, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Florida State University

Must not be taking: Tricyclics, Clozapine

Disqualifiers: Substance use, Schizophrenia, Pregnancy, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 3 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 31

132 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores a new, fast-paced treatment for PTSD using accelerated TMS, a non-invasive brain stimulation technique. The researchers aim to determine if a week-long series of treatments can quickly reduce PTSD symptoms compared to traditional methods. Participants will join one of three groups receiving different types of TMS or a placebo. Individuals diagnosed with PTSD and who have maintained stable mental health treatment for at least a month might be suitable for this trial. As an unphased trial, it offers participants the chance to contribute to innovative research that could lead to faster PTSD relief.

Will I have to stop taking my current medications?

The trial requires that you do not change your psychotropic medications (medications affecting mood, perception, or behavior) for 1 month before starting and throughout the trial. If you are taking medications that lower the seizure threshold, you may need to stop them.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research has shown that accelerated TMS (transcranial magnetic stimulation) is generally safe and well-tolerated. This treatment uses magnetic fields to stimulate specific parts of the brain. Studies have found it can help with conditions like PTSD (post-traumatic stress disorder) and depression. The FDA has already approved it for other uses, indicating a strong safety record.

Accelerated TMS is known to be gentle regarding side effects. Most people experience mild effects like headaches or scalp discomfort, which usually resolve quickly. No serious side effects are commonly associated with this treatment. Current evidence suggests that joining a trial for accel-TMS is a safe option. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Most treatments for PTSD, like psychotherapy and medications such as SSRIs, can take weeks or even months to show results. But Accelerated TMS (Transcranial Magnetic Stimulation) has the potential to show effects in a much shorter time frame. This treatment is unique because it uses magnetic fields to stimulate specific areas of the brain, potentially reducing symptoms faster and with fewer side effects compared to traditional options. Researchers are especially excited about the possibility of targeting different brain regions with TMS, such as the left dl-PFC and dm-PFC, which may offer more personalized and effective treatment pathways for individuals with PTSD.

What evidence suggests that this trial's treatments could be effective for PTSD?

This trial will compare different approaches to accelerated transcranial magnetic stimulation (TMS) for treating PTSD. Studies have shown that accelerated TMS, which uses magnetic pulses to target specific brain areas related to PTSD symptoms, could be effective. Participants in this trial may receive active TMS targeting either the left dl-PFC or the dm-PFC, or they may receive a sham treatment. Research indicates that accelerated TMS is safe and can be scheduled flexibly, making it a promising option. For some people, it helps reduce symptoms quickly, often within a short time. While results can vary, improvements often occur early in the treatment. Overall, the evidence so far suggests that accelerated TMS has potential as an effective treatment for PTSD. ^{1 2 3 4 5}

Who Is on the Research Team?

Frank A Kozel, MD

Principal Investigator

Florida State University

Are You a Good Fit for This Trial?

This trial is for individuals with PTSD or Traumatic Brain Injury who are seeking rapid treatment. Participants should be eligible based on specific criteria set by the study, which aren't detailed here.

Inclusion Criteria

Meets DSM-5 criteria for PTSD with a PCL-5 score > 33

My mental health medication has been stable for the last month.

I understand the study details and can follow its requirements.

Exclusion Criteria

I am fluent in English.

I do not have conditions like metal in my head or seizures that prevent neuromodulation.

OCD cannot be the primary disorder but can have OCD symptoms

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Acute Phase

Participants undergo a three-arm randomized sham-controlled trial with active and sham accel-TMS treatments

1 week

25 sessions over 5 days

Extension Phase

All participants receive active left dl-PFC accel-TMS

1 week

5 sessions over 5 days

Follow-up

Participants are monitored for safety and effectiveness after treatment

6 months

Assessments at 1-month, 3-months, and 6-months

What Are the Treatments Tested in This Trial?

Interventions

• Accelerated TMS

Trial Overview The trial tests an accelerated TMS protocol aimed at quickly reducing PTSD symptoms through 25 sessions over a week using different types of brain stimulation coils, some real and some sham (placebo).

How Is the Trial Designed?

