Treatment of Acute Mood Depressive Episode in Borderline Personality Disorder With rTMS

NCT ID: NCT04870255

Last Updated: 2025-12-10

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

ACTIVE_NOT_RECRUITING

Clinical Phase

NA

Total Enrollment

45 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-07-20

Study Completion Date

2026-12-31

Brief Summary

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This study evaluates the antidepressant effects of an accelerated schedule of theta-burst stimulation, termed accelerated intermittent theta-burst stimulation (aiTBS), in individuals with borderline personality disorder (BPD) or trait and comorbid mood depressive disorder (MDD) or bipolar II disorder in a current mood depressive episode (MDE).

Detailed Description

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This project aims to measure and modulate a mood depressive episode (MDE) in individuals with borderline personality disorder (BPD) trait and comorbid mood depressive disorder (MDD) or bipolar II disorder in a current mood depressive episode (MDE). This study will test the antidepressant effect of aiTBS stimulation over the left dorsolateral prefrontal cortex (L-DLPFC), and aiTBS stimulation over the dorsomedial prefrontal cortex (DMPFC) compared with sham.

Conditions

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Depressive Disorder, Major Borderline Personality Disorder

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Patients will be randomized to receive: active L-DLPFC stimulation, active DMPFC stimulation, or sham stimulation. Group size ratio will be 1:1:1.
Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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Left Dorsolateral Prefrontal Cortex (L-DLPFC)

The accelerated theta burst stimulation protocol will be applied to the left dorsolateral prefrontal cortex (L-DLPFC)

Group Type ACTIVE_COMPARATOR

Left Dorsolateral Prefrontal Cortex (L-DLPFC)

Intervention Type DEVICE

Participants who are randomly assigned to this group will receive active iTBS (intermittent theta burst stimulation) to the left DLPFC. Stimulation intensity will be standardized at 90% of resting motor threshold (adjusted for cortical depth).

Stimulation will be delivered using the Magventure Magpro X100 TMS system.

Dorsomedial Prefrontal Cortex (DMPFC)

The accelerated theta burst stimulation protocol will be applied to the dorsomedial prefrontal cortex (DMPFC)

Group Type ACTIVE_COMPARATOR

Dorsomedial Prefrontal Cortex (DMPFC)

Intervention Type DEVICE

Participants who are randomly assigned to this group will receive active iTBS (intermittent theta burst stimulation) to the DMPFC. Stimulation intensity will be standardized at 100% of resting motor threshold (adjusted for cortical depth).

Stimulation will be delivered using the Magventure Magpro X100 TMS system.

Sham stimulation

Sham (non-active) stimulation will be applied to the left dorsolateral prefrontal cortex (DLPFC) region

Group Type SHAM_COMPARATOR

Sham Stimulation

Intervention Type DEVICE

Participants who are randomly assigned to this group will receive sham stimulation to the left DLPFC.

Sham stimulation will be delivered using the Magventure Magpro X100 TMS system.

Interventions

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Left Dorsolateral Prefrontal Cortex (L-DLPFC)

Participants who are randomly assigned to this group will receive active iTBS (intermittent theta burst stimulation) to the left DLPFC. Stimulation intensity will be standardized at 90% of resting motor threshold (adjusted for cortical depth).

Stimulation will be delivered using the Magventure Magpro X100 TMS system.

Intervention Type DEVICE

Dorsomedial Prefrontal Cortex (DMPFC)

Participants who are randomly assigned to this group will receive active iTBS (intermittent theta burst stimulation) to the DMPFC. Stimulation intensity will be standardized at 100% of resting motor threshold (adjusted for cortical depth).

Stimulation will be delivered using the Magventure Magpro X100 TMS system.

Intervention Type DEVICE

Sham Stimulation

Participants who are randomly assigned to this group will receive sham stimulation to the left DLPFC.

Sham stimulation will be delivered using the Magventure Magpro X100 TMS system.

