NCT07507214

Optimized, Neuroplasticity-Enhanced-Depression (ONE-D) Transcranial Magnetic Stimulation (TMS) Treatment for Female Athletes With Co-morbid Depression and Concussion

Optimized, Neuroplasticity Enhanced-Depression (ONE-D) Transcranial Magnetic Stimulation (TMS) Treatment for Female Athletes With Co-morbid Depression and Concussion

• Status: Not Yet Recruiting
• Phase: Phase 2 / Phase 3
• Study type: Interventional
• Enrollment: 35 (estimated)
• Sponsor: University of Florida · Academic / Other
• Sex: Female
• Age: 18 Years – 65 Years
• Healthy volunteers: Not accepted

Summary

Concussion and depression have long been recognized to be intertwined pathologies.1-3 Although female athletes are more likely to suffer from mental health symptoms than males athletes following a concussion,2 research in this area has been largely biased toward males.4 Recently functional MRI (fMRI) studies5 in concussed athletes have established that there are patterns of local alterations in neural connectivity in the frontal cortex that demonstrate anatomic congruency with transcranial magnetic stimulation (TMS) studies that mapped alternations in neural connectivity to functional and somatic symptoms.6 Thus, there is potential that TMS treatment could decrease both symptom profiles, revolutionizing comorbid treatment options. Possible Benefits: Previous studies have showed a 70% remission rate for depression symptoms. It is possible that participants could have improvement in depressive or concussive symptoms after the ONE-D TMS treatment.

