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The Mechanisms of Underlying Accelerated Repetitive Transcranial Magnetic Stimulation for Treatment-resistant Depression

In this project, the investigators evaluate an accelerated schedule of repetitive transcranial magnetic stimulation for treatment-resistant depression. The investigators focuse on participants' brain activity and blood markers (Reelin, Apoer2, NMDAR, BDNF, exosomes and so on) to deepen the understanding of the mechanism of accelerated rTMS for treatment-resistant depression.

ClinicalTrials.gov IDNCT05607654

PhaseNA

Enrollment60

SponsorFirst Affiliated Hospital of Zhejiang University

Age18 Years

SexALL

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Conditions studied

Treatment-resistant Depression

About this study

Interventions

Device: active iTBS — Participants in the active stimulation group will receive the accelerated intermittent TBS to left DLPFC. The L-DLPFC will be targeted utilizing the neuronavigation system. Stimulation intensity will be standardized at 90% of RMT. Stimulation will be delivered to the L-DLPFC using an NTK-TMS-II100 TMS device,is compatible with the Brainsight TMS navigation system.
Device: sham rTMS — The parameters in the sham arm will be as above with the internal randomization of the device internally switching to sham in a blinded fashion.

Primary outcomes

Change in remission rate of Hamilton Depression Scale (24-items) (HAM-D24) score after treatment. (Baseline, 5-day, 1-month)

Eligibility information

Inclusion Criteria: 1. The current episode met the DSM-5 diagnostic criteria for major depression in patients with first-episode or relapsed unmedicated depression without psychotic symptoms. 2. 24-item Hamilton Depression Scale (HAMD-24) ≥ 20. 3. Age 18-45 years, regardless of gender. 4. Right-handedness. 5. Han Chinese. 6. Signed a written informed consent, willing to participate in the study and be evaluated. Exclusion Criteria: 1. Co-morbid other mental disorders, including: schizophrenia, mental retardation, substance dependence, etc. 2. Patients with metal objects in the body or with other contraindications to MRI scanning 3. Patients with severe or unstable somatic diseases 4. Women during pregnancy or lactation, and women of childbearing age with positive urine HCG test results during the screening period 5. Other conditions that, in the opinion of the investigator, exist that make participation in this clinical trial inappropriate.

Study locations

The First Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang 310000 China

Before you participate: Varda Clinical is an independent discovery tool, not the study sponsor or a medical provider. Eligibility can only be determined by the official study team. Discuss potential risks and benefits with a qualified healthcare professional.

Source: ClinicalTrials.gov. Record last refreshed by Varda Clinical: 2026-09-27.