- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04485455
iTBS for Adolescent Depression: An Open Label Study Evaluating Safety and Efficacy of Treatment
November 29, 2021 updated by: University of North Carolina, Chapel Hill
Open Label Study of the Efficacy, Durability, Safety and Feasibility of Intermittent Theta Burst Stimulation (iTBS) in Adolescents With Major Depressive Disorder: Effect Duration, Suicidality, and Non-Suicidal Self Injurious Behavior
This is an open label, pilot, feasibility study evaluating effects of Intermittent Theta Burst Transcranial Magnetic Stimulation (iTBS) on 5 eligible adolescents for the treatment of depression.
Safety and tolerability will be evaluated with changes in depression scores, and suicidality and non-suicidal self injurious behavior will also be monitored for exploratory and safety measures.
Study Overview
Status
Completed
Conditions
Intervention / Treatment
Detailed Description
This study will investigate the efficacy and durability of the effects of Intermittent Theta Burst Stimulation (iTBS) in adolescent depression by measuring changes in clinical ratings before, during, and after 4 weeks of treatment, up to 12 weeks following treatment.
The investigators expect that subjects will show: improvement in symptoms over 20 iTBS sessions as measured by the Children's Depression Rating Scale Revised (CDRS-R), Hamilton Depression Rating Scale (HAM-D) and Non-suicidal Self Injurious Behavior (NSSIB) measures, and persistence of this reduction of depressive symptoms through the 12 weeks follow up period of the study.
In this study, the investigators will investigate the safety of the effects of iTBS in adolescent depression.
The investigators will investigate safety of the treatment regimen by assessing suicidality.
The investigators expect suicidal thoughts and behavior will reduce with iTBS treatment as measured by the Columbia Suicide Severity Rating Scale (C-SSRS) and a psychiatrist's clinical assessment.
The investigators also expect that those with NSSIB at the start of the trial will have less after iTBS treatments.
The investigators do not expect any change in cognition measured with the Mini Mental Status Exam (MMSE), Trails B, and List Generation.
The investigators will investigate treatment feasibility by assessing treatment completion and withdrawal.
The investigators define the feasibility of iTBS will be defined as feasible by as completion of 15/20 (75%) iTBS treatment sessions by all subjects and withdrawal from treatment of no more than one of five subjects (20%) due to intolerable side effects or persistent symptoms of MDD.
Investigation of efficacy, durability, safety as well as feasibility simultaneously is essential in this preliminary study of the use of iTBS in adolescents in order to justify a larger future study.
This study will include a screening visit, 20 iTBS treatments, and 3 planned follow up visits.
Study Type
Interventional
Enrollment (Actual)
5
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
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North Carolina
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Chapel Hill, North Carolina, United States, 27514
- University of North Carolina at Chapel Hill-Psychiatry Outpatient Clinic
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Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
13 years to 17 years (CHILD)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- A score of greater than 40 on the CDRS-R and 17 on HAM-D.
- Documentation of DSM-V criteria for current MDD or TRD will be required for study entry.
- Patients may be on antidepressant medication at a stable dose or receiving psychotherapy with a licensed provider during the active phase of TMS treatment for 4 weeks.
- Ability to provide consent and take part in questionnaires and scales (i.e.: not currently intellectually disabled).
- The presence of suicidality or NSSIB are not required to enter this study. Although our secondary end-points include suicidality, and the investigators are also exploring NSSIB, and thus this may not lead to many data, the investigators' plan is to use data from this study to justify a larger study where this can be more robustly investigated.
Exclusion Criteria:
- Past or current diagnosis of bipolar disorder, psychosis, seizures or traumatic brain injury.
- Presence of intracranial metallic implants or fragments, which is a contraindication for TMS.
- Lifetime history of (or currently present) epilepsy.
- Current diagnosis of substance abuse, eating disorder, PTSD (Post Traumatic Stress Disorder), or intellectual disability.* Nicotine use disorder will not directly preclude a potential subject from this study. Although chronic nicotine use does effect central nervous system excitability, what would be more confounding to our study would be if there is a sudden change in nicotine use during the treatment phase, as this may affect the motor threshold. Inclusion will however be at the PI's discretion.
- Current imminent suicide ideation or other clinical reasons for inpatient psychiatric hospitalization.
- Currently pregnant. There is currently not adequate data from this population to ensure safety with the scope of this protocol.
- Any reason the investigator determines may cause noncompliance with study rules or is unfit for receiving treatment.
- Currently taking certain medications including antidepressants, stimulants, benzodiazepines, and antipsychotics, antiepileptic (per investigator discretion).
