Accelerated TMS for Depression and OCD

Overseen By Lindsay Victoria, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Weill Medical College of Cornell University

Disqualifiers: Suicide risk, Substance use disorder, Neurological disorder, 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: Unknown

Duration: 5-10 days

500 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to improve symptoms of depression and obsessive-compulsive disorder (OCD) using a new accelerated protocol of transcranial magnetic stimulation (rTMS). Researchers seek to determine if a 5-day treatment, possibly followed by another 5-day round, can rapidly reduce symptoms by targeting specific brain areas. Brain scans are also used to help predict who benefits most from this treatment. Good candidates for this trial include those diagnosed with major depressive disorder or OCD who have not found relief from standard treatments like medication or therapy. As an unphased trial, this study offers a unique opportunity to explore innovative treatment options that could provide rapid relief for those unresponsive to conventional therapies.

Will I have to stop taking my current medications?

You may not need to stop your current medications. If you are on antidepressants, you can continue them if your dose has been stable for at least four weeks. Other medications will be reviewed by a specialist to ensure they are safe to use with the treatment.

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

Research has shown that repetitive transcranial magnetic stimulation (rTMS) is generally safe for treating depression and Obsessive Compulsive Disorder (OCD). Studies have found that faster rTMS treatments are well-tolerated by patients. For depression, rTMS can help improve symptoms in people who haven't had success with other treatments. Specifically, one study found that faster rTMS is safe and effective for managing treatment-resistant depression.

For OCD, faster rTMS has significantly reduced symptoms compared to a placebo (a treatment with no active ingredient). A review of clinical trials demonstrated a noticeable decrease in OCD symptoms with rTMS. While mild side effects like headaches or scalp discomfort can occur, they are usually temporary and not severe.

Since the FDA has already approved rTMS for depression and OCD, this provides extra reassurance about its safety. However, the faster treatment being tested aims to deliver quicker results, so participation in the trial is needed to fully confirm its safety and effectiveness. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about accelerated transcranial magnetic stimulation (TMS) for depression and OCD because it offers a potentially faster and more flexible approach than traditional TMS. Unlike standard treatments that might take weeks, accelerated TMS can show results in just five days. This technique targets specific areas of the brain, the LPFC and DMPFC, and can switch targets if the initial area doesn’t respond, allowing for more personalized care. This adaptability and speed make it a promising alternative for patients who haven't responded to conventional therapies.

What evidence suggests that this trial's treatments could be effective for depression and OCD?

Research has shown that a faster version of repetitive transcranial magnetic stimulation (rTMS) effectively treats depression and OCD. In this trial, participants with treatment-resistant depression will receive accelerated rTMS targeting either the LPFC or DMPFC, with the option to switch targets if they do not respond well. Studies have found that this accelerated rTMS led to noticeable improvement, with 33% of patients feeling better after one week and 43% after four weeks. In another study, a deeper form of this treatment had an 80% success rate, with half of the patients experiencing complete relief from symptoms. For OCD, participants will also receive rTMS targeting either the LPFC or DMPFC, with the option to switch targets for non-responders. This faster TMS significantly reduces symptoms, with some studies noting that the benefits become clearer several weeks after treatment. Overall, accelerated TMS appears promising in quickly easing symptoms for both conditions. ^{1 2 3 5 6}

Who Is on the Research Team?

Conor Liston, MD, PhD

Principal Investigator

Weill Medical College of Cornell University

Are You a Good Fit for This Trial?

This trial is for adults with major depression or OCD who haven't improved after trying at least one medication. They must be stable on their current antidepressants, if any, and able to consent. People with psychotic symptoms, recent substance abuse, significant neurological disorders, imminent suicide risk, or other primary psychiatric diagnoses besides OCD or mild anxiety are excluded.

Inclusion Criteria

I am not on antidepressants or have been on a stable dose for 4+ weeks.

I am able to understand and agree to the study's procedures and risks.

I have been diagnosed with major depression or OCD.

Exclusion Criteria

I have a history of seizures or take medication that could increase my risk of seizures.

I do not have symptoms that would affect my understanding of the trial.

I started psychotherapy within the last 8 weeks.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive a 5-day course of rTMS delivered hourly for 10 hours per day, targeting either the LPFC or DMPFC. Non-responders may receive a second 5-day course targeting the opposite brain area.

5-10 days

Follow-up

Participants are monitored for safety and effectiveness after treatment, including clinical assessments and fMRI scans.

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Accelerated TMS

Trial Overview The study tests an accelerated 5-day rTMS treatment using the MagVenture MagPro System aimed at rapidly improving depression and OCD symptoms. Participants will undergo fMRI scans to find biomarkers predicting TMS benefits. They'll receive intense daily rTMS sessions targeting specific brain areas over a week, possibly followed by another course if partially responsive.

How Is the Trial Designed?

