Deep TMS for PTSD With Suicidal Ideation

Post-traumatic stress disorder (PTSD) is characterized by intrusive re-experiencing, avoidance, emotional numbing, and hyperarousal symptoms, and is associated with substantial functional impairment and elevated risk for suicidal ideation. Pharmacologic and psychotherapeutic treatments, including selective serotonin reuptake inhibitors and trauma-focused therapies, can be effective but often result in incomplete response, high dropout rates, or difficulty tolerating trauma-focused interventions. These limitations highlight the need for additional therapeutic approaches for individuals who remain symptomatic. Deep Transcranial Magnetic Stimulation (DTMS) enables non-invasive modulation of neural circuits involved in fear extinction, emotional regulation, and suicidal ideation. The H1-coil is designed to stimulate deeper cortical regions than standard TMS coils, including areas within the lateral prefrontal cortex (LPFC) that are implicated in PTSD symptom expression and extinction learning. Prior feasibility studies have shown that high-frequency (HF) DTMS applied to the LPFC, particularly when combined with a brief trauma-related exposure, may reduce core PTSD symptoms and is well tolerated. This clinical trial evaluates whether HF DTMS using the H1-coil can reduce suicidal ideation in adults diagnosed with PTSD and active suicidal ideation. Each stimulation session is preceded by a brief script-driven exposure procedure designed to activate trauma-related neural circuits before DTMS. This exposure method has been shown to reliably elicit trauma-related responses and support extinction-based therapeutic mechanisms. The study is designed to assess whether DTMS targeting the prefrontal cortex, combined with controlled trauma-related exposure, can safely and effectively reduce suicidal ideation and PTSD symptoms in adults who remain symptomatic despite standard treatments.