Remotely Non-invasive Brain Stimulation and Videogame to Alleviate Depression

January 17, 2024 updated by: Mor Nahum

The DiSCoVeR Project: Examining the Synergistic Effects of a Cognitive Control Videogame and a Self-administered Non-invasive Brain Stimulation on Alleviating Depression

Major depressive disorder (MDD) is a common, recurrent, and frequent chronic disorder. Treatment is often challenging; up to 40% of patients do not benefit sufficiently from existing antidepressant interventions including trials of medication and psychotherapy. Up to 25% of patients manifest a chronic course of illness, resulting in a need for additional treatment options.

The DiSCoVeR trial is a multi-site, double-blind, sham-controlled, proof-of concept randomized controlled trial (RCT). The study aims to investigate the feasibility and efficacy of an innovative, combined treatment approach, incorporating transcranial direct current stimulation (tDCS) along with a custom-made video game designed to enhance cognitive control in patients with major depressive disorder (MDD).

Patients diagnosis of MDD receive a 6-weeks treatment with prefrontal tDCS along with an active videogame or sham tDCS + sham game for 6 weeks. Follow-up per patient is 6 weeks following treatment. Before, during and after the treatment period different assessment scales will be conducted to record neuropsychological features and the course of symptom changes.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Detailed Description

Major Depressive Disorder (MDD) is a prevalent, seriously impairing, and often recurrent mental disorder. It has been ranked as a leading cause of disability worldwide by the World Health Organization (WHO) as measured by years lived with disability.

A considerable number of patients with MDD experience a chronic course of illness and approximately one third of MDD patients do not respond sufficiently to pharmacological treatment, calling for treatment alternatives.

Non-invasive brain stimulation techniques (NIBS) such as tDCS targeting prefrontal cortical areas have emerged as a safe, promising, and cost-effective alternative to traditional treatment options in patients with MDD.

This study focuses not only on an overall reduction of depressive symptoms, but also an alleviation of cognitive control deficits in particular, since patients with MDD often suffer from cognitive control deficits. tDCS has been shown to directly modulate cognitive control functions in healthy participants and in depressed patients. Another approach to directly modulate cognitive control functions is cognitive control training.

In the present study, an engaging and captivating cognitive control training designed as an action video game will be employed. The primary objective is to test the feasibility and efficacy of this innovative, combined treatment approach for self application, concurrently applying both interventions (tDCS + cognitive control training) in patients suffering from MDD. Additionally, participants have the opportunity to choose to take part in two adjunctive assessments: a biological assessment which includes salivary samples and a multimodal imaging paradigm (structural and functional sequences, including an interleaved TMS-fMRI paradigm).

Study Type

Interventional

Enrollment (Estimated)

114

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

Study Contact Backup

Study Locations

  • Germany
  • Israel
      • Jerusalem, Israel, 12000
        • Not yet recruiting
        • Hadassah University Hospital
        • Contact:
        • Principal Investigator:
          • Omer Bonne, M.D.
  • Latvia
      • Riga, Latvia
        • Recruiting
        • Riga Stradins University (RSU)
        • Contact:
        • Principal Investigator:
          • Elmars Rancans, M.D.

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

18 years to 65 years (Adult, Older Adult)

Accepts Healthy Volunteers

Yes

Description

Inclusion criteria:

  • Men and woman 18-65 years of age.
  • Primary Diagnostic and Statistical Manual (DSM-5) diagnosis of Major Depressive Disorder (MDD), with a single or recurrent episode with the additional requirement of a current episode with a duration of ≥4 weeks.
  • Current depressive episode lasts less than 5 years (the current and previous depressive episodes are demarcated by a period of ≥2 months in which the patient did not meet full criteria for the DSM-5 definition of MDD).
  • Total Hamilton-21 score ≥ 13 at screening visit.
  • Capable and willing to provide informed consent. Patients without antidepressant medication or patients on an adequate (i.e., at least lowest effective) and stable (i.e., for ≥ 6 weeks) dosage of SSRI (Escitalopram, Citalopram, Sertralin, Paroxetin, Fluvoxamin, Fluoxetin), SSNRI (Duloxetin, Venlafaxin) or Others (Mirtazapin, Agomelatin, Vortioxetine)
  • Concomitant psychotherapy is allowed if ongoing for at least 3 months prior to baseline.