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Male or Female, between the ages of 18 and 80 at the time of screening.
* Able to read, understand, and provide written, dated informed consent prior to screening. Proficiency in English sufficient to complete questionnaires / follow instructions during fMRI assessments and aiTBS interventions. Stated willingness to comply with all study procedures, including availability for the duration of the study, and to communicate with study personnel about adverse events and other clinically important information.
* Diagnosed with Major Depressive Disorder (MDD) or Bipolar II, or unspecified depressive disorder AND Borderline Personality Disorder or trait, with a current Mood Depressive Episode (MDE), according to the criteria defined in the Diagnosis and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5).
* MADRS score of ≥20 at screening (Visit 1).
* TMS naive.
* Access to ongoing psychiatric care before and after completion of the study.
* Access to clinical rTMS after study completion.
* In good general health, as evidenced by medical history.
* For females of reproductive potential: use of highly effective contraception for at least 1 month prior to screening and agreement to use such a method during study participation.
* Agreement to adhere to Lifestyle Considerations (see section 5.3) throughout study duration.

Exclusion Criteria

* Pregnancy
* The presence or diagnosis of prominent anxiety disorder, personality disorder, or dysthymia
* Current severe insomnia (must sleep a minimum of 5 hours each night before stimulation)
* Current mania or psychosis
* Bipolar I Disorder and primary psychotic disorders.
* Autism Spectrum disorder or Intellectual Disability
* A diagnosis of obsessive-compulsive disorder (OCD)
* Current moderate or severe substance use disorder or demonstrating signs of acute substance withdrawal.
* Urine screening test positive for illicit substances.
* Any history of ECT (greater than 8 sessions) without meeting responder criteria
* Recent (during the current depressive episode) or concurrent use of a rapid acting antidepressant agent (i.e., ketamine or a course of ECT).
* History of significant neurologic disease, including dementia, Parkinson's or Huntington's disease, brain tumor, unexpected seizure/epilepsy disorder, subdural hematoma, multiple sclerosis, or history of significant head trauma.
* Untreated or insufficiently treated endocrine disorder.
* Contraindications to receiving rTMS (e.g., metal in head, history of seizure, known brain lesion)
* Contraindications to MRI (ferromagnetic metal in their body).
* Any current or past history of any physical condition which in the investigator's opinion might put the subject at risk or interfere with study results interpretation.
* Depth-adjusted aiTBS treatment dose \> 65% maximum stimulator output (MSO)
* Treatment with another investigational drug or other intervention within the study period.
* Any other condition deemed by the PI to interfere with the study or increase risk to the participant.
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Stanford University

OTHER

Sponsor Role lead

Responsible Party

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David Spiegel

Professor, Psych/Major Laboratories and Clinical & Translational Neuroscience

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Nolan Williams, MD

Role: STUDY_DIRECTOR

Stanford University

David Spiegel, MD

Role: PRINCIPAL_INVESTIGATOR

Stanford University

Locations

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Stanford Hospital

Stanford, California, United States

Site Status

Countries

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United States

References

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George MS, Lisanby SH, Avery D, McDonald WM, Durkalski V, Pavlicova M, Anderson B, Nahas Z, Bulow P, Zarkowski P, Holtzheimer PE 3rd, Schwartz T, Sackeim HA. Daily left prefrontal transcranial magnetic stimulation therapy for major depressive disorder: a sham-controlled randomized trial. Arch Gen Psychiatry. 2010 May;67(5):507-16. doi: 10.1001/archgenpsychiatry.2010.46.

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George MS, Wassermann EM, Williams WA, Callahan A, Ketter TA, Basser P, Hallett M, Post RM. Daily repetitive transcranial magnetic stimulation (rTMS) improves mood in depression. Neuroreport. 1995 Oct 2;6(14):1853-6. doi: 10.1097/00001756-199510020-00008.

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Baeken C, Duprat R, Wu GR, De Raedt R, van Heeringen K. Subgenual Anterior Cingulate-Medial Orbitofrontal Functional Connectivity in Medication-Resistant Major Depression: A Neurobiological Marker for Accelerated Intermittent Theta Burst Stimulation Treatment? Biol Psychiatry Cogn Neurosci Neuroimaging. 2017 Oct;2(7):556-565. doi: 10.1016/j.bpsc.2017.01.001. Epub 2017 Jan 20.

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Reference Type BACKGROUND
PMID: 30819549 (View on PubMed)

Other Identifiers

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58950

Identifier Type: -

Identifier Source: org_study_id

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