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

Purpose

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).

Conditions

  • Depressive Disorder, Major
  • Borderline Personality Disorder

Eligibility

Eligible Ages
Between 22 Years and 65 Years
Eligible Genders
All
Accepts Healthy Volunteers
No

Inclusion Criteria

  • Male or Female, between the ages of 22 and 65 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.

Study Design

Phase
N/A
Study Type
Interventional
Allocation
Randomized
Intervention Model
Parallel Assignment
Intervention Model Description
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 Purpose
Treatment
Masking
Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)

Arm Groups

ArmDescriptionAssigned Intervention
Active Comparator
Left Dorsolateral Prefrontal Cortex (L-DLPFC)
The accelerated theta burst stimulation protocol will be applied to the left dorsolateral prefrontal cortex (L-DLPFC)
  • Device: 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.
Active Comparator
Dorsomedial Prefrontal Cortex (DMPFC)
The accelerated theta burst stimulation protocol will be applied to the dorsomedial prefrontal cortex (DMPFC)
  • 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.
Sham Comparator
Sham stimulation
Sham (non-active) stimulation will be applied to the left dorsolateral prefrontal cortex (DLPFC) region
  • 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.

Recruiting Locations

More Details

Status
Recruiting
Sponsor
Stanford University

Study Contact

Bora Kim, MD, MAS
650-800-6929
borakim2@stanford.edu

Detailed Description

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.