Group I: OCD - DMPFC target to (for non-responders) LPFC target Experimental Treatment 1 Intervention

Participants with OCD will receive a 5-day course of rTMS delivered to the DMPFC.Participants may have the option to be crossed over to receive rTMS targeting the opposite brain area (LPFC), enabling us to test whether participants who do not respond well to one target might respond to stimulation of another target. The option to offer a second course of treatment will be based on clinical judgement and re-evaluation of the participant.

Group II: Depression - DMPFC target to (for non-responders) LPFC target Experimental Treatment 1 Intervention

Participants with treatment resistant depression will receive a 5-day course of rTMS delivered to the DMPFC. Participants may have the option to be crossed over to receive rTMS targeting the opposite brain area (LPFC), enabling us to test whether participants who do not respond well to one target might respond to stimulation of another target. The option to offer a second course of treatment will be based on clinical judgement and re-evaluation of the participant.

Group III: Depression - LPFC target to (for non-responders) DMPFC target Active Control 1 Intervention

Participants with treatment resistant depression will receive a 5-day course of rTMS delivered to the LPFC. Participants may have the option to be crossed over to receive rTMS targeting the opposite brain area (DMPFC), enabling us to test whether participants who do not respond well to one target might respond to stimulation of another target. The option to offer a second course of treatment will be based on clinical judgement and re-evaluation of the participant.

Group IV: OCD - LPFC target to (for non-responders) DMPFC target Active Control 1 Intervention

Participants with OCD will receive a 5-day course of rTMS delivered to the LPFC. Participants may have the option to be crossed over to receive rTMS targeting the opposite brain area (DMPFC), enabling us to test whether participants who do not respond well to one target might respond to stimulation of another target. The option to offer a second course of treatment will be based on clinical judgement and re-evaluation of the participant.

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?

Weill Medical College of Cornell University

Lead Sponsor

Trials

1,103

Recruited

1,157,000+

The Wellcome Leap Fund

Collaborator

Trials

1

Recruited

500+

National Institute of Mental Health (NIMH)

Collaborator

Trials

3,007

Recruited

2,852,000+

The New Venture Fund / Foundation for OCD Research

Collaborator

Trials

1

Recruited

500+

Published Research Related to This Trial

A retrospective analysis of six patients with treatment-resistant OCD showed that continuous theta burst stimulation (cTBS) targeting the supplementary motor cortex may help reduce obsessive-compulsive symptoms, suggesting a potential new treatment avenue.

Despite the promising results, the study highlights the need for further research through randomized, sham-controlled trials with larger participant groups to validate the efficacy of cTBS for OCD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Case Series of Continuous Theta Burst Stimulation Treatment for the Supplementary Motor Area Twice a Day in Patients with Obsessive-Compulsive Disorder: A Real World TMS Registry Study in Japan. Noda, Y., Fujii, K., Tokura, F., et al.[2023]

In a study of 54 patients with major depression, the combination of intermittent theta burst stimulation (iTBS) and low-frequency rTMS (LF-rTMS) significantly improved depression and anxiety symptoms more than high-frequency rTMS (HF-rTMS).

The results suggest that iTBS combined with LF-rTMS may be a promising alternative therapy for major depression, offering both efficacy and time-saving benefits compared to traditional methods.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Left intermittent theta burst stimulation combined with right low-frequency rTMS as an additional treatment for major depression: A retrospective study. Mi, Y., Ji, Y., Lou, Z., et al.[2022]

In a case series of 9 patients with major depressive disorder and bipolar disorder, accelerated theta-burst rTMS treatment over 8 days led to significant reductions in depression symptoms, as measured by the CES-D and CGI scales.

The treatment was well tolerated, with mild headaches being the most common side effect, and five patients achieving at least a 50% reduction in symptoms by the end of the treatment period.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Accelerated theta-burst repetitive transcranial magnetic stimulation for depression in South Africa. Bröcker, E., van den Heuvel, L., Seedat, S.[2020]

In a study involving 300 patients with treatment-resistant depression, accelerated bilateral theta burst stimulation (TBS) was found to be effective and safe, with a treatment response rate of 43.7% and a remission rate of 28.2%.

The study revealed no significant differences in efficacy between different TBS intensities or when compared to traditional unilateral 10 Hz rTMS, indicating that the accelerated TBS does not provide faster antidepressant effects.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Accelerated theta burst stimulation for the treatment of depression: A randomised controlled trial. Chen, L., Thomas, EHX., Kaewpijit, P., et al.[2022]

In a study involving 30 treatment-resistant OCD patients, continuous theta burst transcranial magnetic stimulation (cTBS) over the supplementary motor area was found to be safe but did not significantly improve OCD symptoms compared to sham treatment.

Both active and sham cTBS groups showed similar responder rates (28% for cTBS vs. 36% for sham) at both the end of treatment and follow-up, indicating that cTBS may not be an effective intervention for this patient population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Continuous theta burst stimulation over the supplementary motor area in refractory obsessive-compulsive disorder treatment: A randomized sham-controlled trial. Harika-Germaneau, G., Rachid, F., Chatard, A., et al.[2020]

In a randomized-controlled trial involving 32 patients with major depression, bilateral theta burst stimulation (TBS) to the dorsolateral prefrontal cortex showed a significant increase in treatment response compared to sham stimulation, with 9 responders in the TBS group versus 4 in the sham group.

