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Accelerated iTBS for PTSD and Depression
Accelerated Intermittent Theta Burst Stimulation for Depression in Post-Traumatic Stress Disorder: A Single-Arm, Open-Label Feasibility Study
The goal of this pilot clinical trial is to learn if a faster brain stimulation schedule is practical, safe, tolerable, and acceptable. This study looks at accelerated intermittent theta burst stimulation, or accelerated iTBS. This is a non-invasive type of magnetic brain stimulation. This study is for adults with post-traumatic stress disorder (PTSD) and major depressive disorder (MDD).
The main questions this study aims to answer are:
- Can participants complete six short brain stimulation sessions per day for five days?
- Is this treatment schedule safe and tolerable for participants?
- What changes occur in depression symptoms, PTSD symptoms, anxiety, quality of life, and brain activity over time?
Participants will:
- Complete health screening and baseline assessments.
- Receive six short sessions of magnetic brain stimulation per day for five days.
- Have their brain activity measured using an EEG recording.
- Return for a post-treatment assessment at Week 2 and follow-up visits at Week 5 and Week 12.
Studie Overzicht
Toestand
Interventie / Behandeling
Gedetailleerde beschrijving
Studietype
Inschrijving (Geschat)
Fase
- Niet toepasbaar
Contacten en locaties
Studiecontact
- Naam: Radhika Kelkar, MD
- Telefoonnummer: 75805 519-685-8500
- E-mail: radhika.kelkar@lhsc.on.ca
Studie Contact Back-up
- Naam: Mervin Blair, PhD, C.Psych
- Telefoonnummer: 48170 519-646-6100
- E-mail: mervin.blair@sjhc.london.on.ca
Studie Locaties
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Ontario
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London, Ontario, Canada, N6C 0A7
- Werving
- St. Joseph's Health Care London, Parkwood Institute Mental Health Care Building
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Contact:
- Radhika Kelkar, MD
- Telefoonnummer: 75805 519-685-8500
- E-mail: radhika.kelkar@lhsc.on.ca
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Contact:
- Mervin Blair, PhD, C.Psych
- Telefoonnummer: 48170 519-646-6100
- E-mail: mervin.blair@sjhc.london.on.ca
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Hoofdonderzoeker:
- Radhika Kelkar, MD
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Deelname Criteria
Geschiktheidscriteria
Leeftijden die in aanmerking komen voor studie
- Volwassen
- Oudere volwassene
Accepteert gezonde vrijwilligers
Beschrijving
Inclusion Criteria:
- Adults aged 18 years or older.
- Current post-traumatic stress disorder (PTSD) and current major depressive disorder (MDD), confirmed by a structured diagnostic interview (e.g., MINI 6.0 using the PTSD and MDD modules).
- Minimum symptom severity at baseline: HAMD-17 score ≥14 (moderate depression) and/or PCL-5 score ≥33 (probable PTSD).
- On a stable pharmacologic and/or psychotherapeutic regimen for at least 4 weeks prior to baseline, and willing to maintain stability during the treatment phase, unless medically necessary.
- Capacity to provide informed consent and comply with study procedures and visits at St. Joseph's Health Care, London/Parkwood Institute.
- Sufficient English proficiency to complete consent and study assessments.
Exclusion Criteria:
- Neurologic or device-related risks, including seizure history, traumatic brain injury with loss of consciousness greater than 5 minutes, major neurologic illness, or metal/electronic implants contraindicated for transcranial magnetic stimulation.
- Psychiatric or substance-related risks, including current psychotic disorder, acute mania, diagnosis of Bipolar I or Bipolar II disorder, recent substance use disorder, or imminent suicide risk.
- Medical or medication-related risks, including unstable severe illness, high-risk medications, hearing impairment, unwillingness to use ear protection, or prior non-response to an adequate course of theta burst stimulation for the current depression/PTSD episode.
- Enrollment in another interventional trial.
- Inability to comply with the study schedule.
Studie plan
Hoe is de studie opgezet?