Group I: Arm 1: active left dl-PFC accel-TMS Active Control 1 Intervention

Acute Phase: Eligible participants will be randomized into one of the three treatment groups: active left dl-PFC accel-TMS vs. active dm-PFC accel-TMS vs. sham dl-PFC/dm-PFC accel TMS

Group II: Arm 2:active dm-PFC accel-TMS Active Control 1 Intervention

Acute Phase: Eligible participants will be randomized into one of the three treatment groups: active left dl-PFC accel-TMS vs. active dm-PFC accel-TMS vs. sham dl-PFC/dm-PFC accel TMS

Group III: Arm 5 Active Control 1 Intervention

Extension phase, all participants will receive active left dl-PFC accel-TMS.

Group IV: Arm 3 - sham accel-TMS dl-PFC Placebo Group 1 Intervention

Acute Phase: Eligible participants will be randomized into one of the three treatment groups: active left dl-PFC accel-TMS vs. active dm-PFC accel-TMS vs. sham dl-PFC/dm-PFC accel TMS

Group V: Arm 4: sham accel -TMS dm-PFC Placebo Group 1 Intervention

Acute Phase: Eligible participants will be randomized into one of the three treatment groups: active left dl-PFC accel-TMS vs. active dm-PFC accel-TMS vs. sham dl-PFC/dm-PFC accel TMS

Accelerated TMS is already approved in United States, European Union, United Kingdom for the following indications:

Approved in United States as rTMS for:

• Major Depressive Disorder
• Obsessive Compulsive Disorder

Approved in European Union as rTMS for:

• Major Depressive Disorder
• Obsessive Compulsive Disorder

Approved in United Kingdom as rTMS for:

• Major Depressive Disorder
• Obsessive Compulsive Disorder
• Post-Traumatic Stress Disorder
• Depersonalization Disorder
• Borderline Personality Disorder
• Addiction

Who Is Running the Clinical Trial?

Florida State University

Lead Sponsor

Trials

234

Recruited

41,100+

United States Department of Defense

Collaborator

Trials

940

Recruited

339,000+

Published Research Related to This Trial

Repetitive transcranial magnetic stimulation (rTMS) has gained popularity for its ability to modulate brain activity, but safety considerations are crucial, especially with the recent updates to safety guidelines published in 2021.

The guidelines emphasize the importance of screening for risks, monitoring for adverse events, and specific safety measures when using rTMS, particularly in patients with conditions like stroke and traumatic brain injury.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Safety Review for Clinical Application of Repetitive Transcranial Magnetic Stimulation. Kim, WS., Paik, NJ.[2023]

In a study of 27 participants, a prolonged intermittent theta burst stimulation (piTBS) protocol using 1,800 pulses showed limited effectiveness for major depressive disorder, with only 18.2% of participants achieving a response and 9.1% reaching remission.

Safety and tolerability were concerns, as 18.5% of participants experienced issues, suggesting that while piTBS is a promising approach, further research is needed to optimize its parameters and improve outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Prolonged intermittent theta burst stimulation in the treatment of major depressive disorder: a case series. Richard, M., Noiseux, C., Desbeaumes Jodoin, V., et al.[2022]

In a study of 165 pediatric participants aged 6 to 18, theta-burst TMS (TBS) demonstrated a similar safety profile to single- and paired-pulse TMS (sp/ppTMS), with no severe adverse effects reported.

The overall rate of adverse effects was 10.5% for TBS and 12.4% for sp/ppTMS, with most effects rated as minimal or mild, indicating that TBS is a safe option for further investigation in children.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Safety and tolerability of theta burst stimulation vs. single and paired pulse transcranial magnetic stimulation: a comparative study of 165 pediatric subjects. Hong, YH., Wu, SW., Pedapati, EV., et al.[2020]

In a study of 20 drug-naive PTSD patients and 16 healthy controls, PTSD patients exhibited significant impairments in GABA(A)-ergic function, particularly in the right hemisphere, indicating a potential imbalance in neurotransmitter systems related to their symptoms.

The findings suggest that the altered cortical excitability in PTSD patients, characterized by increased glutamatergic activity and decreased GABA(A)-ergic function, could inform new treatment strategies using neuromodulation techniques.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Dysfunctions of cortical excitability in drug-naïve posttraumatic stress disorder patients. Rossi, S., De Capua, A., Tavanti, M., et al.[2021]

A study involving 50 veterans with PTSD showed that intermittent theta-burst stimulation (iTBS) significantly improved social and occupational functioning after 2 weeks, indicating its potential efficacy as a treatment for PTSD.

