- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04842929
Magnetic Randomized Trial in Elderly Depressed (MrTED)
November 9, 2021 updated by: Leandro Valiengo, University of Sao Paulo
Treatment of Depression in the Elderly With Repetitive Transcranial Magnetic Stimulation (rTMS) Using Theta-burst Stimulation (TBS): Randomized, Double-blind, Sham-controlled, Clinical Trial
Major depressive disorder (MDD) is a common psychiatric condition, mostly treated with antidepressant drugs, which are limited for issues such as refractoriness, adverse effects and drug interactions, especially in the elderly population.
In this context, the investigators investigate a non-pharmacological treatment known as recurrent transcranial magnetic stimulation (rTMS) with the theta-burst stimulation (TBS) method for the treatment of geriatric depression.
This treatment modality has almost no adverse effects and avoids the risk associated with polypharmacy, providing an interesting alternative to antidepressant treatments.
Our aim is to evaluate TBS efficacy in the treatment of geriatric depression in a randomized, double-blind, placebo-controlled clinical trial.
Study Overview
Status
Recruiting
Conditions
Intervention / Treatment
Detailed Description
Recurrent transcranial magnetic stimulation (rTMS) is a consolidated procedure for the treatment of depression, with several meta-analyzes demonstrating its efficacy.
The theta-burst stimulation (TBS) method is a modification of the usual rTMS protocol.
As a new protocol, there are still few studies evaluating its efficacy in treatment of major depression, although a recently published meta-analysis has pointed to benefits of this therapeutic modality.
To date, there are no studies published with this method for the treatment of geriatric depression.
This study will be a randomized, placebo-controlled, double-blind clinical trial to evaluate the efficacy of theta-burst rTMS in the treatment of major depressive disorder in the elderly, randomizing 108 subjects to the experimental (TBS) and comparative (sham) groups.
The coil will be positioned in the dorsolateral prefrontal cortex, with intermittent TBS (iTBS, stimulatory) mode on the left and continuous TBS (cTBS, inhibitory) on the right.
Stimulation protocol consists of 1800 pulses on each brain hemisphere, totaling a ten minutes session.
There will be 20 consecutive sessions, one a day, except on weekends and holidays.
The cycle of continuous intervention will last approximately four weeks, after which applications with the same technique will be performed at the end of weeks 6, 8 and 12. Clinical outcome measures will be obtained on eight occasions: treatment baseline, and after 1, 2, 4, 6, 8 and 12 weeks of onset.
The main clinical outcome will be measured using the Hamilton Depression Scale (HDRS), comparing baseline scores with those obtained after 6 weeks of treatment.
As secondary endpoints, we will use the Global Clinical Impression Scale (CGI), the CIRS (Cumulative Illness Rating Scale), the Geriatric Depression Scale (GDS), the intermediate scores obtained on the HDRS scale, the Positive and Negative Affect Scale (PANAS), the Montgomery-Asberg Depression Rating Scale (MADRS), and variations in serum BDNF concentrations; all these evaluation tools have validated versions in Portuguese.
As tolerability and safety parameters, the incidence of adverse events and the occurrence of manic/hypomanic symptoms will be evaluated by the Young Mania Scale (YMRS).
TBS stimulation will be evaluated in terms of safety, tolerability and effectiveness for the treatment of major depression in the elderly, possibly becoming another therapeutic option useful for patients with poor response or contraindications to the use of antidepressants.
Study Type
Interventional
Enrollment (Anticipated)
108
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 Contact
- Name: Leandro Valiengo
- Phone Number: (11) 2661-8159
- Email: pesquisa.neuropsiquiatria@gmail.com
Study Locations
-
-
SP
-
Sao Paulo, SP, Brazil
- Recruiting
- University of Sao Paulo
-
Principal Investigator:
- Leandro Valiengo, MD
-
-
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
60 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Major Depressive Disorder;
- Patients older than 60 years
- Hamilton equal or higher than 17
Exclusion Criteria:
- Other mental disorders (alcohol or drug addiction, psychotic disorders, dementia, bipolar disorder);
- Presence of serious neurological or clinical diseases;
- Resence of severe suicidal ideation and CIRS (Cumulative Illness Rating Scale) score> 7, characterizing a set of clinical morbidities that could impair adherence to the research protocol, bipolar disorder and/or presence of manic symptoms (hypo) demonstrated with more than 8 points in the Young Mania Rating Scale.
