This multi-center, double-blind study, randomized controlled trial aims to evaluate the efficacy and safety of Temporal Interference transcranial Alternating Current Stimulation (TI-tACS) in patients with major depressive disorder (MDD) Participants with major depressive disorder will be randomized to receive high-frequency TI-tACS(130 Hz), low-frequency TI-tACS(2Hz), or sham stimulation targeting the right amygdala. The intervention consists of 20 stimulation sessions administered over 2 weeks (twice a day for 5 consecutive days, followed by a 2-day break, and another 5 consecutive days). Clinical assessments will be conducted at baseline, during treatment, and at multiple follow-up time points up to 6 months. The primary outcome for MDD is the change from baseline in the Hamilton Depression Rating Scale (HAMD-17) at week 2. Secondary outcomes include changes in clinical symptoms, cognitive function, and safety profiles.
Major depressive disorder (MDD) is a highly prevalent psychiatric disorder associated with substantial disability and impaired quality of life. Neuroimaging studies have demonstrated abnormalities in distributed cortical-subcortical circuits, particularly involving the amygdala, which plays a central role in emotional processing and symptom regulation. Although several neuromodulation techniques have shown therapeutic potential, currently available approaches have limited ability to selectively modulate deep brain structures without invasive procedures. Temporal interference transcranial alternating current stimulation (TI-tACS) is a novel non-invasive neuromodulation technique that delivers two high-frequency alternating currents with slightly different frequencies to generate a low-frequency envelope within deep brain regions. This approach enables selective modulation of deep neural structures, such as the amygdala, while minimizing stimulation of the overlying cortex. This is a multicenter, randomized, triple-blind, sham-controlled clinical trial designed to evaluate the efficacy, safety, and neurobiological mechanisms of TI-tACS in participants with MDD. Participants will be enrolled randomized to receive active or sham TI-tACS according to the study protocol. Approximately 102 participants will be recruited. Following written informed consent, participants will undergo baseline assessments and subsequent study evaluations according to the protocol. Study assessments include clinical evaluations, neurocognitive testing, electroencephalography (EEG), magnetic resonance imaging (MRI), and biological sample collection. TI-tACS treatment consists of 20 stimulation sessions administered over two weeks (two sessions per day for five consecutive days, followed by a two-day break, and another five consecutive treatment days). Participants will also complete scheduled post-treatment follow-up assessments to evaluate the persistence of treatment effects and the long-term safety of TI-tACS.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
102
Temporal Interference transcranial Alternating Current Stimulation (TI-tACS) is a non-invasive neuromodulation technique that generates a low-frequency (130HZ or 2HZ) envelope field in deep brain regions, particularly the right amygdala, through the interaction of two high-frequency currents.
Sham Temporal Interference transcranial Alternating Current Stimulation will mimic the sensory experience of active stimulation without delivering effective current.
Change from baseline in the Hamilton Depression Rating Scale(HAMD-17) scores at week 2.
The 17-item Hamilton Depression Rating Scale (HAMD-17) is a clinician-administered instrument used to assess the severity of depressive symptoms. The scale consists of 17 items with a total score ranging from 0 to 52. Higher scores indicate more severe depressive symptoms. The primary outcome for MDD participants will be calculated as the change in HAMD-17 score from baseline to Week 2.
Time frame: 2 weeks(from baseline)
Change in Montgomery-Åsberg Depression Rating Scale (MADRS) Score
The Montgomery-Åsberg Depression Rating Scale (MADRS) is a clinician-administered instrument used to assess the severity of depressive symptoms and sensitivity to treatment-related changes. The scale consists of 10 items with a total score ranging from 0 to 60. Higher scores indicate more severe depressive symptoms.
Time frame: Baseline to month 2 follow-up
Adverse Events Related to treatment
Incidence, type, and severity of adverse events related to the transcranial temporal interference stimulation, assessed using a standardized Neuromodulation Adverse Effects Questionnaire.
Time frame: Baseline to month 2 follow-up
Change in Patient Health Questionnaire-9 (PHQ-9)
A 9-item self-report questionnaire used to assess depressive symptom severity. Total scores range from 0 to 27, with higher scores indicating greater depression severity.