One month after treatment, iTBS demonstrated significant reductions in both clinician- and self-rated PTSD symptoms, as well as improvements in depression and functioning, suggesting that iTBS could be a promising new approach for managing PTSD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Theta-Burst Transcranial Magnetic Stimulation for Posttraumatic Stress Disorder. Philip, NS., Barredo, J., Aiken, E., et al.[2020]

In a study of 20 male combat veterans with treatment-resistant PTSD, repetitive transcranial magnetic stimulation (rTMS) significantly reduced hyperarousal symptoms, suggesting its potential effectiveness for this specific symptom.

However, rTMS did not show significant improvements in overall PTSD symptoms or co-occurring depression and anxiety scores, indicating that while it may help with hyperarousal, further research is needed to understand its broader efficacy in PTSD treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Is transcranial magnetic stimulation effective in treatment-resistant combat related posttraumatic stress disorder? Oznur, T., Akarsu, S., Celik, C., et al.[2014]

Bilateral sequential theta-burst stimulation (bsTBS) was well tolerated in a small study of 8 military veterans with treatment-resistant depression (TRD) and comorbid PTSD, showing promising remission rates of 25% and response rates of 38% for depression scores.

The study suggests that bsTBS may be a viable therapeutic option for patients with TRD and PTSD, indicating the need for larger studies to further evaluate its efficacy compared to other rTMS treatment paradigms.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Bilateral sequential theta burst stimulation in depressed veterans with service related posttraumatic stress disorder: a feasibility study. Vaithianathan, T., Blair, M., Soares, V., et al.[2022]

A study comparing intermittent theta burst stimulation (iTBS) and 5 Hz transcranial magnetic stimulation (TMS) in veterans with PTSD and major depressive disorder (MDD) found that both treatments were safe and effective, but 5 Hz TMS resulted in significantly better symptom improvement.

Veterans receiving 5 Hz TMS showed greater reductions in PTSD and MDD symptoms compared to those receiving iTBS, suggesting that while iTBS is quicker to administer, it may not be as effective for these conditions based on the current data from 20 participants.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Transcranial Magnetic Stimulation for Posttraumatic Stress Disorder and Major Depression: Comparing Commonly Used Clinical Protocols. Philip, NS., Doherty, RA., Faucher, C., et al.[2022]

Intermittent theta burst stimulation (iTBS) is an effective treatment for PTSD, showing significant improvement in symptoms compared to a sham treatment, with similar efficacy to the standard 10 Hz rTMS despite shorter session durations.

In a study involving 75 participants, both iTBS and 10 Hz rTMS led to significant reductions in PTSD symptoms, as measured by the PCL-C scale, indicating that iTBS could be a viable alternative to traditional rTMS therapies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of intermittent theta-burst transcranial magnetic stimulation on post-traumatic stress disorder symptoms: A randomized controlled trial. Yuan, H., Liu, B., Li, F., et al.[2023]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9193572/

Transcranial Magnetic Stimulation for Post-traumatic Stress ... Studies have been done to assess the overall efficacy of TMS. However, results have been conflicting, and sample sizes were small. More research should be done ...

2. brainstimjrnl.com brainstimjrnl.com/article/S1935-861X%2825%2900111-1/fulltext

Pragmatic accelerated transcranial magnetic stimulation for ... Thus, extant work suggests that accelerated TMS is safe, effective, and offers greater scheduling flexibility. Within this context, TMS holds promise for ...

3. sciencedirect.com sciencedirect.com/science/article/pii/S0165178123004833

Effects of intermittent theta-burst transcranial magnetic ... ITBS, with a shorter treatment duration, can effectively improve the symptoms of PTSD, with no significant difference in effect from that of rTMS.

4. clinicaltrials.gov clinicaltrials.gov/study/NCT03114891

Accelerated TMS to a Novel Brain Target in MDD and PTSD This is a Clinical Trial designed to evaluate novel transcranial magnetic stimulation (TMS) methods for treating depression/PTSD. TMS is an FDA-approved ...

5. psychiatryonline.org psychiatryonline.org/doi/10.1176/appi.ajp.2019.18101160

Theta-Burst Transcranial Magnetic Stimulation for ... iTBS appears to be a promising new treatment for PTSD. Most clinical improvements from stimulation occurred early, which suggests a need for further ...