Research Studies

Ongoing Studies

Use of Repetitive Transcranial Magnetic Stimulation to Augment Hypnotic Analgesia

NIH/NCCIH Grant # 1R33AT009305-01

ClinicalTrials.gov ID: NCT02969707

 

We will be using function neuroimaging (fMRI) to understand the brain systems affected when hypnosis and hypnotic analgesia are augmented with repetitive transcranial magnetic stimulation (rTMS), a form of non-invasive brain stimulation to 100 people with fibromyalgia, a chronic pain condition. The investigators will measure the effect of rTMS-augmentation on the brain networks underlying hypnotizability, as well as the effect of rTMS-augmentation on hypnotic analgesia networks. We hope to demonstrate that a combination of these psychological and neuromodulatory treatments will be more effective than hypnosis alone, thereby enhancing the depth of hypnosis, range of hypnosis and the efficacy of hypnotic analgesia and hopefully creating a new treatment modality for individuals suffering from pain syndromes such as fibromyalgia pain. 

 

This study is currently recruiting! 

 

If you have been diagnosed with fibromyalgia and are interested in participating, please fill out our quick survey to see if you qualify (only takes ~2 minutes).

https://is.gd/brainstimulationstudy

 

If you would prefer to speak to a member of our study team, please contact us at:

650-736-2233 or brainstimulationstudy@stanford.edu

Accelerated Theta Burst in Treatment-Resistant Depression: A Dose Finding and Biomarker Study

This research study is looking for ninety-five people with depression to enroll at Stanford University. 

 

A new treatment for depression involves stimulating the brain with an electromagnet placed on the scalp that rapidly turns on and off. This treatment is called transcranial magnetic stimulation. As the magnet rapidly turns on and off, the electrical currents in the brain tend to synchronize with the magnet. Brief treatments with this appear to help patients with depression.

 

This study is looking for participants that have depression with a history of being unresponsive to at least one medication, that might respond to this new treatment. This new treatment is looking at a new way of using transcranial magnetic stimulation to treat depression and is called theta burst stimulation. It involves using a shorter period of stimulation for each treatment, which might benefit patients. We hope to learn if this shorter type of transcranial magnetic stimulation is effective in treating depression. 

 

This study is currently recruiting! 

 

If you have been diagnosed with treatment-resistant depression and are interested in participating, please fill out our survey to see if you qualify. This is a multi-step screening process.

https://is.gd/stanford_atbs_study

If you would prefer to speak to a member of our study team, please contact us at:

 

Claudia Tischler          650-498-8535    ctischler@stanford.edu

 

For further information on the clinical trial, click here

Bilateral Accelerated Theta Burst in Treatment-Resistant Bipolar Depression: A Biomarker Study

We are doing this research study to find out if a new form of repetitive transcranial magnetic stimulation (rTMS) is effective in treating treatment-resistant bipolar depression. rTMS is approved by the U.S. Food and Drug Administration (FDA) for the treatment of MDD in adults with depression that have not benefited from medication. This FDA-approved treatment involves stimulating the left frontal area of the head with an electromagnet that produces a magnetic field delivered in short bursts. These bursts are focused on an area of the brain that is thought to be involved in causing depression. As the magnet rapidly turns on and off, the electrical currents in the brain tend to synchronize with the magnet. TMS has been shown to help some patients with depression.

In this study, we are looking at a new way of using intermittent TBS to treat treatment-resistant bipolar depression.  The name of this new procedure is “accelerated intermittent theta-burst stimulation (aiTBS)”.  aiTBS involves using shorter periods of stimulation over multiple treatments received each day for five days.  We hope to learn if this shorter type of TMS is effective in treating bipolar depression. This open-label pilot study will be conducted with 30 patients who will receive active aiTBS treatment.