- Metal implants;
- Epilepsy or electronics in the cephalic segment;
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: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Active Stimulation
Active Comparator: Active stimulation with pulses emitted according to intervention description
|
The coil will be positioned in the prefrontal dorsolateral cortex, with intermintent TBS (TBSi) mode on the left and continuous TBS (TBSc) on the right.
1800 pulses will be used on each side, totaling 10 minutes of total duration.
There will be 20 consecutive sessions, one per day, except on weekends and holidays, totaling around 4 weeks.
A day of stimulation with the same technique will be done in the 6th week, 8th week and 12th week.
|
Sham Comparator: Sham Stimulation
Sham Comparator: The blinding will be done with a sham coil, which consists of a coil that reproduces the sound that the true coil does, but without generating the magnetic field.
|
The coil will be positioned in the prefrontal dorsolateral cortex, with intermintent TBS (TBSi) mode on the left and continuous TBS (TBSc) on the right.
1800 pulses will be used on each side, totaling 10 minutes of total duration.
There will be 20 consecutive sessions, one per day, except on weekends and holidays, totaling around 4 weeks.
A day of stimulation with the same technique will be done in the 6th week, 8th week and 12th week.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Changes in Hamilton Rating Scale for Depression, 17 items (HDRS-17)
Time Frame: Weeks 0 and 6
|
Continuous measure (score changes).
|
Weeks 0 and 6
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in HDRS-17
Time Frame: Weeks 1, 2, 4, 6, 8, 12
|
Continuous measure (score changes).
|
Weeks 1, 2, 4, 6, 8, 12
|
Change in Montgomery-Asberg Depression Rating Scale (MADRS)
Time Frame: Weeks 1, 2, 4, 6, 8, 12
|
Continuous measure (score changes).
|
Weeks 1, 2, 4, 6, 8, 12
|
Change in Global Clinical Impression Scale (CGI)
Time Frame: Weeks 1, 2, 4, 6, 8, 12
|
Continuous measure (score changes).
|
Weeks 1, 2, 4, 6, 8, 12
|
Change in Cumulative Illness Rating Scale (CIRS)
Time Frame: Weeks 1, 2, 4, 6, 8, 12
|
Continuous measure (score changes).
|
Weeks 1, 2, 4, 6, 8, 12
|
Change in Geriatric Depression Scale (GDS)
Time Frame: Weeks 1, 2, 4, 6, 8, 12
|
Continuous measure (score changes).
|
Weeks 1, 2, 4, 6, 8, 12
|
Change in Positive and Negative Affect Scale (PANAS)
Time Frame: Weeks 1, 2, 4, 6, 8, 12
|
Continuous measure (score changes).
|
Weeks 1, 2, 4, 6, 8, 12
|
Change in serum BDNF concentrations
Time Frame: Weeks 0 and 6
|
Continuous measure (score changes).
|
Weeks 0 and 6
|
Response HDRS 17
Time Frame: Week 12
|
Response (≥50% improvement from week 0 to 12)
|
Week 12
|
Remission of HDRS 17
Time Frame: Week 12
|
Remission (HDRS-17 ≤ 8)
|
Week 12
|
Young Manic Rating Scale (YMRS)
Time Frame: Weeks 0, 1, 2, 4, 6, 8, 12
|
Serious adverse events include treatment-emergent hypomania/mania (YMRS>8), suicide, psychiatric hospitalization and others life-threatening or incapacitant events
|
Weeks 0, 1, 2, 4, 6, 8, 12
|
Serious adverse events
Time Frame: Up to week 12
|
Serious adverse events include treatment-emergent hypomania/mania (YMRS>8), suicide, psychiatric hospitalization and others life-threatening or incapacitant events
|
Up to week 12
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Conditioned pain modulation
Time Frame: Week 0 and 4
|
Temperature of the thermode reported as painful
|
Week 0 and 4
|
Actigraphy
Time Frame: 1 week before treatment up to 4 weeks after finishing study
|
Continuous measure (score changes).
|
1 week before treatment up to 4 weeks after finishing study
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Collaborators
Investigators
- Principal Investigator: Leandro Valiengo, University of Sao Paulo
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
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)
January 16, 2019
Primary Completion (Anticipated)
September 20, 2022
Study Completion (Anticipated)
December 20, 2022
Study Registration Dates
First Submitted
January 20, 2021
First Submitted That Met QC Criteria
April 9, 2021
First Posted (Actual)
April 13, 2021
Study Record Updates
Last Update Posted (Actual)
November 15, 2021
Last Update Submitted That Met QC Criteria
November 9, 2021
Last Verified
November 1, 2021
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 2.643.551
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
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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