Detailed description

Concussion and depression have long been recognized to be intertwined pathologies.1-3 Although female athletes are more likely to suffer from mental health symptoms than males athletes following a concussion,2 research in this area has been largely biased toward males.4 Recently functional MRI (fMRI) studies5 in concussed athletes have established that there are patterns of local alterations in neural connectivity in the frontal cortex that demonstrate anatomic congruency with transcranial magnetic stimulation (TMS) studies that mapped alternations in neural connectivity to functional and somatic symptoms.6 Thus, there is potential that TMS treatment could decrease both symptom profiles, revolutionizing comorbid treatment options. The objective of this application is to treat female athletes with depression and concussion with the Optimized, Neuroplasticity-Enhanced techniques in Depression (ONE-D) protocol.7 This is an innovative, one-day duration TMS treatment for depression. We propose to utilize tradition depression assessments, such as the Patient Health Questionnaire 9 (PHQ-9)8, as well as athlete-specific symptom inventories, including the Post-Concussion Symptom Scale (PCSS)9 and the Sport Mental Health Assessment Tool 1 (SMHAT-1)10 surveys to test our central hypothesis that female athletes with a history of concussion and depression will experience symptom improvement in depression inventories as well as athlete-specific symptom domains. We will assess associations between TMS treatment and depression through PHQ-9 and SMHAT-1 and associations between TMS treatment and concussion symptoms through PCSS. Treatment Delivery Once the subject completes the consent process, they will begin the ONE-D TMS protocol.9 The protocol consists of pharmacologic neural priming via a single dose of orally dissolving d-cycloserine (125 mg).The UF-World Equestrian center (WEC) pharmacy will dispense this medication prior to the study visit. The WEC pharmacy is located in the same physical building as the clinic where the treatment will take place. Patients will obtain their medication from the pharmacy prior to their treatment appointment. The medications will be consumed one hour (50-70 min) prior to the start of the first treatment under study staff supervision. After consuming the medication, the participant will begin baseline symptom inventory scores, including Sport Concussion Office Assessment Tool 6 (SCOAT6), Post-Concussion Symptom Scale (PCSS), Patient Health Questionnaire 9 (PHQ-9) and the Sport Mental Health Assessment Tool 1 (SMHAT-1).18 The treatment protocol consists of an AMPA device delivering accelerate theta-burst stimulation for a total of 600 pulses over 3 minute sessions.9 The treatment is repeated every 30 minutes (± 3 min) for a total of 20 sessions over 9.5 hours in a single day. The treatment will be performed by the research assistant or the research coordinator under PI supervision. The Ampa TMS system was selected for this study as it uses anatomic locations to guide treatment targets, as opposed to other commercially available TMS systems that require FMRI imaging to create individual treatment plans. AMPS technology is FDA approved to be utilized in this manner. Treatment parameters: * 3 Hz x 600 pulses * 90% of motor threshold for contralateral upper extremity Symptom inventories will be recorded at weeks 3, 6, and 12 after the treatment session. The surveys will be collected through Redcap. Due to the nature of the surveys, the subjects will be called by a member of the research team during business hours so that if any subject is deemed positive for suicidality, the research team can immediately contact the PI and refer patient to treatment as stated in DSMB/DSMP. This may include a 911 welfare check. At the 12-week mark, the subjects will be called via zoom video call to complete the SCOAT6. 1. Mez J, Daneshvar DH, Kiernan PT, et al. Clinicopathological Evaluation of Chronic Traumatic Encephalopathy in Players of American Football. JAMA. 2017;318(4):360-370. doi:10.1001/jama.2017.8334 2. Sandhu MRS, Schonwald A, Boyko M, et al. The association between female sex and depression following traumatic brain injury: A systematic review and meta-analysis. Neurosci Biobehav Rev. 2025;168:105952. doi:10.1016/j.neubiorev.2024.105952 3. McKee AC, Mez J, Abdolmohammadi B, et al. Neuropathologic and Clinical Findings in Young Contact Sport Athletes Exposed to Repetitive Head Impacts. JAMA Neurol. 2023;80(10):1037-1050. doi:10.1001/jamaneurol.2023.2907 4. D'Lauro C, Jones ER, Swope LM, Anderson MN, Broglio S, Schmidt JD. Under-representation of female athletes in research informing influential concussion consensus and position statements: an evidence review and synthesis. Br J Sports Med. Published online July 18, 2022:bjsports-2021-105045. doi:10.1136/bjsports-2021-105045 5. Meier TB, Giraldo-Chica M, España LY, et al. Resting-State fMRI Metrics in Acute Sport-Related Concussion and Their Association with Clinical Recovery: A Study from the NCAA-DOD CARE Consortium. J Neurotrauma. 