Using Brain Network Biomarkers to Guide rTMS Treatment for Adults with Treatment Resistant Depression

What this Trial Is About

Researchers are investigating the use of repetitive transcranial magnetic stimulation rTMS to treat patients with treatment-resistant depression, a condition where standard antidepressant medications have failed. This study aims to confirm whether a new approach using brain connectivity patterns measured by resting state functional MRI fMRI can improve how rTMS is targeted to different brain areas for better outcomes. The study also seeks to understand how rTMS affects brain networks in these patients. Participants will be randomly assigned to one of three groups one receiving standard rTMS targeting the left dorsolateral prefrontal cortex DLPFC, another receiving rTMS targeted to the brain area predicted to be most effective for their depression subtype based on brain imaging either DLPFC or dorsomedial prefrontal cortex, DMPFC, and a third group receiving rTMS targeting the opposite brain area than predicted. The treatment uses intermittent theta burst stimulation iTBS delivered at 120% of the resting motor threshold in short bursts totaling about 3 minutes per session. Throughout the study, participants will undergo brain scans, behavioral tests, and clinical assessments before and after the treatment period of 7 to 10 weeks. The main measure of success is the change in depression severity using a standard rating scale. Researchers will also monitor changes in brain connectivity and other depression symptom scores. Safety and treatment effects will be closely observed during the trial, which lasts up to 21 weeks including follow-up.

Biomarker-guided rTMS for Treatment Resistant Depression