Any positive drug testing from a urine drug test unless medically indicated with a valid prescription.
- Those with marijuana/cannabis positive results may retest later if at that time they do not meet criteria for substance abuse at screening and agree to refrain from use for the duration of study participation. Decision to be made by Investigator discretion.
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: TREATMENT
- Allocation: NA
- Interventional Model: SINGLE_GROUP
- Masking: NONE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
EXPERIMENTAL: iTBS Therapy
Teenage participants with depression will receive iTBS therapy using a Transcranial Magnetic Stimulation (TMS) protocol delivering electro-magnetic stimulation
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Motor Threshold determination, done prior to starting treatments, determines the location and the intensity for the iTBS treatments.
A magnetic field is applied with increasing intensity stimulating the motor region of the brain until there is thumb movement; this indicates the intensity of the treatments; the location for treatment is in the sensory area parallel to this location.
Other Names:
iTBS is a particular TMS protocol which delivers the magnetic field in triplet bursts (three stimulations very close together at a frequency of 50 Hz very quickly).
The triplet bursts are repeated at a rate of 5 Hz for 2 seconds (30 pulses), followed by 8 seconds rest, repeated 20 times for a total of 600 pulses.
Each treatments lasts approximately 3 minutes, and sessions are provided 20 times (Monday-Friday for 4 consecutive weeks).
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in HAM-D Score From Baseline to Week 1
Time Frame: Baseline, Week 1
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The Hamilton Rating Scale for Depression (HAM-D) total score comprises a sum of the 17 individual item scores which ranges from 0 to 52.
Higher scores indicate a greater degree of depression.
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Baseline, Week 1
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Change in CDRS-R Score From Baseline to Week 1
Time Frame: Baseline, Week 1
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The Children's Depression Rating Scale-Revised (CDRS-R) total score ranges from 17 (minimal or no symptoms of depression) to 113 (indicative of depression) is a semi-structured, clinician-rated instrument designed for use with children and adolescents between the ages of 6 to 17 years of age and their caregivers.
The CDRS-R evaluates the presence and severity of symptoms commonly associated with depression in childhood.
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Baseline, Week 1
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Change in HAM-D Score From Baseline to Week 2
Time Frame: Baseline, Week 2
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The Hamilton Rating Scale for Depression (HAM-D) total score comprises a sum of the 17 individual item scores which ranges from 0 to 52.
Higher scores indicate a greater degree of depression.
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Baseline, Week 2
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Change in CDRS-R Score From Baseline to Week 2
Time Frame: Baseline, Week 2
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The Children's Depression Rating Scale-Revised (CDRS-R) total score ranges from 17 (minimal or no symptoms of depression) to 113 (indicative of depression) is a semi-structured, clinician-rated instrument designed for use with children and adolescents between the ages of 6 to 17 years of age and their caregivers.
The CDRS-R evaluates the presence and severity of symptoms commonly associated with depression in childhood.
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Baseline, Week 2
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Change in HAM-D Score From Baseline to Week 3
Time Frame: Baseline, Week 3
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The Hamilton Rating Scale for Depression (HAM-D) total score comprises a sum of the 17 individual item scores which ranges from 0 to 52.
Higher scores indicate a greater degree of depression.
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Baseline, Week 3
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Change in CDRS-R Score From Baseline to Week 3
Time Frame: Baseline, Week 3
|
The Children's Depression Rating Scale-Revised (CDRS-R) total score ranges from 17 (minimal or no symptoms of depression) to 113 (indicative of depression) is a semi-structured, clinician-rated instrument designed for use with children and adolescents between the ages of 6 to 17 years of age and their caregivers.
The CDRS-R evaluates the presence and severity of symptoms commonly associated with depression in childhood.
|
Baseline, Week 3
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Change in HAM-D Score From Baseline to Week 4
Time Frame: Baseline, Week 4
|
The Hamilton Rating Scale for Depression (HAM-D) total score comprises a sum of the 17 individual item scores which ranges from 0 to 52.
Higher scores indicate a greater degree of depression.
|
Baseline, Week 4
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Change in CDRS-R Score From Baseline to Week 4
Time Frame: Baseline, Week 4
|
The Children's Depression Rating Scale-Revised (CDRS-R) total score ranges from 17 (minimal or no symptoms of depression) to 113 (indicative of depression) is a semi-structured, clinician-rated instrument designed for use with children and adolescents between the ages of 6 to 17 years of age and their caregivers.
The CDRS-R evaluates the presence and severity of symptoms commonly associated with depression in childhood.