2020;37(1):152-162. doi:10.1089/neu.2019.6471 6. Milano BA, Palm S, Burke MJ, et al. Lesion network localization of functional and somatic symptoms. MedRxiv Prepr Serv Health Sci. Published online March 7, 2025:2025.03.06.25323494. doi:10.1101/2025.03.06.25323494 7. Vaughn DA, Marino B, Engelbertson A, et al. Real-world effectiveness of a single-day regimen for transcranial magnetic stimulation using Optimized, Neuroplasticity-Enhanced techniques in Depression (ONE-D): An open-label case series. Transcranial Magn Stimul. 2025;5. doi:10.1016/j.transm.2025.100200 8. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606-613. doi:10.1046/j.1525-1497.2001.016009606.x 9. Kontos AP, Elbin RJ, Schatz P, et al. A revised factor structure for the post-concussion symptom scale: baseline and postconcussion factors. Am J Sports Med. 2012;40(10):2375-2384. doi:10.1177/0363546512455400 10. Gouttebarge V, Bindra A, Blauwet C, et al. International Olympic Committee (IOC) Sport Mental Health Assessment Tool 1 (SMHAT-1) and Sport Mental Health Recognition Tool 1 (SMHRT-1): towards better support of athletes' mental health. Br J Sports Med. 2021;55(1):30-37. doi:10.1136/bjsports-2020-102411 11. Eagle SR, Womble MN, Elbin RJ, Pan R, Collins MW, Kontos AP. Concussion Symptom Cutoffs for Identification and Prognosis of Sports-Related Concussion: Role of Time Since Injury. Am J Sports Med. 2020;48(10):2544-2551. doi:10.1177/0363546520937291 12. Broglio SP, Cantu RC, Gioia GA, et al. National Athletic Trainers' Association position statement: management of sport concussion. J Athl Train. 2014;49(2):245-265. doi:10.4085/1062-6050-49.1.07 13. D'Lauro C, Jones ER, Swope LM, Anderson MN, Broglio S, Schmidt JD. Under-representation of female athletes in research informing influential concussion consensus and position statements: an evidence review and synthesis. Br J Sports Med. Published online July 18, 2022:bjsports-2021-105045. doi:10.1136/bjsports-2021-105045 14. Musko PA, Demetriades AK. Are Sex Differences in Collegiate and High School Sports-Related Concussion Reflected in the Guidelines? A Scoping Review. Brain Sci. 2023;13(9):1310. doi:10.3390/brainsci13091310 15. Harmon KG, Drezner J, Gammons M, et al. American Medical Society for Sports Medicine position statement: concussion in sport. Clin J Sport Med Off J Can Acad Sport Med. 2013;23(1):1-18. doi:10.1097/JSM.0b013e31827f5f93 16. Rogers DL, Tanaka MJ, Cosgarea AJ, Ginsburg RD, Dreher GM. How Mental Health Affects Injury Risk and Outcomes in Athletes. Sports Health. 2024;16(2):222-229. doi:10.1177/19417381231179678 17. Wolanin A, Hong E, Marks D, Panchoo K, Gross M. Prevalence of clinically elevated depressive symptoms in college athletes and differences by gender and sport. Br J Sports Med. 2016;50(3):167-171. doi:10.1136/bjsports-2015-095756 18. Rogers DL, Tanaka MJ, Cosgarea AJ, Ginsburg RD, Dreher GM. How Mental Health Affects Injury Risk and Outcomes in Athletes. Sports Health. 2024;16(2):222-229. doi:10.1177/19417381231179678 19. Reardon CL, Factor RM. Sport psychiatry: a systematic review of diagnosis and medical treatment of mental illness in athletes. Sports Med Auckl NZ. 2010;40(11):961-980. doi:10.2165/11536580-000000000-00000 20. Mollica A, Greben R, Oriuwa C, Siddiqi SH, Burke MJ. Neuromodulation Treatments for Mild Traumatic Brain Injury and Post-concussive Symptoms. Curr Neurol Neurosci Rep. 2022;22(3):171-181. doi:10.1007/s11910-022-01183-w 21. Patricios JS, Schneider KJ, Dvorak J, et al. Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport-Amsterdam, October 2022. Br J Sports Med. 2023;57(11):695-711. doi:10.1136/bjsports-2023-106898 22. Coris EE, Moran B, Sneed K, et al. Stimulant Therapy Utilization for Neurocognitive Deficits in Mild Traumatic Brain Injury. Sports Health. 2022;14(4):538-548. doi:10.1177/19417381211031842 23. Sharp T, Collins H. Mechanisms of SSRI Therapy and Discontinuation. Curr Top Behav Neurosci. 2024;66:21-47. doi:10.1007/7854\_2023\_452 24. Billingham SAM, Whitehead AL, Julious SA. An audit of sample sizes for pilot and feasibility trials being undertaken in the United Kingdom registered in the United Kingdom Clinical Research Network database. BMC Med Res Methodol. 2013;13:104. doi:10.1186/1471-2288-13-104 25. Browne RH. On the use of a pilot sample for sample size determination. Stat Med. 1995;14(17):1933-1940. doi:10.1002/sim.4780141709 26. Wennberg R, Hiploylee C, Tai P, Tator CH. Is Concussion a Risk Factor for Epilepsy? Can J Neurol Sci J Can Sci Neurol. 2018;45(3):275-282. doi:10.1017/cjn.2017.300 27. Fitzgerald PB. An update on the clinical use of repetitive transcranial magnetic stimulation in the treatment of depression. J Affect Disord. 2020;276:90-103. doi:10.1016/j.jad.2020.06.067 28. Mathias CW, Michael Furr R, Sheftall AH, Hill-Kapturczak N, Crum P, Dougherty DM. What's the harm in asking about suicidal ideation? Suicide Life Threat Behav. 2012 Jun;42(3):341-51.

Conditions

• Concussion
• Depression

Interventions

Type	Name	Description
DEVICE	ONE-D TMS protocol and d-cycloserine (125 mg)	Begin the ONE-D TMS protocol.9 The protocol consists of pharmacologic neural priming via a single dose of orally dissolving d-cycloserine (125 mg).

Timeline

• Start date: 2026-06-01
• Primary completion: 2028-06-01
• Completion: 2028-06-01
• First posted: 2026-04-02
• Last updated: 2026-04-02

Locations

1 site across 1 country: United States

Regulatory

• FDA-regulated device study