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Posttraumatic Stress Disorder (PTSD)NCT07327385

To Investigate the Change of Brain and Autonomic Function From Different Protocols of Repeated Transcranial Magnetic Stimulation Therapy for Patients With Post-traumatic Stress Disorder Comorbid Major Depressive Disorder

A study testing Prolonged Intermittent Theta-Burst Stimulation (prolonged iTBS) and High-Frequency Repetitive Transcranial Magnetic Stimulation (HF-rTMS) in people with Posttraumatic Stress Disorder (PTSD) and Depression - Major Depressive Disorder, run by Tri-Service General Hospital (TSGH) at 1 site in Taiwan.

Not yet recruiting

Opening soon. The study is approved but enrolment has not started yet. Sites may already take enquiries.

Sites and contacts
Official record
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Trial summary

This study aims to investigate the immediate neurophysiological and autonomic effects of two noninvasive brain stimulation protocols-prolonged intermittent theta-burst stimulation (prolonged iTBS) and high-frequency repetitive transcranial magnetic stimulation (HF-rTMS)-in patients with posttraumatic stress disorder… Read more about this study

Who is it for?
Ages 18 to 65 years
What is being tested?
Prolonged Intermittent Theta-Burst Stimulation (prolonged iTBS) and High-Frequency Repetitive Transcranial Magnetic Stimulation (HF-rTMS)
Type of treatment
Medical device
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
50 participants
Where
1 siteTaiwan
Study dates
9 Feb 2026to 31 Dec 2028
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 65 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Adults aged 18 to 65 years.
  • Clinical diagnosis of posttraumatic stress disorder (PTSD) according to DSM-5 criteria, confirmed by a board-certified psychiatrist.
  • Presence of comorbid major depressive disorder with stable clinical condition.
  • PTSD symptom severity defined as: PTSD Checklist for DSM-5, Chinese version (C-PCL-5) total score ≥ 31.
  • Depressive symptom severity defined as: Patient Health Questionnaire-9 (PHQ-9) total score ≥ 10.
  • Stable psychiatric medication regimen for at least 4 weeks prior to enrollment, or medication-free.
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  • Ability to understand the study procedures and provide written informed consent.
  • Normal or corrected-to-normal vision and hearing.
  • Ability to comply with study procedures and visit schedule.

Who cannot join

  • Lifetime diagnosis of schizophrenia spectrum disorders, bipolar disorder, or pervasive developmental disorders.
  • Alcohol or substance use disorder (excluding caffeine and nicotine) within the past 6 months.
  • Ongoing trauma-focused psychotherapy during the study period.
  • Prior exposure to repetitive TMS treatment exceeding five sessions.
  • Current or recent (within the past year) suicidal ideation or behavior, defined as: PHQ-9 item 9 score ≥ 1, confirmed by clinical psychiatric evaluation.
  • Self-injurious behavior requiring medical attention within the past 3 months.
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  • History of epilepsy, seizure disorder, or family history of epilepsy.
  • Significant neurological disorders, severe traumatic brain injury, or history of brain surgery.
  • Presence of implanted metallic or electronic medical devices (e.g., pacemakers, cochlear implants, neurostimulators).
  • Uncontrolled major medical illnesses or severe cardiovascular disease.
  • Pregnancy or breastfeeding.
  • Skin lesions or infections at the stimulation site.
  • Use of medications known to significantly lower seizure threshold (e.g., tricyclic antidepressants or certain analgesics).
  • Any condition deemed by the investigator to render the participant unsuitable for rTMS.

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Taiwan1 site
  • Tri-Service General Hospital

    Taipei, Neihu, 114

    Tso-Yi Chao, BS, 886-2-87923311 ext. 754660, loveinazuma1917@gmail.com

    Tien-Yu Chen, PhD, MD

Other trials in Taiwan

About this study

Official title: The Pathophysiological Mechanisms and Novel Treatments Linking Stress and Mental Health Conditions -To Investigate the Change of Brain and Autonomic Function From Different Protocols of Repeated Transcranial Magnetic Stimulation Therapy for Patients With Post-traumatic Stress Disorder Comorbid Major Depressive Disorder: a Randomized, Double-blind, Crossover Study

This study aims to investigate the immediate neurophysiological and autonomic effects of two noninvasive brain stimulation protocols-prolonged intermittent theta-burst stimulation (prolonged iTBS) and high-frequency repetitive transcranial magnetic stimulation (HF-rTMS)-in patients with posttraumatic stress disorder (PTSD) comorbid with major depressive disorder (MDD). Using a randomized, double-blind, sham-controlled crossover design, changes in prefrontal cortical activity measured by functional near-infrared spectroscopy (fNIRS) and autonomic nervous system function measured by heart rate variability (HRV) will be assessed before and immediately after a single stimulation session.

