Synchronized Cervical or Auricular VNS With Prefrontal rTMS for Treatment Resistant Depression (TRD)
Medical University of South Carolina
Summary
The purpose of the research is to test out a combined treatment for depression where the investigators stimulate a nerve in the ear while at the same time stimulate the brain with magnets. These treatments are called transcutaneous (through the skin) auricular (ear) vagus nerve stimulation (taVNS) and transcranial (through the skull) magnetic stimulation (TMS). For participants who already have a cervical VNS device, the investigators will not change their treatment and will use this in place of the taVNS. The investigators think this combined method might treat depressive symptoms better than either alone. This study is in person at the Institute of Psychiatry in downtown Charleston on the MUSC campus. First, participants will have a screening session and then will have 6 treatment days total where participants will receive either VNS treatment alone, TMS treatment alone, or both at the same time. The treatment that participants start with will be randomized, and they will have 2 treatment days of each combination.
Eligibility
- Age range
- 18–75 years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria: * 18-75 years old * Undergoing cervical VNS or have tried and failed two antidepressant medications in the current episode * Able to provide informed consent * English speaking and can read and write * 17-item Hamilton Depression Rating Scale (HAM-D) score ≥20 * Not responding to talking therapy. Exclusion Criteria: * Preexisting neurological disorders, or dementia * History of major head trauma * Life expectancy \<1 year * Any type of cognitive impairment that would require approval/signature of a legal guardian/representative for participation * A score of \>2 on quest…
Interventions
- DeviceVagus Nerve Stimulation
All taVNS sessions will use the following parameters: 25Hz, 500us pulse width, on for 7 seconds, off for 12 seconds.The length of VNS treatment sessions will be identical to TMS treatment sessions and will have the same 30 minute break between each treatment session. These treatments (active or sham) will be administered to participants each treatment day, for a total of 6 different treatment days, but only 4 are active.
- DeviceTranscranial Magnetic Stimulation
Participants will receive 20 trains of 30 pulses each for a total of 600 pulses per session. We will repeat this for 6 sessions each day, with at least 30 minutes between each session. These treatments (active or sham) will be administered to participants each treatment day, for a total of 6 different treatment days, but only 4 are active, so participants will get 24 TMS sessions over the course.
Location
- Medical University of South Carolina Institute of PsychiatryCharleston, South Carolina