Long Term Follow-up of Deep Brain Stimulation for Treatment-Resistant Depression

The long term follow up of a pilot study in which the invesitagors proposed to test whether high frequency stimulation of the subcallosal cingulate (SCC) is a safe and efficacious antidepressant treatment in five TRD patients, to compare the effects of left-sided vs. right-sided stimulation, and to investigate potential mechanisms of action of this intervention. Importantly, this study will be used to assess the need for and assist in planning a larger, more definitive trial of SCC DBS for TRD.

Study Overview

• Status: Active, not recruiting
• Conditions: Treatment Resistant Depression; Depressive Disorder, Treatment-Resistant; Depression, Bipolar
• Intervention / Treatment: Device: SCC DBS

Detailed Description

The U.S. lifetime prevalence of major depressive disorder (MDD) is 17%. A number of treatments are available for depression including medications, psychotherapy and various somatic treatments. Unfortunately, up to two-thirds of patients remain symptomatic following first-line treatment and a third fail to achieve remission (defined as full resolution of depressive symptoms) after four established treatments; approximately 10%-20% of depressed patients may show virtually no improvement despite multiple, often aggressive treatments. Thus, a conservative estimate places the U.S. prevalence of treatment-resistant depression (TRD) at 1%-3%. TRD has a high risk of suicide, is a major cause of disability and is responsible for doubling of overall health care costs.

For patients with TRD there are limited evidence-based treatment options. Transcranial magnetic stimulation (TMS) may have efficacy for patients that have failed no more than one antidepressant medication 10-12, but response and remission rates are relatively low (under 30% and 20% respectively). Vagus nerve stimulation (VNS) may have efficacy in patients that have failed 4-6 antidepressant treatments but long-term response and remission rates are again low (about 20% and 10% respectively). Electroconvulsive therapy(ECT) can be effective in TRD patients with remission rates of 50%-60%. However, more than 70% of TRD patients will relapse within 6 months following a successful acute treatment course. For patients that have failed ECT, there are no evidence-based treatment options. Therefore, there is great need for novel treatment approaches for TRD.

Prior clinical trials have shown that SCC DBS has the potential to be a valuable treatment option for patients with TRD. Further developing this treatment will involve confirming its effectiveness and identifying ways to optimize its use. In this study the investigators intend to test the safety and efficacy of chronic SCC DBS as a treatment for TRD and compare the safety and efficacy of left-sided versus right-sided stimulation using a double-blind, randomized, cross-over design.

• Study Type: Observational
• Enrollment (Actual): 5

Contacts and Locations

Study Locations

• United States
  • New Hampshire
    • Lebanon, New Hampshire, United States, 03766
      • Dartmouth-Hitchcock Medical Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years to 68 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Patients who are enrolled in the DBS for TRD study at DHMC will be given the opportunity to enroll in the ten year follow-up study at the end of the DBS for TRD study in which they are currently enrolled. Patients will be informed of the option during the screening phase of the DBS for TRD study as well as a reminder 2 weeks prior to completion of the study. A total of five (5) patients will be enrolled in this study

Description

Inclusion Criteria:

• Have received DBS for TRD
• Ability to provide written informed consent
• Willing to comply with all necessary study visits

Exclusion Criteria:

• Significant cerebrovascular risk factors or a previous stroke, documented major head trauma or neurodegenerative disorder.
• Other currently active clinically significant Axis I psychiatric diagnosis including schizophrenia, panic disorder, obsessive-compulsive disorder, generalized anxiety disorder or post-traumatic stress disorder. Patients with severe Axis II personality disorders will also be excluded if the personality disorder is likely to interfere with cooperation and adherence to the study protocol.
• Current psychotic symptoms.
• Evidence of global cognitive impairment.
• Substance abuse or dependence not in full sustained remission (i.e., not active for at least one year).
• Active suicidal ideation with intent; suicide attempt within the last six months; more than three suicide attempts within the last two years.
• Pregnancy or plan to become pregnant during the study period.
• General contraindications for DBS surgery (cardiac pacemaker/defibrillator or other implanted devices).
• Inability or unwillingness to comply with long-term follow-up.
• History of intolerance to neural stimulation of any area of the body.
• Participation in another drug, device or biologics trial within the preceding 30 days.
• Conditions requiring repeated MRI scans.
• Conditions requiring diathermy.
• Conditions requiring anticoagulant medication.
• Terminal illness associated with expected survival of <12 months.

Study Plan

How is the study designed?

Design Details

• Observational Models: Case-Only
• Time Perspectives: Other

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
DBS Long Term Follow Up; 5 participants who were in a prior study to receive DBS are enrolled to have their progress and DBS devices monitored for a period of 12 years.	Device: SCC DBS; Deep Brain Stimulator; Other Names: Libra(TM) Implantable Deep Brain Stimulation (DBS) System

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Physician assessment of current status	During this phase, patients will be evaluated every 12 months by the study psychiatrist (via in-person, phone or video call visit) to assess device functioning, adverse events and current status of depression. Collectively, this information will be used to evaluate each patient's current status. No formal instruments will be used to collect these data. This information will be documented in a note to file.	Every 12 months

Collaborators and Investigators

• Sponsor: Paul Holtzheimer

Study record dates

Study Major Dates

• Study Start (Actual): April 18, 2016
• Primary Completion (Anticipated): November 22, 2026
• Study Completion (Anticipated): November 22, 2028

Study Registration Dates

• First Submitted: August 17, 2017
• First Submitted That Met QC Criteria: November 28, 2017
• First Posted (Actual): December 4, 2017

Study Record Updates

• Last Update Posted (Actual): February 23, 2022
• Last Update Submitted That Met QC Criteria: February 22, 2022
• Last Verified: February 1, 2022

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Behavioral Symptoms; Mental Disorders; Mood Disorders; Bipolar and Related Disorders; Depression; Depressive Disorder; Bipolar Disorder; Depressive Disorder, Treatment-Resistant
• Other Study ID Numbers: D12131; 23442 (Other Identifier: Dartmouth Committee for the Protection of Human Subjects)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: Yes