Read the detailed description

Posttraumatic stress disorder (PTSD) is a chronic psychiatric condition frequently accompanied by depressive symptoms and autonomic dysregulation. Although pharmacotherapy and psychotherapy are standard treatments, many patients show limited response or experience significant side effects. Repetitive transcranial magnetic stimulation (rTMS) has emerged as a promising noninvasive neuromodulatory intervention; however, the optimal stimulation protocol for PTSD remains unclear.

This randomized, double-blind, crossover study is designed to compare the immediate effects of prolonged iTBS and HF-rTMS applied to the right dorsolateral prefrontal cortex (DLPFC) on brain function and autonomic regulation in adults with PTSD comorbid with MDD. Each participant will receive one active stimulation session (either prolonged iTBS or HF-rTMS) and one sham stimulation session in a randomized order, separated by a 7-day washout period to minimize carryover effects.

Prefrontal cortical activation will be measured using multi-channel functional near-infrared spectroscopy (fNIRS), and autonomic nervous system activity will be assessed using heart rate variability (HRV) analysis derived from electrocardiographic recordings. The primary objective is to characterize protocol-specific neurophysiological response patterns and identify quantifiable biomarkers of brain stimulation response that may inform future personalized treatment strategies for PTSD with comorbid depression.

Being tested
Prolonged Intermittent Theta-Burst Stimulation (prolonged iTBS), High-Frequency Repetitive Transcranial Magnetic Stimulation (HF-rTMS), Sham Transcranial Magnetic Stimulation
Keywords
PTSD, functional near-infrared spectroscopy, Heart Rate Variability; HRV, rTMS
Medical subject headings
Stress Disorders, Post-Traumatic

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Prolonged Intermittent Theta-Burst Stimulation (prolonged iTBS)Device

    Prolonged intermittent theta-burst stimulation is delivered using a Magstim Rapid2 stimulator with a figure-eight coil targeting the right dorsolateral prefrontal cortex (DLPFC), localized with the Beam F4 method. Stimulation is administered at 80% of individual motor threshold using an intermittent theta-burst pattern (2 seconds on, 8 seconds off), consisting of 3-pulse bursts at 50 Hz repeated at 5 Hz. A single session lasts approximately 9.5 minutes and delivers a total of 1,800 pulses.

  • High-Frequency Repetitive Transcranial Magnetic Stimulation (HF-rTMS)Device

    High-frequency rTMS is delivered using a Magstim Rapid2 stimulator with a figure-eight coil targeting the right dorsolateral prefrontal cortex (DLPFC), localized with the Beam F4 method. Stimulation follows the DASH protocol at 120% of motor threshold and 10 Hz frequency, with 4-second stimulation trains (40 pulses per train) followed by an 11-second inter-train interval, for a total of 75 trains. The single-session duration is approximately 18.75 minutes, delivering 3,000 pulses.

  • Sham Transcranial Magnetic StimulationDevice

    Sham stimulation is delivered using a placebo coil identical in appearance and acoustic output to the active coil but without producing a magnetic field sufficient to induce cortical stimulation. Sham sessions match the corresponding active stimulation protocol in duration and procedure to maintain blinding.

Study groups in NCT07327385
Study groupRoleWhat they receive
Prolonged iTBS With Sham ControlExperimentalParticipants in this arm receive a single-session prolonged intermittent theta-burst stimulation (prolonged iTBS) targeting the right dorsolateral prefrontal cortex, as well as a sham stimulation session in a randomized crossover sequence. Each stimulation session is separated by a 7-day washout period. Neurophysiological and autonomic measures are obtained immediately before and after each session.
Receives: Device: Prolonged Intermittent Theta-Burst Stimulation (prolonged iTBS); Device: Sham Transcranial Magnetic Stimulation
HF-rTMS With Sham ControlExperimentalParticipants in this arm receive a single-session high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) targeting the right dorsolateral prefrontal cortex, as well as a sham stimulation session in a randomized crossover sequence. Each stimulation session is separated by a 7-day washout period. Neurophysiological and autonomic measures are obtained immediately before and after each session.
Receives: Device: High-Frequency Repetitive Transcranial Magnetic Stimulation (HF-rTMS); Device: Sham Transcranial Magnetic Stimulation

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change in Prefrontal Cortical Activation

    Change in prefrontal cortical activation, measured as differences in oxygenated hemoglobin (HbO₂) concentration using multi-channel functional near-infrared spectroscopy (fNIRS). Measurements are obtained at rest immediately before and immediately after each stimulation session to assess acute neurophysiological effects of prolonged intermittent theta-burst stimulation and high-frequency repetitive transcranial magnetic stimulation.

