Brain MRI (Magnetic Resonance Imaging) Scans of Patients With Treatment Resistant Depression (TRD) and Healthy Controls

Volumetric Brain MRI (Magnetic Resonance Imaging) Comparison of Patients With Treatment Resistant Depression (TRD) Undergoing Deep Brain Stimulation (DBS) With Age, Sex and Education Matched Healthy Controls

Treatment resistant depression (TRD) is a major health concern, with 10% of patients with major depressive disorder not responding to conventional treatments. The investigators propose to compare the MRI (magnetic resonance imaging) brain scans of patients with TRD, which were collected during surgical planning for deep brain stimulation, with age, sex, handedness and education-matched healthy volunteer controls, to investigate anatomical differences, specifically the volume of certain brain structures.

Study Overview

• Status: Completed
• Conditions: Mental Disorders

Detailed Description

All the patients treated at Frenchay Hospital, UK, with deep brain stimulation (DBS) for treatment resistant depression (TRD) will be given a Patient Information Sheet, and asked if they would like to participate in this research related to their condition. If they indicate they would like to participate, patients will be asked to sign a separate informed consent form (ICF) to give permission for their previously collected MRI scan to be used for this new research purpose. Information on handedness of the patients has not been previously collected, so patients will be given a short questionnaire to determine their handedness. The patients will not be required to perform any further tasks.

For each patient that agrees to participate in the study, two healthy matched control participants will be recruited. Participants will be recruited from an existing volunteer database and by local advertisements.

Respondents interested in participating will be given a letter of invite and a participant information sheet. They will be asked several basic questions including contact details, health status, age, sex, handedness, highest qualification achieved, and scanning requirements in order to assess their basic suitability for the study. If suitable, participants will be invited to attend a screening visit. Here, the informed consent form will be signed, then their medical history will be taken, and they will be given a MINI neuropsychiatric evaluation to assess their physical and mental status. Females who have the possibility of being pregnant will be asked to provide a urine sample to check they are not pregnant, and will be required to use adequate contraception until after their scan.

If suitable, participants will complete two computerised tests of mood. Then they will have a scan date booked at Frenchay hospital. At the scanning visit, participants will be assessed for any changes in health since their screening visit, and then will complete an MRI scan. The same scanner with the same sequences will be used for the healthy controls that were used for the patients. Two sequences will be collected: a coronal T1 FFE (fast field echo) volume acquisition and an axial high resolution T2 limited volume acquisition where 16 slices are collected with 8 above the ACPC (anterior commissure posterior commissure) plane and 8 below. These sequences match the sequences that our DBS patients have had and will allow both automated anatomical quantitative analysis (using Statistical Parametric Mapping version 5 (SPM5)) and quantitative description of other MRI signals such as white matter bright spots. Participants will receive no payment, but can have a printout of their scan if they wish.

The scans will then be analysed and compared to the patient scans.

• Study Type: Observational
• Enrollment (Actual): 21

Contacts and Locations

Study Locations

• United Kingdom
  • Bristol, United Kingdom, BS2 8HW
    • Bristol Royal Infirmary

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 26 years to 64 years (Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Patients who have received Deep Brain Stimulation (DBS) for Treatment Resistant Depression at Frenchay Hospital, UK., and healthy volunteers who are matched to the DBS patients, sampled from the local area.

Description

Inclusion Criteria:

• Up to 12 females and 4 males, sex, handedness and age (±5 years) matched for the DBS patients.

Exclusion Criteria:

• Current or past psychiatric disorder as assessed with MINI and clinical interview.
• Significant head injury.
• Standard MRI risk criteria (metallic clips or pins in body, pacemaker, aneurysm clips, pregnancy, possibility of metal in eyes including history of traumatic eye injury, shrapnel or bullet injuries).
• Inability to lie in the scanner for whatever reason (e.g. claustrophobia).
• Current acute medical illness.
• Started on new medicines in the last two months that the investigator feels may interfere with the study.
• Any medical condition that in the principle investigator's opinion is not matched in the DBS sample (e.g. epilepsy, diabetes, cardiac/hepatic/renal failure but not hypertension).
• The investigator feels that the volunteer is unsuitable for the research protocol, or unable or unwilling to comply with study procedures.

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort
Patients; Up to 8 patients who have received Deep Brain Stimulation for Treatment Resistant Depression at Frenchay Hospital (UK) will be recruited.
Healthy volunteers; Up to 16 healthy volunteers, matched to the DBS patients on age, sex, handedness, and education, will be recruited.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Region of interest analysis	Comparison of RoI volumes of specific brain structures between patients with TRD undergoing deep brain stimulation (DBS) and healthy volunteers. Specific brain regions are: hippocampus, orbitofrontal cortex and subgenual cingulate, amygdala, dorsal anterior cingulate cortex, and dorsomedial prefrontal cortex.	6 months
Whole brain analysis	Whole brain MRI volumetric comparison between TRD patients undergoing DBS and healthy volunteers.	6 months
Comparison of abnormalities	Comparison of other potential abnormalities e.g. areas of hyperintensity in white matter in specific brain volumes between patients with TRD undergoing DBS and healthy volunteers.	6 months

Collaborators and Investigators

• Sponsor: University of Bristol
• Collaborators: North Bristol NHS Trust
• Investigators: Principal Investigator: Andrea Malizia, MD, University of Bristol

Study record dates

Study Major Dates

• Study Start: February 1, 2010
• Primary Completion (Actual): February 1, 2012
• Study Completion (Actual): February 1, 2012

Study Registration Dates

• First Submitted: July 13, 2010
• First Submitted That Met QC Criteria: July 13, 2010
• First Posted (Estimate): July 14, 2010

Study Record Updates

• Last Update Posted (Estimate): July 12, 2012
• Last Update Submitted That Met QC Criteria: July 11, 2012
• Last Verified: August 1, 2011

More Information

Terms related to this study

• Keywords: Treatment resistant depression; Deep brain stimulation; Brain volumetric analysis
• Additional Relevant MeSH Terms: Behavioral Symptoms; Mood Disorders; Depressive Disorder; Depression; Mental Disorders; Depressive Disorder, Treatment-Resistant
• Other Study ID Numbers: UoB1112; 10/H0102/15 (Other Identifier: Southmead REC)