- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01829165
Brain Imaging of rTMS Treatment for Depression
A Causal Neural Network-level Understanding of Depression and Its Treatment Through Concurrent TMS and fMRI
The overarching goal of this research program is to elucidate causal and directional neural network- level abnormalities in depression, and how they are modulated by an individually-tailored, circuit-directed intervention. By using concurrent TMS and fMRI, the investigators can overcome a major limitation of neuroimaging - the inability to demonstrate causality. The investigators' findings will serve as a platform for future studies wherein TMS treatment can be directly guided by the investigators' ability to image and causally manipulate specific neural networks.
Aim 1: To examine causal interactions between two major brain networks in depression.
Aim 2: To examine the impact of antidepressant TMS on causal network abnormalities in depression.
Hypothesis 1: Depressed subjects will show blunted responses, compared to healthy controls, in two targeted and interacting networks, using concurrent transcranial magnetic stimulation (TMS) and functional magnetic resonance imaging (fMRI).
Hypothesis 2: Treatment of patients with high-frequency repetitive TMS (rTMS) will result in normalization of baseline network-level deficits, and be predicted by degree of baseline network abnormalities.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
California
-
Palo Alto, California, United States, 94304
- Stanford University
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Men and women, ages 18 to 50
- Depression assessed through phone screen
- Must comprehend English well to ensure adequate comprehension of the fMRI and TMS instructions, and of clinical scales
- Has failed >1 previous adequate antidepressant medication trials
- Right-handed
- No current or history of neurological disorders
- No seizure disorder or risk of seizures
Exclusion Criteria:
- Any contraindication to being scanned in the 3T scanners at the Lucas Center or CNI such as having a pacemaker or implanted device that has not been cleared for scanning at the Lucas Center or CNI
- Any unstable medical condition, any significant CNS neurological condition such as stroke, seizure, tumor, hemorrhage, multiple sclerosis, etc
- Current rTMS treatment or prior treatment failure with rTMS
- Current electroconvulsive therapy (ECT) or prior treatment failure with ECT
- Currently pregnant or breastfeeding
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: rTMS Treatment
rTMS will be delivered for 20 sessions over 4 weeks.
Active 10 Hz rTMS will be delivered using neuro-navigation based on participants' own fMRI images.
Daily treatment regiments will last 36.5 minutes and rTMS will be delivered at 120% of the participant's motor threshold.
Participants will be monitored during the rTMS sessions for adverse events and/or side effects.
|
MRI-compatible TMS stimulator
Other Names:
|
Sham Comparator: Sham Treatment
rTMS will be delivered for 20 sessions over 4 weeks. Placebo 10Hz rTMS will be delivered through sham stimulation electrodes. The rTMS coil will be positioned using neuro-navigation based on participants' own fMRI images, mimicking active rTMS treatment. Daily treatment regiments will last 36.5minutes and sham rTMS will be delivered at 120% of the participant's motor threshold. Participants will be monitored during the rTMS sham sessions for adverse events and/or side effects. Upon completing the sham 20 sessions participants are unblinded and offered 20 further treatments of guaranteed open-label treatment. The open-label treatment would follow the active rTMS treatment protocol. |
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Clinician Administered HAM-D
Time Frame: Baseline; Day 10; Day 20
|
The Hamilton Depression Rating Scale (HAM-D) is a 24-item clinician-administered assessment utilized as a way of determining a patient's level of depression before, during, and after treatment.
It takes approximately 15-20 minutes to complete the interview and score the results.
Subscale scores are 0-2 (10 questions), 0-3 (2 questions), and 0-4 (12 questions).
Subscales are totaled for an overall score (range 0 -76).
For the overall score and all subscales, lower scores correspond to fewer symptoms, and higher scores correspond more symptoms.
|
Baseline; Day 10; Day 20
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
fMRI/TMS Assessed Neural Network Connectivity
Time Frame: Up to 3 months.
|
From pre- to post-treatment, improvement will be based on enhanced functional connectivity.
|
Up to 3 months.
|
Implicit Emotion Regulation
Time Frame: Up to 3 months
|
Implicit emotion regulation assessed through emotion conflict task performed during functional imaging.
Performance based on reaction time and recruitment of emotion regulation regions during the task.
|
Up to 3 months
|
fMRI-assessed Resting Connectivity
Time Frame: Up to 3 months.
|
From pre- to post-treatment of patients with high-frequency repetitive TMS (rTMS) improvement shall be measured by normalization of baseline network-level deficits.
|
Up to 3 months.
|
Collaborators and Investigators
Sponsor
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
Additional Relevant MeSH Terms
Other Study ID Numbers
- 21206
- P30MH089888-01 (U.S. NIH Grant/Contract)
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.
Clinical Trials on Depression
-
ProgenaBiomeRecruitingDepression | Depression, Postpartum | Depression, Anxiety | Depression Moderate | Depression Severe | Clinical Depression | Depression in Remission | Depression, Endogenous | Depression ChronicUnited States
-
Washington University School of MedicineCompletedTreatment Resistant Depression | Late Life Depression | Geriatric Depression | Refractory Depression | Therapy-Resistant DepressionUnited States, Canada
-
Kintsugi Mindful Wellness, Inc.Sonar Strategies; Vituity PsychiatryRecruitingDepression | Depression Moderate | Depression Severe | Depression MildUnited States
-
University of California, San FranciscoRecruitingDepression Moderate | Depression Mild | Depression, TeenUnited States
-
University GhentUniversiteit Antwerpen; Janssen-Cilag Ltd.RecruitingDepression Moderate | Depression Severe | Depression MildBelgium
-
Baylor College of MedicineUniversity of TexasRecruitingDepression | Depression Moderate | Depression Severe | Suicide and Self-harm | Depression in Adolescence | Depression MildUnited States
-
University of Cape TownNational Institute of Mental Health (NIMH)CompletedPostpartum Depression | Clinical Depression | Moderate DepressionSouth Africa
-
Washington University School of MedicinePatient-Centered Outcomes Research Institute; National Institute of Mental...CompletedMajor Depressive Disorder | Treatment Resistant Depression | Treatment-Refractory Depression | Late Life Depression | Geriatric DepressionUnited States, Canada
-
Northern Illinois UniversityUniversity Autonoma de Santo DomingoTerminatedDepression Moderate | Depression MildUnited States, Dominican Republic
-
Gerbera Therapeutics, Inc.Not yet recruitingPostpartum Depression | Depression, Postpartum | Postnatal Depression | Post-partum Depression | Post-Natal DepressionUnited States
Clinical Trials on rTMS Treatment
-
Changping LaboratoryRecruitingObsessive-Compulsive Disorder | OCDChina
-
Changping LaboratoryNot yet recruitingMajor Depressive Disorder | Treatment Resistant DepressionChina
-
Changping LaboratoryWest China Hospital; The Second Affiliated Hospital of Xinxiang Medical University and other collaboratorsRecruitingMajor Depressive Disorder | Treatment Resistant DepressionChina
-
Changping LaboratoryNot yet recruitingObsessive-Compulsive Disorder | OCD
-
University of ManitobaUnknownAlzheimer's DiseaseCanada, Australia
-
Sunnybrook Health Sciences CentreRecruiting
-
Zhujiang HospitalUnknownPost-stroke DepressionChina
-
Ospedale Regionale di LuganoRecruitingMild Cognitive ImpairmentSwitzerland
-
Centre Hospitalier Henri LaboritRecruitingObsessive-Compulsive DisorderFrance
-
Wave NeuroscienceCompleted