Time frame: Baseline to month 2 follow-up
Change in the Hamilton Anxiety Rating Scale (HAMA) Score
The Hamilton Depression Rating Scale-17 (HAMD-17) is a 17-item clinician-administered scale used to assess the severity of depressive symptoms. The total score ranges from 0 to 52, with higher scores indicating more severe depressive symptoms.
Time frame: Baseline to month 2 follow-up
Change in Young Mania Rating Scale (YMRS) Score
The Young Mania Rating Scale (YMRS) is an 11-item clinician-administered instrument used to assess the severity of manic symptoms and to monitor treatment-emergent mania or hypomania. Total scores range from 0 to 60, with higher scores indicating more severe manic symptoms.
Time frame: Baseline to month 2 follow-up
Change in Pittsburgh Sleep Quality Index (PSQI) Score
The Pittsburgh Sleep Quality Index (PSQI) is a 19-item self-report questionnaire used to assess subjective sleep quality and sleep disturbances over the previous month. The questionnaire generates a global score ranging from 0 to 21, with higher scores indicating poorer sleep quality.
Time frame: Baseline to month 2 follow-up
Change in Beck Scale for Suicide Ideation (BSI) Score
The Beck Scale for Suicide Ideation (BSI) is a 19-item clinician-administered instrument used to assess the severity of suicidal thoughts, attitudes, and intentions. Total scores range from 0 to 38, with higher scores indicating more severe suicidal ideation.
Time frame: Baseline to month 2 follow-up
hange in 10-item Connor-Davidson Resilience Scale (CD-RISC-10) Score
The 10-item Connor-Davidson Resilience Scale (CD-RISC-10) is a 10-item self-report questionnaire used to assess psychological resilience and the ability to cope with adversity. Total scores range from 0 to 40, with higher scores indicating greater psychological resilience.
Time frame: Baseline to month 2 follow-up
Change in Chinese Version of the Cognitive Emotion Regulation Questionnaire (CERQ-C) Score
The Chinese Version of the Cognitive Emotion Regulation Questionnaire (CERQ-C) is a 36-item self-report questionnaire used to assess cognitive emotion regulation strategies in response to stressful or negative life events. Total scores range from 36 to 180, with higher scores indicating greater use of cognitive emotion regulation strategies.
Time frame: Baseline to month 2 follow-up
Change in State Anxiety Inventory (S-AI) Score
The State Anxiety Inventory (S-AI) is a 20-item self-report questionnaire used to assess transient anxiety experienced at the time of assessment. Total scores range from 20 to 80, with higher scores indicating greater state anxiety.
Time frame: Baseline to month 2 follow-up
Change in Generalized Anxiety Disorder-7 (GAD-7) Score
A 7-item self-report questionnaire used to assess the severity of generalized anxiety symptoms. Total scores range from 0 to 21, with higher scores indicating greater anxiety severity.
Time frame: Baseline to month 2 follow-up(post treatment)
Change in 17-item Hamilton Depression Rating Scale (HAMD-17) Score
The 17-item Hamilton Depression Rating Scale (HAMD-17) is a 17-item clinician-administered instrument used to assess the severity of depressive symptoms. Total scores range from 0 to 52, with higher scores indicating more severe depressive symptoms.
Time frame: Baseline to month 2 follow-up
Change in Sheehan Disability Scale (SDS) Score
he Sheehan Disability Scale (SDS) is a 3-item self-report questionnaire used to assess functional impairment in work/school, social life, and family life/home responsibilities. Total scores range from 0 to 30, with higher scores indicating greater functional impairment.
Time frame: Baseline to month 2 follow-up
Change in Snaith-Hamilton Pleasure Scale (SHAPS) Score
The Snaith-Hamilton Pleasure Scale (SHAPS) is a 14-item self-report questionnaire used to assess anhedonia, or the ability to experience pleasure. Total scores range from 14 to 56, with higher scores indicating greater anhedonia (reduced ability to experience pleasure).
Time frame: Baseline to month 2 follow-up
Change in Ruminative Responses Scale (RRS) Score
The Ruminative Responses Scale (RRS) is a 22-item self-report questionnaire used to assess the tendency to engage in repetitive negative thinking in response to depressed mood or distress. Total scores range from 22 to 88, with higher scores indicating greater rumination.
Time frame: Baseline to month 2 follow-up
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