The study also indicated a trend towards higher remission rates in the TBS group as measured by the Beck Depression Inventory, suggesting that TBS may enhance the effectiveness of ongoing medication and psychotherapy in treating major depression.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Treatment of major depression with bilateral theta burst stimulation: a randomized controlled pilot trial. Plewnia, C., Pasqualetti, P., Große, S., et al.[2018]

In a study involving 33 OCD patients, continuous Theta Burst Stimulation (cTBS) targeting the orbitofrontal cortex (OFC) was found to be well tolerated and led to significant improvements in anxiety symptoms and overall severity of OCD after 10 treatment sessions.

While the treatment showed a notable effect on anxiety and global severity scores, the improvements in obsessive and compulsive symptoms were not statistically significant when controlling for other variables, suggesting that the primary benefit of cTBS may be in reducing anxiety associated with OCD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy of intensive orbitofrontal continuous Theta Burst Stimulation (iOFcTBS) in Obsessive Compulsive Disorder: A Randomized Placebo Controlled Study. Dutta, P., Dhyani, M., Garg, S., et al.[2021]

An 18-year-old female with treatment-refractory obsessive-compulsive disorder (OCD) showed significant symptom improvement after receiving combined repetitive transcranial magnetic stimulation (rTMS) and intermittent theta-burst stimulation targeting the bilateral dorsolateral prefrontal cortex and supplementary motor area.

This case suggests that using a sequential stimulation approach to target different brain regions may enhance the effectiveness of rTMS therapy for patients with OCD, indicating a potential new strategy for treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Targeting Three Brain Regions (Bilateral SMA, Left and Right DLPFC) Sequentially in One Session Using Combined Repetitive Transcranial Magnetic Stimulation and Intermittent Theta-burst Stimulation in Treatment-refractory Obsessive-compulsive Disorder: A Case Report. Chou, PH., Sack, AT., Su, KP.[2022]

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 clinical trial involving patients with treatment-resistant depression, both 10 Hz repetitive transcranial magnetic stimulation (rTMS) and intermittent theta-burst stimulation (iTBS) effectively reduced suicidality, with remission rates of 43.7% and 49.1% respectively, showing no significant difference between the two methods.

There was a strong correlation between reductions in suicidality and overall depression severity, indicating that improvements in suicidal thoughts were linked to greater decreases in depressive symptoms.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of high frequency versus theta-burst repetitive transcranial magnetic stimulation on suicidality in patients with treatment-resistant depression. Mehta, S., Downar, J., Mulsant, BH., et al.[2023]

In a pilot study involving 29 OCD patients, continuous theta burst stimulation (cTBS) targeting the bilateral supplementary motor area significantly relieved OCD symptoms in 37.93% of participants, indicating its potential efficacy as a treatment.

The study found that functional connectivity between specific brain regions could predict the effectiveness of cTBS, with a high area under the curve (AUC) of 0.85, suggesting that neuroimaging may help identify which patients are more likely to benefit from this intervention.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The functional connectivity predictor of therapeutic effect of continuous theta burst stimulation on obsessive-compulsive disorder: A preliminary study. Li, P., Cheng, J., Fan, Q., et al.[2022]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12090592/

Accelerated repetitive transcranial magnetic stimulation in ... Results indicated that accelerated rTMS is well-tolerated and safe, leading to a 33% response rate at week 1 and an increase to 43% at week 4 [ ...

2. sciencedirect.com sciencedirect.com/science/article/pii/S0165178123004328

Real world efficacy and safety of various accelerated deep ... Highlights · Accelerated Deep TMS with the H1 coil has an 80% response and 51% remission rate. · The six-month durability of accelerated Deep TMS is 93%.

3. nature.com nature.com/articles/s41386-023-01599-z

Accelerated TMS - moving quickly into the future of ... Overall, accelerated TMS appears to hold promise to reduce treatment time and achieve rapid reduction in depressive symptoms, but at this time ...

4. psychiatryonline.org psychiatryonline.org/doi/10.1176/appi.ajp.20230879

Theta Burst TMS Technology: Great Promise and a Lot to ... The results of the study showed that TBS was noninferior to rTMS (35.4% vs. 32.9% remission rates, respectively) with a similar dropout rate and ...

5. jamanetwork.com jamanetwork.com/journals/jamapsychiatry/fullarticle/2796747

Repetitive Transcranial Magnetic Stimulation vs Theta ... In older adults with treatment-resistant depression, bilateral theta burst stimulation compared with standard bilateral rTMS achieved noninferior reduction in ...

6. mayoclinic.org mayoclinic.org/tests-procedures/transcranial-magnetic-stimulation/about/pac-20384625

Transcranial magnetic stimulation Transcranial magnetic stimulation (TMS) is a procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of major depression.