Ontwerpdetails
- Primair doel: Behandeling
- Toewijzing: NVT
- Interventioneel model: Opdracht voor een enkele groep
- Masker: Geen (open label)
Wapens en interventies
Deelnemersgroep / Arm |
Interventie / Behandeling |
|---|---|
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Experimenteel: Accelerated iTBS
Participants will receive active accelerated intermittent theta burst stimulation (iTBS).
Treatment will consist of six short stimulation sessions per day delivered over five consecutive days, for a total of 30 sessions.
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Accelerated intermittent theta burst stimulation, also called accelerated iTBS, is a non-invasive magnetic brain stimulation intervention.
Stimulation is delivered to the left dorsolateral prefrontal cortex using a transcranial magnetic stimulation system.
Participants receive six short sessions per day over five consecutive days.
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Wat meet het onderzoek?
Primaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
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Recruitment rate
Tijdsspanne: Study recruitment period, up to 12 months
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Recruitment rate will be assessed as the number of participants enrolled per month during the active recruitment period.
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Study recruitment period, up to 12 months
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Consent rate
Tijdsspanne: Study recruitment period, up to 12 months
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Consent rate will be assessed as the proportion of eligible individuals approached who provide informed consent.
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Study recruitment period, up to 12 months
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Treatment adherence
Tijdsspanne: Treatment Days 1 through 5
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Treatment adherence will be assessed as the percentage of scheduled accelerated iTBS sessions completed during the 5-day treatment course.
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Treatment Days 1 through 5
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Retention through Week 12 follow-up
Tijdsspanne: Baseline through Week 12
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Retention will be assessed as the proportion of enrolled participants who complete the Week 12 follow-up visit.
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Baseline through Week 12
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Adverse events
Tijdsspanne: Treatment Days 1 through Week 12
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Adverse events will be assessed as the proportion of participants who experience one or more adverse events during treatment and follow-up.
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Treatment Days 1 through Week 12
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Serious adverse events
Tijdsspanne: Treatment Days 1 through Week 12
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Serious adverse events will be assessed as the proportion of participants who experience one or more serious adverse events during treatment and follow-up.
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Treatment Days 1 through Week 12
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Discontinuations due to adverse events
Tijdsspanne: Treatment Days 1 through Week 12
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Tolerability will be assessed as the proportion of participants who discontinue accelerated iTBS because of adverse events.
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Treatment Days 1 through Week 12
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Participant satisfaction with accelerated iTBS
Tijdsspanne: Week 2, Week 5, and Week 12
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Participant satisfaction will be assessed using a 5-point Likert satisfaction rating scale.
Scores range from 1 to 5, with higher scores indicating greater satisfaction.
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Week 2, Week 5, and Week 12
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Participant feedback on accelerated iTBS
Tijdsspanne: Week 2, Week 5, and Week 12
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Participant feedback will be assessed using brief feedback questions about the accelerated iTBS treatment schedule and overall study experience.
Responses will be summarized descriptively.
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Week 2, Week 5, and Week 12
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Secundaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
|---|---|---|
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Exploratory change in clinician-rated depression symptom severity measured by HAMD-17
Tijdsspanne: Baseline, Week 2, Week 5, and Week 12
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Clinician-rated depression symptom severity will be assessed using the Hamilton Depression Rating Scale-17.
Total scores range from 0 to 52, with higher scores indicating greater depression symptom severity.
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Baseline, Week 2, Week 5, and Week 12
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Exploratory change in self-reported depression symptom severity measured by PHQ-9
Tijdsspanne: Baseline, Week 2, Week 5, and Week 12
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Self-reported depression symptom severity will be assessed using the Patient Health Questionnaire-9.
Total scores range from 0 to 27, with higher scores indicating greater depression symptom severity.
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Baseline, Week 2, Week 5, and Week 12
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Exploratory change in self-reported PTSD symptom severity measured by PCL-5
Tijdsspanne: Baseline, Week 2, Week 5, and Week 12
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Self-reported PTSD symptom severity will be assessed using the PTSD Checklist for DSM-5.
Total scores range from 0 to 80, with higher scores indicating greater PTSD symptom severity.
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Baseline, Week 2, Week 5, and Week 12
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Exploratory change in clinician-rated PTSD symptom severity measured by CAPS-5
Tijdsspanne: Baseline, Week 2, and Week 12
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Clinician-rated PTSD symptom severity will be assessed using the Clinician-Administered PTSD Scale for DSM-5.