    Measured: Immediately before stimulation and immediately after each single stimulation session (active and sham), within each study period

Secondary outcomes (4)
  1. Change in Autonomic Nervous System Activity

    Autonomic nervous system activity assessed by heart rate variability (HRV) derived from 5-minute resting-state electrocardiographic recordings. HRV parameters are analyzed to evaluate acute changes in autonomic regulation following active versus sham brain stimulation.

    Measured: Immediately before stimulation and immediately after each single stimulation session (active and sham), within each study period

  2. Incidence of Adverse Events

    Frequency and type of adverse events, including local discomfort, headache, dizziness, autonomic symptoms, or other reported events, assessed using standardized safety checklists immediately after stimulation, during 24-hour follow-up, and at post-study visit.

    Measured: From the start of the first stimulation session through 7 days after the second stimulation session

  3. Change in PTSD Symptom Severity

    Change in posttraumatic stress disorder symptom severity measured by the PTSD Checklist for DSM-5, Chinese version (C-PCL-5), used to monitor symptom stability and safety during the crossover study. This instrument consists of 20 items, each scored from 0 to 4, resulting in a total score range of 0-80. A cut-off score between 31 and 33 is commonly used to indicate clinically significant symptoms, with higher scores reflecting greater symptom severity.

    Measured: Baseline, before the second stimulation session (Day 8), and 7 days after completion of the crossover phase

  4. Change in Depressive Symptom Severity

    Change in depressive symptom severity assessed using the Patient Health Questionnaire-9 (PHQ-9), primarily for safety monitoring and detection of symptom exacerbation during the study period. The 9-item PHQ-9 utilizes a 4-point Likert scale ranging from 0 (not at all) to 3 (nearly every day), with a total score range of 0-27. Scores are interpreted as mild (10-14), moderate (15-19), or severe (≥ 20) depressive symptoms.

    Measured: Baseline, before the second stimulation session (Day 8), and 7 days after completion of the crossover phase

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted8 Jan 2026
  2. Study start9 Feb 2026 (estimated)
  3. Primary completion31 Dec 2028 (estimated)
  4. Study completion31 Dec 2028 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Crossover
Model description
This study uses a randomized, double-blind, sham-controlled, crossover design to examine the immediate neurophysiological effects of noninvasive brain stimulation in patients with posttraumatic stress disorder comorbid with major depressive disorder. Each participant receives both an active stimulation session (either prolonged intermittent theta-burst stimulation or high-frequency repetitive transcranial magnetic stimulation) and a sham stimulation session in a randomized sequence. A washout period of 7 days is implemented between sessions to minimize potential carryover effects. Blinding is maintained for participants and outcome assessors, while stimulation operators are not involved in outcome evaluation. Prefrontal cortical activity and autonomic nervous system responses are assessed immediately before and after each stimulation session.
Masking
Double blind
Who is masked
Participant, Outcomes assessor
Enrolment
50 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07327385
Sponsor's protocol ID
C202405067
Status last verified
Feb 2026
First submitted
24 Dec 2025
Last updated
17 Feb 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No

Questions about this trial

What is this clinical trial studying?

A study testing Prolonged Intermittent Theta-Burst Stimulation (prolonged iTBS) and High-Frequency Repetitive Transcranial Magnetic Stimulation (HF-rTMS) in people with Posttraumatic Stress Disorder (PTSD) and Depression - Major Depressive Disorder, run by Tri-Service General Hospital (TSGH) at 1 site in Taiwan.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 9 inclusion and 14 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: opening soon, as of the sponsor's last update on 17 Feb 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Taiwan. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Tao-Yi Chao, BS (886-2-87923311 ext. 754660, loveinazuma1917@gmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change in Prefrontal Cortical Activation (time frame: Immediately before stimulation and immediately after each single stimulation session (active and sham), within each study period). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 17 Feb 2026.

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