Exclusion Criteria:

  • Investigators, site personnel directly affiliated with this study, and their immediate families (immediate family is defined as a spouse, parent, child or sibling, whether by birth or legal adoption).
  • Addiction to gaming as assessed by the Gaming Disorder Test (GDT).

  • Individuals diagnosed with the following psychiatric conditions (current unless otherwise stated):

    • Depression assessed as secondary to a general medical condition or substance-induced
    • Substance abuse or substance dependence (except nicotine, caffeine) in the last 6 months
    • Psychotic disorder (lifetime)
    • Bipolar disorder (I and II; lifetime)
    • Eating disorder if stated as primary diagnosis
    • Obsessive compulsive disorder if stated as primary diagnosis
    • Post-traumatic stress disorder if stated as primary diagnosis
    • Generalized anxiety disorder if stated as primary diagnosis
    • Panic disorder/ social anxiety if stated as primary diagnosis
    • Personality disorder if stated as primary diagnosis

  • Individuals diagnosed with a significant neurological disorder or insult including, but not limited to:

    • Increased intracranial pressure
    • Space occupying brain lesion
    • History of cerebrovascular accident
    • Transient ischemic attack within two years
    • Cerebral aneurysm, dementia
    • Parkinson's disease
    • Huntington's chorea
    • Multiple sclerosis
    • Epilepsy
  • Electroconvulsive therapy (ECT) treatment in current episode
  • History of tDCS, except for single tDCS sessions in experimental studies
  • Use of any investigational drug within 6 weeks from baseline
  • Suicidal risk based on MADRS item 10 score of 4-6 or attempted suicide in current episode
  • Acute, unstable cardiac disease
  • Intracranial implant or any other metal object within or near the head (excluding the mouth) that cannot be safely removed; implanted neuro-stimulators
  • Known or suspected pregnancy (according to pregnancy test), and women of childbearing potential not using effective contraception
  • History of seizures
  • Treatment with deep brain stimulation or vagus nerve stimulation and/or any other intracranial implants (clips, cochlear implants)
  • Any relevant unstable medical condition (e.g. acute, unstable cardiac disease)

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: Double

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Active treatment
active tDCS (using the Neuroelectrics Starstim tCS 5G kit) and cognitive and emotional control video game
Device: active tDCS
Treatment will be applied daily 5 days/week for a period of 6 weeks, which equals a tDCS stimulation for a total of 30 treatment sessions. Every treatment session consists of 30 minutes of intervention.
Behavioral: cognitive and emotional control video game
a video game targeting cognitive and emotional control. total of 30 treatment sessions. Every treatment session consists of 30 minutes of intervention.
Sham Comparator: Sham treatment
sham tDCS (using the Neuroelectrics Starstim tCS 5G kit) and non-active videogame
Device: sham tDCS
sham stimulation for a total of 30 treatment sessions. Every treatment session consists of 30 minutes of intervention.
Behavioral: sham video game
a video game which does not target cognitive control, played for total of 30 treatment sessions. Every treatment session consists of 30 minutes of intervention.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Feasibility of treatment
Time Frame: Six weeks
Feasibility is met if a patient will complete 20 sessions per protocol with a probability of more than 50.00%.Completion per protocol is achieved, if the patient completes 20 sessions per protocol with a probability of more than 50 percent.
Six weeks

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Efficacy-Improvement on the MADRS scores compared to baseline.
Time Frame: six weeks

Change from baseline in the Montgomery Åsberg Depression Rating Scale (MADRS) scores at week 6 post-randomization compared to baseline.

The MADRS scores severity of depression on a scale from 0-60. Higher scores indicate worse depression. A total score between 0-6 indicates that the patient is in the normal range (no depression), 7-19 indicates mild depression, 20-34 indicates moderate depression, and a score of 35 and greater indicates severe depression.
six weeks

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Mor Nahum

Collaborators

Hadassah Medical Organization
Ludwig-Maximilians - University of Munich
Riga Stradins University

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.

General Publications

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)

June 22, 2021

Primary Completion (Estimated)

June 30, 2024

Study Completion (Estimated)

December 31, 2024

Study Registration Dates

First Submitted

June 7, 2021

First Submitted That Met QC Criteria

July 3, 2021

First Posted (Actual)

July 7, 2021

Study Record Updates

Last Update Posted (Estimated)

January 18, 2024

Last Update Submitted That Met QC Criteria

January 17, 2024

Last Verified

January 1, 2024

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 388-20-HMO

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

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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