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Depression - Major Depressive DisorderDUAL MODNCT07879924

Dual Neuromodulation for Depression: Boosting TMS With tES

A study testing Transcranial Magnetic Stimulation and Transcranial Alternating Current Stimulation in people with Depression - Major Depressive Disorder, run by Mersey Care NHS Trust at 2 sites in United Kingdom.

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

Major depressive disorder (MDD) is a common and disabling condition. Transcranial magnetic stimulation (TMS) is an established non-invasive neuromodulation treatment for depression, but clinical response varies considerably between individuals. Read more about this study

Who is it for?
Ages 18 to 59 years
Conditions the study is for
Depression - Major Depressive Disorder
What is being tested?
Transcranial Magnetic Stimulation and Transcranial Alternating Current Stimulation
Type of treatment
Medical device
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
60 participants
Where
2 sitesUnited Kingdom
Study dates
Sep 2026to Sep 2027
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 59 years
  • All sexes
  • No healthy volunteers
  • Adult

Who may be able to join

  • Adults aged 18-59 years old inclusive
  • Able to read and understand English
  • Capacity to provide informed consent to the study
  • PHQ-9 (Patient Health Questionnaire) score of 10-19 at screening
  • Meets criteria for a current major depressive episode (standardised SCID-RV interview)
  • Consents to researchers informing GP (and, if relevant, Local Mental Health Team) of study involvement

Who cannot join

  • Currently under, or in need of, the care of mental health crisis (intensive home treatment) services
  • Current mood disorder with psychotic features (SCID-5-RV interview)
  • Current or past diagnosis of bipolar disorder, psychotic disorder, dementia, or mild cognitive impairment, or in the last twelve months alcohol/substance use disorder (SCID-5-RV interview)
  • PHQ-9 suicide item score of greater than one
  • MADRS suicide item score of greater than three
  • Diagnosis of epilepsy or previous seizures or suspected seizures (other than seizures associated with fever with none beyond age five)
Show all 16Show fewer
  • Active significant skin conditions affecting the scalp, forehead or behind the ears (e.g. psoriasis)
  • Current known hearing problems or tinnitus
  • Cochlear implants, neurostimulators, pacemaker, intracardiac lines, infusion devices
  • Unremovable metal on head, neck or scalp (including unremovable hair extensions that contain metal, metallic piercings or red/orange/pink/yellow tattoos which may contain ferromagnetic dyes), or potential metal fragments in eyes
  • Known or suspected pregnancy (if, on the day, a participant is unsure, they will be given the option to rebook the testing session or to conduct a urine pregnancy test - however, they will be advised that pregnancy tests are only accurate from the first day of a missed period)
  • Medications judged to carry a significant increased risk of seizures
  • Allergies to substances in the tACS paste
  • Major unstable medical illness requiring further investigation or treatment
  • Changes in psychoactive medications in the two weeks preceding screening
  • Involvement in another clinical trial in the past three months, or current involvement in research study or trial that involves an intervention (medication, neuromodulation, psychotherapy)

Trial locations and contacts

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

United Kingdom2 sites
  • Mersey Care Mood Clinic at Knowsley Resource and Recovery Centre

    Liverpool, L35 5DR

    Jade Thai, +44 151 351 8858, jade.thai@merseycare.nhs.uk

    Yue Peng

  • Mersey Care Mood Clinic at Knowsley Resource and Recovery Centre

    Liverpool, L35 5DR

    Yue Peng

Other trials in United Kingdom

About this study

Official title: Developing an Approach for Boosting the Effects of Transcranial Magnetic Stimulation in Major Depressive Disorder Using Synchronised Transcranial Electrical Stimulation ("tsTMS")

Major depressive disorder (MDD) is a common and disabling condition. Transcranial magnetic stimulation (TMS) is an established non-invasive neuromodulation treatment for depression, but clinical response varies considerably between individuals. One possible reason for this variability is that the effects of TMS may depend on the pattern of ongoing brain activity at the time stimulation is delivered.

This mechanistic, randomised, single-blind study will investigate whether synchronising TMS with transcranial alternating current stimulation (tACS), a form of weak electrical brain stimulation, can enhance the neurophysiological and cognitive effects of TMS in people experiencing a current moderate major depressive episode. The combined intervention is referred to as synchronised TMS (tsTMS).

Read more

Up to 60 participants will be recruited and randomised in a 1:1:1 ratio to one of three groups: (1) TMS synchronised to the peak of a theta-frequency tACS waveform, (2) TMS synchronised to the trough of a theta-frequency tACS waveform, or (3) TMS combined with sham tACS. Participants will receive five daily neuromodulation sessions over one week.

The primary objective is to estimate variability in change in emotional processing, measured using the Cambridge Cognition Emotional Bias Task, in order to inform the design and sample size calculation of a future clinical trial. The study will also assess participant acceptability and tolerability of the intervention. Secondary objectives include exploring changes in brain oscillatory activity measured using electroencephalography (EEG), cognitive performance, mood and anxiety symptoms, functional outcomes, and digital biomarkers collected from an optional wearable device.