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Baseline, Week 4
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of Occurrences of Passive Suicidal Ideation
Time Frame: Up to 12 Weeks Post-Treatment Completion, a total of up to 16 weeks
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Columbia Suicide Severity Rating Scale (C-SSRS) is a semi-structured interview that has "yes or no" answers to assess the likelihood of a subject harming themselves, including "yes/no" to passive suicidal ideation.
Participants indicating a "yes" response to any of these questions were reported as having passive suicidal ideation.
Each participant was assessed at 8 timepoints during the study.
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Up to 12 Weeks Post-Treatment Completion, a total of up to 16 weeks
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Number of Participants Who Completed the Study
Time Frame: Up to Week 5
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Feasibility for this protocol is partially determined by completion rate.
Treatment completion is defined in this protocol by 75% of treatments completed (15/20) per subject.
This will be measured through completion of Week 4 of treatment (Week 5 of protocol when including screening phase).
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Up to Week 5
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Number of Participants Who Withdrew From the Study
Time Frame: Up to Week 5
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Feasibility for this protocol is partially determined by withdrawal rate.
Withdrawal is defined as no more than 1 out of 5 subjects (20% of participants) withdrawing due to intolerable side effects caused by treatment or persistent depressive symptoms.
This will be measured through completion of Week 4 of treatment (Week 5 of protocol when including screening phase).
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Up to Week 5
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Durability of Treatment Effect With HAM-D Scores
Time Frame: From Baseline up to 12 Weeks Post-Treatment Completion, a total of up to 16 weeks
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Change in scores of Hamilton Depression Rating Scale (HAM-D) will be evaluated comparing Baseline to each follow-up phase at 1 week, 4 weeks, and 12 weeks post-treatment.
The (HAM-D) total score comprises a sum of the 17 individual item scores which ranges from 0 to 52.
Higher scores indicate a greater degree of depression.
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From Baseline up to 12 Weeks Post-Treatment Completion, a total of up to 16 weeks
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Durability of Treatment Effect With CDRS-R Scores
Time Frame: Up to 12 Weeks Post-Treatment Completion, a total of up to 16 weeks
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Change in scores of Children Depression Rating Scale Revised (CDRS-R) during follow-up phase at 1 week, 4 weeks, and 12 weeks post-treatment.
The Children's Depression Rating Scale-Revised (CDRS-R) total score ranges from 17 (minimal or no symptoms of depression) to 113 (indicative of depression) is a semi-structured, clinician-rated instrument designed for use with children and adolescents between the ages of 6 to 17 years of age and their caregivers.
The CDRS-R evaluates the presence and severity of symptoms commonly associated with depression in childhood.
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Up to 12 Weeks Post-Treatment Completion, a total of up to 16 weeks
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Number of Occurrences of Non-Suicidal Self Injurious Behavior Through SITBI
Time Frame: Up to 12 Weeks Post-Treatment Completion, a total of up to 16 weeks
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Self Injurious Thoughts and Behavior Interview (SITBI) is a semi-structured interview commonly used and administered by a clinician to determine if self-harm behavior has been present since the last visit.
This will be evaluated at baseline (screening), once per week during the treatment phase, and at each follow up visit.
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Up to 12 Weeks Post-Treatment Completion, a total of up to 16 weeks
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Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Investigators
- Principal Investigator: Shahzad Ali, MD, University of North Carolina, Chapel Hill
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (ACTUAL)
September 21, 2020
Primary Completion (ACTUAL)
April 30, 2021
Study Completion (ACTUAL)
July 29, 2021
Study Registration Dates
First Submitted
July 21, 2020
First Submitted That Met QC Criteria
July 21, 2020
First Posted (ACTUAL)
July 24, 2020
Study Record Updates
Last Update Posted (ACTUAL)
November 30, 2021
Last Update Submitted That Met QC Criteria
November 29, 2021
Last Verified
November 1, 2021
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 19-1100
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
YES
IPD Plan Description
Deidentified individual data that supports the results will be shared beginning 9 to 36 months following publication provided the investigator who proposes to use the data has approval from an Institutional Review Board (IRB), Independent Ethics Committee (IEC), or Research Ethics Board (REB), as applicable, and executes a data use/sharing agreement with UNC.
IPD Sharing Time Frame
9 to 36 months following publication
IPD Sharing Access Criteria
Approval from an IRB, IEC, or REB and an executed data use/sharing agreement with UNC.
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
- ICF
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
Yes
product manufactured in and exported from the U.S.
Yes
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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