If you have been diagnosed with treatment-resistant depression and are interested in participating, please fill out our survey to see if you qualify. This is a multi-step screening process.

https://is.gd/bipolar_screening_atbs

If you would prefer to speak to a member of our study team, please contact us at:

Romina Nejad     650-497-3933    rnejad@stanford.edu

Accelerated Intermittent Theta Burst Stimulation for Depressive Symptoms

Repetitive transcranial magnetic stimulation (rTMS) is effective at inducing antidepressant responses in patients with treatment-resistant depression. Depressive symptoms are not restricted to individuals with major depressive disorder (MDD); for example, individuals with bipolar disorder, schizophrenia, anorexia nervosa, opioid use and alcohol use disorder have greater than 10 times higher risk of suicide than the general population. Initial studies suggest that rTMS could be effective at inducing antidepressant responses transdiagnostically but responses typically take two to four weeks. A new type of rTMS, intermittent theta-burst stimulation (iTBS), has been shown to be five times more potent than traditional rTMS. More potent stimulation means patients can be stimulated for less time, meaning more sessions could be administered per day, potentially resulting in much faster antidepressant responses. This study proposes a novel approach for targeting depressive symptoms, aiming to induce antidepressant responses within five days, addressing the imminent risk for suicidal patients.

 

Establishing Imaging Biomarkers for Spaced Theta-Burst Stimulation

We plan to use functional magnetic resonance imaging (fMRI) methods to assess brain changes following spaced theta burst stimulation (TBS), a new form of repetitive transcranial magnetic stimulation (rTMS), in 10 healthy participants. We will measure the effects of both excitatory (intermittent, iTBS) and inhibitory (continuous, cTBS) TBS applied to the motor cortex, a system that when stimulated produces a readily observable behavioral response (e.g., movement of a given body region). In addition to brain activity, during tasks and at rest change following the applications of spaced cTBS and iTBS. Additionally, the aim is to determine the duration of the spaced TBS effects on brain activity and behavior. This study will provide an understanding of the functional brain and behavioral changes that occur following spaced TBS to the motor cortex and has implications for reducing the long treatment schedules associated with classical rTMS protocols.

Accelerated Theta Burst stimulation for Treatment of Alcohol Use Disorder

Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive procedure and an established technology. Research in patients with alcohol use disorder has shown some promising results. The limitations of this approach include the duration of the treatment (approximately 40 minutes per treatment session). Recently, researchers have aggressively pursued modifying the treatment parameters, such as using accelerated intermittent theta-burst stimulation (aTBS), to reduce treatment times with possible enhanced efficacy with some preliminary success.This study intends to further modify the parameters to create a more rapid form of the treatment and look at the change in neuroimaging biomarkers.

The Effect of Cortisol Administration on Neural Correlates of Emotion in Depression

The subgenual cingulate is an area of the brain is known to be hyperactive in patients with depression and to normalize with successful treatment. The hormone cortisol has been shown to inhibit the subgenual cingulate in healthy subjects during some types of emotion processing. Depressed patients are thought to have reduced sensitivity to cortisol. In this study we attempt to inhibit the subgenual cingulate of depressed patients by giving extra cortisol in the form of orally administered hydrocortisone.


Past Studies

Attenuation of Antidepressant Effects of Ketamine by Opioid Receptor Antagonism

Objective: In addition to N-methyl-D-aspartate receptor antagonism, ketamine produces opioid system activation. The objective of this study was to determine whether opioid receptor antagonism prior to administration of intravenous ketamine attenuates its acute antidepressant or dissociative effects.

Method: In a proposed double-blind crossover study of 30 adults with treatment-resistant depression, the authors performed a planned interim analysis after studying 14 participants, 12 of whom completed both conditions in randomized order: placebo or 50 mg of naltrexone preceding intravenous infusion of 0.5 mg/kg of ketamine. Response was defined as a reduction >=50% in score on the 17-item Hamilton Depression Rating Scale (HAM-D) score on postinfusion day 1.

Results: In the interim analysis, seven of 12 adults with treatment-resistant depression met the response criterion during the ketamine plus placebo condition. Reductions in 6-item and 17-item HAM-D scores among participants in the ketamine plus naltrexone condition were significantly lower than those of participants in the ketamine plus placebo condition on postinfusion days 1 and 3. Secondary analysis of all participants who completed the placebo and naltrexone conditions, regardless of the robustness of response to ketamine, showed similar results. There were no differences in ketamine-induced dissociation between conditions. Because naltrexone dramatically blocked the antidepressant but not the dissociative effects of ketamine, the trial was halted at the interim analysis.

Conclusions: The findings suggest that ketamine’s acute antidepressant effect requires opioid system activation. The dissociative effects of ketamine are not mediated by the opioid system, and they do not appear sufficient without the opioid effect to produce the acute antidepressant effects of ketamine in adults with treatment-resistant depression.

 

Am J Psychiatry 2018; 175:1–11; doi: 10.1176/appi.ajp.2018.18020138