Effects of rTMS Compared to SSRI as Early Treatment of Depression (Early-TMS)
Major Depressive Disorder
What this study involves
The registry says this study is recruiting. Individual locations may have different availability.
- Study type
- Interventional
- Phase
- Not applicable
- Age range
- 18 years - 65 years
- Sex eligible
- All sexes
- Healthy volunteers
- Not accepted
- Participants
- 106 Estimated
These are starting points, not an eligibility decision. The research team must review the full requirements.
About the research
The aim of this randomized multicentre phase 2 clinical trial is to compare the effects of rTMS and SSRI medication as early treatment of depression. In this two-stage, therapy response-adapted trial, 106 patients suffering from non-treatment resistant major depression (non-TR MD) will be randomized in Stage I to either 4 weeks bilateral theta burst stimulation (TBS) or 4 weeks antidepressant SSRI medication. The allocation to Stage II occurs therapy response-adapted. Patients receive either a maintenance treatment or a switch to the respective other treatment arm. The primary outcome is the comparison of the two study arms with regard to therapy response measured with the Montgomery-Asberg Depression Rating Scale (MADRS) after 4 weeks at the end of Stage I.
Read the full description
This is a therapy response-adapted, two-phase, randomized and controlled study. Initially, the study participants will be randomized to two treatment arms (Stage I: 4 weeks TBS vs. SSRI). After completion of Stage I, the allocation to Stage II (4 weeks) occurs therapy response-adapted. The type of further treatment depends on whether a remission, a treatment response or non-response has occurred in Stage I. If remission has been achieved, the treatment form already applied is continued as maintenance therapy. In the case of non-response, a switch to the other treatment arm takes place. For patients who show a treatment response but have not achieved remission, the corresponding patient preference is given special consideration for Stage II and thus determines the type of further treatment. Depending on patient preference, it is therefore possible both to continue treatment from Stage I and to switch to the other treatment arm.
The study aims to answer the question of whether a 4-week bilateral TBS is not inferior to standard antidepressant treatment with an SSRI in drug-naïve patients with MD in terms of efficacy and tolerability.
Who may be able to participate?
The list below is the sponsor’s full registry wording. It can include conditions, prior treatment, test results and other requirements. A match in search does not mean you qualify.
Inclusion Criteria:
- male, female, or diverse gender;
- age between 18 and 65 years;
- moderate to severe MD according to the diagnostic criteria of DSM-5;
- MADRS Score ≥ 20 points;
- the duration of the episode must be at least 2 weeks and not exceed a period of 2 years;
- no previous antidepressant treatment; indication for antidepressant medication;
- patients must be capable of giving informed consent.
Exclusion Criteria:
- acute suicidal ideation (MADRS item 10 score \> 4);
- presence of psychotic symptoms;
- antiepileptic drugs or benzodiazepines in a dosage equivalent to \> 1 mg Lorazepam/d;
- comorbid Axis I disorder (except anxiety disorders and ADHD);
- presence of severe, clinically relevant, and predominant comorbid personality disorder;
- treatment resistance defined as the failure of at least one adequate antidepressant treatment attempt in the current or previous depressive episode;
- neurological pre-existing conditions such as severe traumatic brain injury, neoplasms, brain surgery, stroke within the last 3 months, neurodegenerative diseases: epilepsy or history of epileptic seizures;
- cardiac pacemaker (not compatible with MRI);
- intracranial metallic implants;
- previous rTMS treatment;
- deep brain stimulation;
- other severe somatic diseases; pregnancy;
- contraindications for the use of escitalopram.
Treatment, groups and participation
The registry may describe treatments and study duration without a complete visit calendar. Ask the study team for the exact schedule, procedures, risks, costs and alternatives. Keep your usual care plan unless your treating clinician tells you otherwise.
- Assignment
- Random assignment
- Masking
- Single masked
theta burst stimulation (TBS)
In Stage I, participants receive 4-week bilateral theta burst stimulation. Bilateral TBS consists of 20 sessions that are conducted daily from Monday to Friday over a period of 4 weeks. The target regions are the right and left dorsolateral prefrontal cortex (dlPFC). On the left hemisphere, intermittent TBS (iTBS) is applied, which has a stimulating effect on the target region similar to 10 Hz rTMS. On the right dlPFC, continuous TBS (cTBS) is applied, which has an inhibitory effect similar to 1 Hz rTMS.
Device: bilateral theta burst stimulation
SSRI treatment
In Stage I, participants receive escitalopram (10mg/day) as standard medication for 4 weeks. In justified individual cases and according to the decision of the study physician, a higher dose or another SSRI can be administered.
Drug: SSRI treatment
bilateral theta burst stimulation DEVICE
Each stimulation session consists of 600 stimuli applied in bursts of 3 pulses at 50 Hz, with an interstimulus interval of 200 ms. iTBS is administered 20 times for 2 seconds to the left dlPFC, with an intertrain interval of 8 seconds and cTBS continuously for 40 seconds to the right dlPFC in alternating order.
SSRI treatment DRUG
Participants receive 4 weeks SSRI treatment with escitalopram (10mg/day) as standard drug.
What researchers are measuring
Outcome measures describe what is being studied. They are not proof that a treatment works.
Primary measures
response rates after Stage I
Time frame: 4 weeks
The primary endpoint is the comparison of the two study arms with regard to the number of participants achieving therapy response (reduction of MADRS score ≥ 50%) after 4 weeks at the end of Stage I.
Review the complete result tables and limitations in the official record.
Open official results ↗Research locations (1)
The overall study status and a local site’s status can differ. Confirm that location’s availability before traveling.
1 locations
University Hospital TuebingenTübingen, GermanyRecruiting
Study team and timeline
- Lead sponsor
- University Hospital Tuebingen
- Study start
- Sep 15, 2024 Actual
- Primary completion
- Jul 31, 2027 Estimated
- Study completion
- Dec 31, 2027 Estimated
- First posted
- Aug 9, 2024 Actual
- Last updated
- Nov 10, 2026 Actual
Official study contacts
Official study title
Repetitive Transcranial Magnetic Stimulation (rTMS) as an Early Intervention in Major Depression (MD) Compared to Antidepressant Selective Serotonin Reuptake Inhibitor (SSRI) Medication (Early-TMS)
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Source: ClinicalTrials.gov API v2. Information is submitted by sponsors and investigators. NLM does not approve the safety or science of all listed studies. Registry disclaimer.
Retrieved: Nov 12, 2026 · Last registry update: Nov 10, 2026