Bilateral Accelerated Theta Burst in Treatment-Resistant Bipolar Depression
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ClinicalTrials.gov Identifier: NCT03953417 |
Recruitment Status :
Active, not recruiting
First Posted : May 16, 2019
Last Update Posted : November 22, 2021
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Condition or disease | Intervention/treatment | Phase |
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Treatment Resistant Depression | Device: Bilateral accelerated intermittent theta-burst treatment | Not Applicable |
Study Type : | Interventional (Clinical Trial) |
Estimated Enrollment : | 30 participants |
Allocation: | N/A |
Intervention Model: | Single Group Assignment |
Masking: | None (Open Label) |
Primary Purpose: | Treatment |
Official Title: | Bilateral Accelerated Theta Burst Stimulation in Treatment-Resistant Bipolar Depression |
Actual Study Start Date : | July 1, 2019 |
Estimated Primary Completion Date : | July 1, 2023 |
Estimated Study Completion Date : | July 30, 2023 |

Arm | Intervention/treatment |
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Experimental: Bilateral accelerated intermittent theta burst treatment
All participants will receive accelerated intermittent theta-burst stimulation.
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Device: Bilateral accelerated intermittent theta-burst treatment
All participants will receive bilateral accelerated intermittent theta-burst stimulation to the left and right DLPFC. Treatment will be targeted by utilizing the Localite neuronavigation system. Stimulation intensity will be standardized at 90% of resting motor threshold adjust to the skull to cortical surface distance. Stimulation will be delivered to left and right-DLPFC using the MagPRo stimulator. |
- Change from baseline Montgomery Asberg Depression Rating Scale (MADRS) [ Time Frame: Baseline and immediately post-treatment ]
A ten item diagnostic questionnaire used to measure the severity of depressive episodes in patients with mood disorders.
The MADRS uses a 0 to 6 severity scale, scored following the interview. Scoring/Interpretation: Higher scores indicate increasing depressive symptoms. ... Cut-off points include: 0 to 6 - symptom absent, 7 to 19 - mild depression, 30 to 34 - moderate, 35 to 60 - severe depression.
- Change from baseline Young Mania Rating Scale (YMRS) [ Time Frame: Baseline and immediate post-treatment ]
The Young Mania Rating Scale (YMRS) is one of the most frequently utilized rating scales to assess manic symptoms. The scale has 11 items and is based on the patient's subjective report of his or her clinical condition.
There are four items that are graded on a 0 to 8 scale (irritability, speech, thought content, and disruptive/aggressive behavior), while the remaining seven items are graded on a 0 to 4 scale. These four items are given twice the weight of the others to compensate for poor cooperation from severely ill patients.
Typical YMRS baseline scores can vary a lot. They depend on the patients' clinical features such as mania (YMRS = 12), depression (YMRS = 3), or euthymia (YMRS = 2).

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Ages Eligible for Study: | 18 Years to 80 Years (Adult, Older Adult) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Male or female, 18 to 80 years of age.
- Able to provide informed consent.
- Diagnosed with Bipolar Disorder and currently experiencing a Major Depressive Episode (MDE).
- Participants must currently be on a stable and adequate dose of a mood stabilizer and medication intake must remain stable throughout study enrollment.
- Participants may also have a history of intolerance to antidepressant medications. These patients with the intolerance history will not be required to be currently taking an antidepressant medication.
- Meet the threshold on the total HAMD17 score of >/=20 at both screening and baseline visits (Day -5/-14 and Day 0).
- Meet the threshold on the BDI-II, with a score of >/=17 at both screening and baseline visits (Day -5/-14 and Day 0).
- Meet the threshold on the total MADRS score of >/=20 at both screening and baseline visits (Day -5/-14 and Day 0).
- In good general health, as ascertained by medical history.
- If female, a status of non-childbearing potential or use of an acceptable form of birth control.
- History of rTMS failure with FDA approved rTMS parameters is permitted.
Exclusion Criteria:
- Female of childbearing potential who is not willing to use one of the specified forms of birth control during the study.
- Female that is pregnant or breastfeeding.
- Female with a positive pregnancy test at participation.
- Total HAMD-17 score of < 20 at the screen or baseline visits.
- Total MADRS score of < 20 at the screen or baseline visits.
- Total BDI-II score of < 17 at the screen or baseline visits.
- Current diagnosis of a Substance Use Disorder (Abuse or Dependence, as defined by DSM-IV-TR), with the exception of nicotine dependence.
- Current diagnosis of Axis I disorders other than Dysthymic Disorder, Generalized Anxiety Disorder, Social Anxiety Disorder, Panic Disorder, Agoraphobia, or Specific Phobia (unless one of these is comorbid and clinically unstable, and/or the focus of the participant's treatment for the past six months or more).
- History of schizophrenia or schizoaffective disorders, or any history of psychotic symptoms in the current or previous depressive episodes.
- Any Axis I or Axis II Disorder, which at screening is clinically predominant to their bipolar depression or has been predominant to their bipolar depression at any time within six months prior to screening.
- Considered at significant risk for suicide during the course of the study.
- Has a clinically significant abnormality on the screening examination that might affect safety, study participation, or confound interpretation of study results.
- Participation in any clinical trial with an investigational drug or device within the past month or concurrent to study participation.
- 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.
- History of positive screening urine test for drugs of abuse at screening: cocaine, amphetamines, barbiturates, opiates.
- Current (or chronic) use of opiates.
- History of epilepsy.
- History of shrapnel or metal in the head or skull.
- History of cardiovascular disease or cardiac event.
- History of OCD.
- History of autism spectrum disorder.
- Current psychosis
- Any change in medication of which the study PI is not aware of.

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03953417
United States, California | |
Stanford University | |
Palo Alto, California, United States, 94305 |
Principal Investigator: | Ian Kratter, MD, PhD | Stanford University |
Responsible Party: | Ian Kratter, Clinical Assistant Professor, Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford University |
ClinicalTrials.gov Identifier: | NCT03953417 |
Other Study ID Numbers: |
49486 |
First Posted: | May 16, 2019 Key Record Dates |
Last Update Posted: | November 22, 2021 |
Last Verified: | November 2021 |
Individual Participant Data (IPD) Sharing Statement: | |
Plan to Share IPD: | No |
Plan Description: | clintrials.gov |
Studies a U.S. FDA-regulated Drug Product: | No |
Studies a U.S. FDA-regulated Device Product: | Yes |
Product Manufactured in and Exported from the U.S.: | No |
Bipolar Disorder Treatment Resistant Depression Transcranial Magnetic Stimulation (TMS) Theta Burst |
Depression Depressive Disorder Depressive Disorder, Treatment-Resistant Bipolar Disorder |
Behavioral Symptoms Mood Disorders Mental Disorders Bipolar and Related Disorders |