This study is designed to investigate mechanisms and feasibility rather than provide a full therapeutic course of TMS. Findings will be used to inform the development of a future definitive clinical trial evaluating whether synchronised neuromodulation can improve outcomes in depression.

Being tested
Transcranial Magnetic Stimulation, Transcranial Alternating Current Stimulation
Keywords
Transcranial Magnetic Stimulation, TMS, Major Depressive Disorder, MDD, Depression, Neuromodulation, Transcranial Alternating Current Stimulation, tACS
Medical subject headings
Depressive Disorder, Major, Depression

What participants receive

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

  • Transcranial Magnetic StimulationDevice

    Also called TMS

    Transcranial Magnetic Stimulation (TMS) is a non-invasive neuromodulation intervention delivered using a magnetic coil positioned over the scalp to generate brief magnetic pulses that stimulate targeted cortical brain regions.

  • Transcranial Alternating Current StimulationDevice

    Also called tACS

    Transcranial Alternating Current Stimulation (tACS) is a non-invasive neuromodulation intervention that delivers a weak alternating electrical current through electrodes placed on the scalp to modulate neural oscillatory activity in targeted brain regions.

Study groups in NCT07879924
Study groupRoleWhat they receive
Peak synchronising TMS to tACS (tsTMS-p)ExperimentalNot described
Receives: Device: Transcranial Magnetic Stimulation; Device: Transcranial Alternating Current Stimulation
Trough synchronising TMS to tACS (tsTMS-t)ExperimentalNot described
Receives: Device: Transcranial Magnetic Stimulation; Device: Transcranial Alternating Current Stimulation
TMS with sham tACSPlacebo comparatorNot described
Receives: Device: Transcranial Magnetic Stimulation

What is being measured

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

  1. Change in emotional bias (Cambridge Neuropsychological Test Automated Battery (CANTAB) Emotional Bias task)

    Difference in shift of emotional bias between participants who receive five sessions of tsTMS (tACS + TMS) and participants who receive TMS alone (the two forms of tsTMS under study will be individually compared to TMS).

    Measured: First measured at the baseline session (28 days within the first stimulation session), then measured at the fifth stimulation session, and finally repeated at the follow-up session (within 7 days +/- 3 days after the final, fifth stimulation session)

  2. Frequency of adverse effects and tolerability

    Total adverse effects score derived from the participant-completed adverse effects questionnaire administered after each stimulation session. The total score combines the frequency and severity of reported adverse effects.

    Measured: After each of the five stimulation sessions.

  3. Participant experience and acceptability

    Participant perceptions of the acceptability and experience of receiving tsTMS or TMS with sham tACS and of participating in the study, assessed through a semi-structured qualitative interview.

    Measured: Follow-up visit within 7 days (±3 days) after the fifth stimulation session

Secondary outcomes (14)
  1. Change in task-related theta-frequency brain oscillatory activity

    Change in task-related theta-frequency brain oscillatory activity following neuromodulation, measured using electroencephalography (EEG). The outcome will compare changes in the fronto-midline theta activity during a working memory task between participants receiving tsTMS and those receiving TMS with sham tACS.

    Measured: Stimulation Day 1. Pre-stimulation to post-stimulation (multiple timepoints at 5 min and 30 min post-stimulation) within the same session.

  2. Change in Frontal Theta Power

    Change in resting-state frontal theta power measured using EEG during eyes-open and eyes-closed conditions before and after neuromodulation. Changes following tsTMS will be compared with TMS with sham tACS.

    Measured: Stimulation Day 1. Pre-stimulation to post-stimulation (multiple timepoints at 5min and 30min post-stimulation) within the same session.

  3. Change in Central Beta Power

    Change in resting-state central beta power measured using electroencephalogram (EEG) during eyes-open and eyes-closed conditions before and after neuromodulation. Changes following tsTMS will be compared with TMS with sham tACS.

    Measured: Stimulation Day 1. Pre-stimulation to post-stimulation (multiple timepoints at 5min and 30min post-stimulation) within the same session.

  4. Change in Occipital Alpha Power

    Change in resting-state occipital alpha power measured using EEG during eyes-open and eyes-closed conditions before and after neuromodulation. Changes following tsTMS will be compared with TMS with sham tACS.

    Measured: Stimulation Day 1. Pre-stimulation to post-stimulation (multiple timepoints at 5min and 30min post-stimulation) within the same session.

  5. Change in Subjective Cognitive Difficulties (Perceived Deficits Questionnaire for Depression, 5-item version (PDQ-5-D))

    Change in subjective cognitive difficulties from baseline to follow-up, assessed using the Perceived Deficits Questionnaire (PDQ-5-D). Changes following tsTMS will be compared with TMS with sham tACS.

    Total scores range from 0 to 20, with higher scores indicating greater perceived cognitive difficulties and lower scores indicating better subjective cognitive functioning.

