- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01718730
Cortical Excitability and Inhibition in MDD
Cortical Excitability and Inhibition in Children and Adolescents With Major Depressive Disorder
The purpose of this study is to learn if measures of brain activity are different in children and adolescents with depression who are in different stages of treatment. This is important because it may identify a biological marker for depression that could one day be used to identify depressed children who would benefit from certain treatments (medications for example), or to monitor how well treatments are working. Brain activity measures(known as cortical excitability and inhibition) will be collected by Transcranial Magnetic Stimulation (TMS). TMS is a noninvasive (no surgery or implants) brain stimulation technology which can make parts of the brain work without putting any wires or chemicals into the body. Measurements will take place over one 3-hour visit. This study does not provide any form of treatment.
*There is an optional portion of the study that uses a brain scan to gather measures of brain structure and brain chemicals. The brain scan is called magnetic resonance and spectroscopy (MRI/MRS). MRI/MRS uses magnetic fields to study the structure of the brain and brain chemicals. The PI will determine eligibility for the MRI/MRS portion of the study.
Study Overview
Status
Intervention / Treatment
Detailed Description
This study is focused on understanding the neurophysiology of major depressive disorder (MDD), and the impact of selective serotonin reuptake inhibitors (SSRIs) in children and adolescents. This is a cross-sectional study which will utilize single and paired-pulse transcranial magnetic stimulation (TMS) to collect measures of glutamatergic cortical excitability (the motor threshold and intracortical facilitation), and GABAergic cortical inhibition (the cortical silent period and intracortical inhibition) of the motor cortex in chilren and adolescents in various disease states of MDD. The optional proton magnetic resonance spectroscopy and imaging scans (MRS/MRI) at 3 Tesla (3T) will examine glutamate concentrations in the motor cortex and anterior cingulate cortex.
This is a biomarker study (MRI/MRS and TMS neurophysiology measures); treatment is not provided in any form. This study will not utilize Repetitive Transcranial Magnetic Stimulation (rTMS).
Study Type
Enrollment (Actual)
Contacts and Locations
Study Locations
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Minnesota
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Rochester, Minnesota, United States, 55905
- Mayo Clinic
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Sampling Method
Study Population
Description
Inclusion Criteria:
- Adolescents from the ages of 13 to 21, male or female.
- Subjects with MDD (groups 2, 3, and 4):
- Must have a Children's Depression Rating Scale, Revised (CDRS-R) score of 40 or higher
- Must have a Clinical Global Impression-Severity scale (CGI-S) score of 4 or higher.
- Group 1: (50 subjects): Subjects who have mild (CDRS-R score < 40) but clinically significant depression.
- Group 2: (50 subjects): Subjects with moderate to severe MDD who have not yet initiated treatment with an SSRI.
- Group 3: (50 subjects): Subjects with moderate to severe MDD that has responded to treatment with an SSRI.
- Group 4: (50 subjects): Subjects with moderate to severe MDD which has not responded to treatment with an SSRI.
- Capable of providing informed assent (consent if age 18) in addition to consent by parent or guardian.
- Subjects and at least 1 parent must be fluent in English.
Exclusion Criteria:
- Primary Axis I or II disorder other than MDD.
- Unprovoked seizure history, seizure disorder, history of febrile seizures, family history of epilepsy.
- Any significant findings on the TMS Adult Safety Screen (TASS) or contraindications to MRI/MRS
- Subjects who are judged by the Principal Investigator to be at imminent risk for self harm or suicide as indicated by interview or C-SSRS.
- Pregnancy or suspected pregnancy in females.
Metal in the head (except the mouth*), implanted medication pumps, cardiac pacemaker.
* Subjects with braces will be excluded from MRI/MRS portion of study only
- Prior brain surgery.
- Risk for increased intracranial pressure such as a brain tumor.
- Any unstable medical condition.
Study Plan
How is the study designed?
Design Details
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
---|---|
Mild depression
Subjects with mild, but clinically significant depression
|
Single and paired-pulse TMS applied to the motor cortex will collect measures of cortical excitability and inhibition.
Other Names:
MRS/MRI Scans will examine glutamate concentrations in the motor cortex and anterior cingulate cortex.
Other Names:
|
Moderate to Severe MDD
Subjects with moderate to severe major depressive disorder who have not yet initiated treatment with an SSRI
|
Single and paired-pulse TMS applied to the motor cortex will collect measures of cortical excitability and inhibition.
Other Names:
MRS/MRI Scans will examine glutamate concentrations in the motor cortex and anterior cingulate cortex.
Other Names:
|
MDD with response to SSRI
Subjects with moderate to severe major depressive disorder that has responded to an SSRI
|
Single and paired-pulse TMS applied to the motor cortex will collect measures of cortical excitability and inhibition.
Other Names:
MRS/MRI Scans will examine glutamate concentrations in the motor cortex and anterior cingulate cortex.
Other Names:
|
MDD without response to SSRI
Subjects with moderate to severe major depressive disorder which has not responded to treatment with an SSRI
|
Single and paired-pulse TMS applied to the motor cortex will collect measures of cortical excitability and inhibition.
Other Names:
MRS/MRI Scans will examine glutamate concentrations in the motor cortex and anterior cingulate cortex.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Cortical Excitability and Inhibition at Motor Cortex
Time Frame: Baseline
|
Motor Threshold (MT) is a single-pulse TMS measure of cortical excitability.
A higher MT indicates decreased cortical excitability.
Intracortical Facilitation (ICF) is a paired-pulse TMS measure of cortical excitability.
A higher ICF indicates increased cortical excitability.
Cortical Silent Period (CSP) is a single-pulse TMS measure of cortical inhibition.
Longer CSP durations indicate greater cortical inhibition.
Intracortical Inhibition (ICI) is a paired pulse TMS measure of cortical inhibition.
A lower ICI indicates increased cortical inhibition, and a higher ICI indicates decreased cortical inhibition.
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Baseline
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Glutamate Concentrations in the Motor Cortex and Anterior Cingulate Cortex
Time Frame: Baseline
|
Glutamate concentrations will be measured with proton magnetic resonance imaging at 3T.
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Baseline
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Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Paul E Croarkin, D.O., Mayo Clinic
Publications and helpful links
Helpful Links
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
- Adolescent
- Child
- MDD
- Cortical excitability
- Glutamate
- Magnetic resonance spectroscopy
- MRS
- TMS
- SSRI
- Major depressive disorder
- Motor threshold
- Motor cortex
- Mild MDD
- Mild depression
- Cortical inhibition
- Cortical silent period
- Intracortical facilitation
- Intracortical inhibition
- gamma-aminobutyric acid (GABA)
- N-methyl-D-aspartate (NMDA)
Additional Relevant MeSH Terms
Other Study ID Numbers
- 12-000335
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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