Total symptom severity scores range from 0 to 80, with higher scores indicating greater PTSD symptom severity.
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Baseline, Week 2, and Week 12
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Exploratory change in anxiety symptom severity measured by GAD-7
Tijdsspanne: Baseline, Week 2, Week 5, and Week 12
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Anxiety symptom severity will be assessed using the Generalized Anxiety Disorder-7 item Scale.
Total scores range from 0 to 21, with higher scores indicating greater anxiety symptom severity.
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Baseline, Week 2, Week 5, and Week 12
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Exploratory change in cognitive function measured by MoCA
Tijdsspanne: Baseline, Week 2, Week 5, and Week 12
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Cognitive function will be assessed using the Montreal Cognitive Assessment.
Total scores range from 0 to 30, with higher scores indicating better cognitive function.
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Baseline, Week 2, Week 5, and Week 12
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Exploratory change in functioning and disability measured by WHODAS 2.0
Tijdsspanne: Baseline, Week 2, Week 5, and Week 12
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Functioning and disability will be assessed using the WHO Disability Assessment Schedule 2.0
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Baseline, Week 2, Week 5, and Week 12
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Exploratory change in quality of life measured by Q-LES-Q-SF
Tijdsspanne: Baseline, Week 2, Week 5, and Week 12
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Quality of life will be assessed using the Quality of Life Enjoyment and Satisfaction Questionnaire Short Form.
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Baseline, Week 2, Week 5, and Week 12
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Baseline clinical global severity measured by CGI-S
Tijdsspanne: Baseline
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Clinical global severity will be assessed using the Clinical Global Impression-Severity scale.
Scores range from 1 to 7, with higher scores indicating greater illness severity.
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Baseline
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Exploratory change in clinical global improvement measured by CGI-I
Tijdsspanne: Week 2, Week 5, and Week 12
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Clinical global improvement will be assessed using the Clinical Global Impression-Improvement scale.
Scores range from 1 to 7, with lower scores indicating greater clinical improvement.
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Week 2, Week 5, and Week 12
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Exploratory change in resting-state EEG alpha power
Tijdsspanne: Baseline, Treatment Day 1, and Treatment Day 5
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Resting-state EEG alpha power recorded at frontal electrodes will be assessed using EEG recordings collected at baseline and on treatment Days 1 and 5. On Days 1 and 5, brief resting-state EEG recordings will be collected immediately before and after each iTBS session to explore neurophysiological changes associated with accelerated iTBS.
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Baseline, Treatment Day 1, and Treatment Day 5
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Exploratory change in resting-state EEG gamma power
Tijdsspanne: Baseline, Treatment Day 1, and Treatment Day 5
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Resting-state EEG gamma power recorded at frontal electrodes will be assessed using EEG recordings collected at baseline and on treatment Days 1 and 5. On Days 1 and 5, brief resting-state EEG recordings will be collected immediately before and after each iTBS session to explore neurophysiological changes associated with accelerated iTBS.
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Baseline, Treatment Day 1, and Treatment Day 5
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Medewerkers en onderzoekers
Onderzoekers
- Hoofdonderzoeker: Radhika Kelkar, MD, St. Joseph's Health Care London, Parkwood Institute, Finch Family Mental Health Care Building
Studie record data
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Studie start (Geschat)
Primaire voltooiing (Geschat)
Studie voltooiing (Geschat)
Studieregistratiedata
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Meer informatie
Termen gerelateerd aan deze studie
Trefwoorden
Aanvullende relevante MeSH-voorwaarden
Andere studie-ID-nummers
- AiTBS-PTSD-MDD--001
- 127851 (Andere identificatie: Western HSREB Project ID)
Plan Individuele Deelnemersgegevens (IPD)
Bent u van plan om gegevens van individuele deelnemers (IPD) te delen?
Informatie over medicijnen en apparaten, studiedocumenten
Bestudeert een door de Amerikaanse FDA gereguleerd geneesmiddel
Bestudeert een door de Amerikaanse FDA gereguleerd apparaatproduct
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