# Evaluating a Novel Method to Determine the rTMS Dose Needed for Treating Depression After Spinal Cord Injury

> **NIH VA IK2** · RALPH H JOHNSON VA MEDICAL CENTER · 2024 · —

## Abstract

Depression is a leading cause of disability worldwide and is one of the most prevalent neuropsychiatric disorders
following spinal cord injury (SCI). The burden of depression post-SCI is significant, as it is associated with higher
cost, lower quality of life, and shorter survival time. Treating depression can be complicated, but it is vital.
Repetitive transcranial magnetic stimulation (rTMS), a type of non-invasive brain stimulation, is an FDA-approved
treatment option for depression that is utilized throughout the Veterans Affairs (VA) health system. However, no
published studies have examined the effectiveness of rTMS for depression post-SCI. The updated Clinical
Practice Guidelines for Spinal Cord Medicine for the Management of Mental Health Disorders (2020) by the
Paralyzed Veterans of America recommends explicitly that future research examines rTMS in the SCI population.
The critical challenge of administering rTMS for depression post-SCI is dosing. Currently, the resting motor
threshold, a motor response of the right abductor pollicis brevis, is used to dose rTMS. Over half of the SCI
population has incomplete or complete tetraplegia, indicating some degree of upper extremity [(UE)] impairment.
Thus, if using current rTMS dosing parameters, it is plausible to conclude that over half the SCI population could
be excluded from receiving rTMS for depression or may receive an improper dose, impacting the intervention's
safety and effectiveness. [This study specifically addresses current limitations in treating depression post-
SCI using rTMS and will: (1) identify the target electric-field (e-field) for rTMS; (2) evaluate a novel
method, reverse-calculation e-field modeling, to determine the rTMS dose to treat depression in
individuals with SCI; (3) conduct a pilot clinical trial using reverse-calculation e-field modeling to dose
rTMS for depression post-SCI; (4) provide the appropriate training environment for the applicant to
develop into an independent VA researcher; and (5) generate the necessary pilot data to support a future
VA Merit Award application.] E-field modeling is a computational model that accounts for the TMS coil type,
circuitry and placement, individual anatomy obtained through T1 and T2- weighted magnetic resonance images,
and conductivity variance between tissue types. [First, using existing trial data, e-field modeling will be used to
determine the target e-field dose for treating depression with rTMS.] Next, twenty-four individuals with SCI and
depression will be randomized to receive either 6-weeks of rTMS treatment dosed using reverse-calculation e-
field modeling (n=18) or sham treatment (n=6). We will examine the between-group effects of treatment on
depressive symptoms using the Hamilton Rating Scale for Depression. The dose identified by reverse-calculation
e-field modeling will be used in combination with FDA-approved parameters: 3,000 pulses/session at 10 Hz, 5
days/week for 6 weeks. Study outcomes will include c...

## Key facts

- **NIH application ID:** 10733447
- **Project number:** 5IK2RX003972-02
- **Recipient organization:** RALPH H JOHNSON VA MEDICAL CENTER
- **Principal Investigator:** Catherine Jefferson VanDerwerker
- **Activity code:** IK2 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2022-11-01 → 2027-10-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10733447

## Citation

> US National Institutes of Health, RePORTER application 10733447, Evaluating a Novel Method to Determine the rTMS Dose Needed for Treating Depression After Spinal Cord Injury (5IK2RX003972-02). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10733447. Licensed CC0.

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