    Measured: Baseline and follow-up visit (within 7 days ±3 days after the fifth stimulation session).

  6. Change in Choice Reaction Time

    Change in reaction time performance from baseline to follow-up, assessed using the THINC-it Choice Reaction Time task. Changes following tsTMS will be compared with TMS with sham tACS.

    Measured: Baseline and follow-up visit (within 7 days ± 3 days after the fifth stimulation session).

  7. Change in Digit Symbol Substitution Test (DSST) Performance

    Change in cognitive performance from baseline to follow-up, assessed using the Digit Symbol Substitution Test (DSST). Changes following tsTMS will be compared with TMS with sham tACS.

    The score is the total number of correct symbol-digit substitutions completed during the test period. Higher scores indicate better cognitive performance and faster processing speed, while lower scores indicate poorer performance.

    Measured: Baseline and follow-up visit (within 7 days ± 3 days after the fifth stimulation session).

  8. Change in Physical Activity Levels

    Change in physical activity levels measured using the optional EmbracePlus wearable device. Activity metrics include actigraphy-derived activity measures and step count. Changes following tsTMS will be compared with TMS with sham tACS.

    Measured: Continuously from baseline assessment until the follow-up visit (approximately 1 to 5 weeks).

  9. Change in Gait Characteristics

    Change in gait characteristics measured using the optional EmbracePlus wearable device from baseline to follow-up. Changes following tsTMS will be compared with TMS with sham tACS.

    Measured: Continuously from baseline assessment until the follow-up visit (approximately 1 to 5 weeks).

  10. Change in Sleep Metrics

    Change in sleep-related measures recorded using the optional EmbracePlus wearable device from baseline to follow-up. Changes following tsTMS will be compared with TMS with sham tACS.

    Measured: Continuously from baseline assessment until the follow-up visit (approximately 1 to 5 weeks).

  11. Change in Pulse Rate

    Change in pulse rate measured using the optional EmbracePlus wearable device from baseline to follow-up. Changes following tsTMS will be compared with TMS with sham tACS.

    Measured: Continuously from baseline assessment until the follow-up visit (approximately 1 to 5 weeks).

  12. Change in Skin Temperature

    Change in skin temperature measured using the optional EmbracePlus wearable device from baseline to follow-up. Changes following tsTMS will be compared with TMS with sham tACS.

    Measured: Continuously from baseline assessment until the follow-up visit (approximately 1 to 5 weeks).

  13. Change in Electrodermal Activity

    Change in electrodermal activity measured using the optional EmbracePlus wearable device from baseline to follow-up. Changes following tsTMS will be compared with TMS with sham tACS.

    Measured: Continuously from baseline assessment until the follow-up visit (approximately 1 to 5 weeks).

  14. Change in Respiratory Rate

    Change in respiratory rate measured using the optional EmbracePlus wearable device from baseline to follow-up. Changes following tsTMS will be compared with TMS with sham tACS.

    Measured: Continuously from baseline assessment until the follow-up visit (approximately 1 to 5 weeks).

Timeline

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

  1. First posted19 Oct 2026
  2. Study startSep 2026 (estimated)
  3. Primary completionAug 2027 (estimated)
  4. Study completionSep 2027 (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
Basic science
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Participant
Enrolment
60 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07879924
Sponsor's protocol ID
26/EE/0120
Acronym
DUAL MOD
Status last verified
Aug 2026
First submitted
24 Aug 2026
Last updated
19 Oct 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: Individual participant data (IPD) collected during this study will not be made available to other researchers due to participant confidentiality, consent limitations, and data governance requirements.

Publications

  • Briley PM, Boutry C, Webster L, Veniero D, Harvey-Seutcheu C, Jung J, Liddle PF, Morriss R. Intermittent theta burst stimulation with synchronised transcranial alternating current stimulation leads to enhanced frontal theta oscillations and a positive shift in emotional bias. Imaging Neurosci (Camb). 2024 Jan 25;2:imag-2-00073. doi: 10.1162/imag_a_00073. eCollection 2024.

    PubMed 40800403

Questions about this trial

What is this clinical trial studying?

A study testing Transcranial Magnetic Stimulation and Transcranial Alternating Current Stimulation in people with Depression - Major Depressive Disorder, run by Mersey Care NHS Trust at 2 sites in United Kingdom.

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 6 inclusion and 16 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 19 Oct 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in United Kingdom. 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. Some participants in this study may receive a placebo. 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 Yue Peng (+44 151 351 8858, dualmod.contact@merseycare.nhs.uk), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change in emotional bias (Cambridge Neuropsychological Test Automated Battery (CANTAB) Emotional Bias task) (time frame: First measured at the baseline session (28 days within the first stimulation session), then measured at the fifth stimulation session, and finally repeated at the follow-up session (within 7 days +/- 3 days after the final, fifth stimulation session)). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT07879924, which also lists 1 linked publication.

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 19 Oct 2026; AzTrials last refreshed its copy on 31 Oct 2026.

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