Imaging- vs. Scalp-Targeted Accelerated TMS for Depression: The Number Needed to Scan Trial

Launched by BRIGHAM AND WOMEN'S HOSPITAL · Jun 26, 2025

Keywords

ClinConnect Summary

This clinical trial is studying a treatment called accelerated transcranial magnetic stimulation (aTMS) for people with major depression. aTMS uses magnetic pulses to gently stimulate specific parts of the brain to help improve mood. Unlike traditional TMS, which is given once a day over several weeks, aTMS delivers multiple treatments each day over just five days. This study wants to find out whether using brain scans (MRI) to guide the treatment works better than the usual method of targeting the treatment based on measurements of the scalp. This is important because MRI-guided treatment might be more precise but is also more expensive and harder to access.

People who might be eligible for this study are adults between 22 and 80 years old who have moderate to severe depression that has not improved well with treatment so far. Participants need to be able to speak English well enough to understand and agree to the study, and must have stable antidepressant use or no medications for at least four weeks before starting. During the study, participants will receive multiple aTMS sessions each day for five days, with either MRI-based or scalp-based targeting, assigned randomly. They will be asked to avoid alcohol, tobacco, and recreational drugs before sessions and follow some lifestyle guidelines during the study. This trial is not yet recruiting but aims to help doctors understand the best way to deliver this promising depression treatment.

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • Age 22-80
• • English proficiency sufficient for informed consent, questionnaires/tasks, and treatment
• • Primary diagnosis of major depressive disorder per DSM-V criteria (Quick Structured Clinical Interview for DSM-5)
• • \>20 on Beck Depression Inventory (BDI)
• • \>20 on the Montgomery-Åsberg Depression Rating Scale (MADRS)
• • Moderate to severe level of treatment resistance (Maudsley Staging Method)
• • Stable antidepressant medication regimen, or remain medication free, for 4 weeks prior to treatment and to remain on this regimen throughout the study until the 1-month post-treatment visit.
• • Primary clinician (e.g. psychiatrist, therapist, psychologist, APRN, PA, etc.) responsible for psychiatric care before, during, and after the trial
• • Agreement to lifestyle considerations
• • Abstain from becoming pregnant from screening to one-month after treatment (the MRI visit)
• • Continue usual intake patterns of caffeine- or xanthine-containing products (e.g. coffee, tea, soft drinks, chocolate) throughout treatment
• • Abstain from alcohol, tobacco, and recreational drugs for at least 24 hours before the start of each MRI and TMS session