- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05179785
Examining the Effect of EEG-guided Theta Burst Stimulation in Bipolar Disorder
Establishing the Effect of Electroencephalography (EEG)-Guided Theta Burst Stimulation on Reducing Mania/Hypomania-related Affect and Reward Driven Behavior in Bipolar Disorder
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
This study aims to examine the effect of electroencephalography (EEG)-guided theta burst stimulation (TBS) on reducing mania/hypomania-related affect and reward driven behavior in adults with BD. Eligible participants will undergo 6 study visits: a screening visit, a baseline MRI visit, TBS motor thresholding visit, and 3 cTBS/EEG visits. Participants will receive brain stimulation and have brain activity recorded by EEG at each of the 3 cTBS/EEG study visits. The research associates (except for the research associate administering the TBS) and participants will be blinded to the brain area receiving TBS, which will be randomized and counterbalanced beforehand. Certain information is withheld to protect the scientific integrity of the study design.
The goal of the study is to reduce overactivity in the reward neural network (RNet) and increase activity in the central executive control network (CEN) using theta burst stimulation (TBS). The region in the RNet to be targeted by inhibitory (continuous, cTBS) is the left ventrolateral prefrontal cortex (vlPFC); and the region in the CEN to be targeted by excitatory (intermittent, iTBS) is the right dorsolateral prefrontal cortex (dlPFC)
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Yiming Wang
- Phone Number: 4122466620
- Email: wangy40@upmc.edu
Study Contact Backup
- Name: Jill P Morris-Tillman
- Phone Number: 4123838206
- Email: morristillmanje@upmc.edu
Study Locations
-
-
Pennsylvania
-
Pittsburgh, Pennsylvania, United States, 15213
- University of Pittsburgh
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion criteria:
- 18-35 years of age
- Diagnosis of BD (DSM-5 criteria) in remission (euthymic for >2 months) or in a manic/hypomanic episode [manic/hypomanic or euthymic adults with BD (3-fifths manic/hypomanic); euthymic for > 2 months from most recent BD episode OR current manic/hypomanic episode]
- Not psychotic
- Score <3 on delusions, hallucinations, unusual thought content, and conceptual disorganization items of the Positive and Negative Syndrome Scale (PANSS)
- Unmedicated or on any combination of anxiolytics (benzodiazepines, buspirone, pregabalin, hydroxyzine) as needed, and/or atypical antipsychotics, and/or lithium, and/or other mood stabilizers, and/or non-SNRI antidepressants and/or non benzodiazepine hypnotics, as these are commonly-prescribed medications for BD
- Provides the contact information of a medical provider (including but not limited to a PCP) that we may communicate with for any concerns of escalating symptoms of mania
Exclusion criteria:
- Not 18-35 years of age
- Diagnosis of BD in a depressive episode or Diagnosis of BP in partial remission, euthymia that fails to meet full remission criterion of a period of at least 2 months in which there are no significant symptoms, e.g., only partial remission of symptoms or full remission of symptoms but for <2 months
- Diagnosis of BD in a depressive episode
- Personal and family history of epilepsy (TBS exclusion)
- Binge alcohol drinking
- Taking substances in the last month that can elevate seizure risk including but not limited to SNRI antidepressants, bupropion and stimulants (TBS exclusion)
- History of head injury, neurological, pervasive developmental disorder (e.g. autism), systemic medical disease and treatment (medical records, participant report)
- Mini-Mental State Examination score (cognitive state) <24
- Premorbid NAART IQ estimate<85
- Visual disturbance: <20/40 Snellen visual acuity
- History of alcohol/substance use disorder (SUD; all substances, except nicotine), and/or illicit substance use (except cannabis) over the last 6 months (SCID-5). Note: lifetime/present cannabis use (at non-abuse (<3 times in the past month) and non SUD levels) will be allowed, given its common usage in BD and young adults. Cannabis SUD over the last 6 months will not be allowed. Urine tests on scan days will exclude current illicit substance use (except cannabis). Salivary alcohol tests on scan days will exclude intoxicated individuals
- Binge drinking in the week before, and/or >3 units/day for the 3 days before, and/or alcohol in the last 12 hrs before, any TBS visit, confirmed at screening and scan days (to avoid TBS during alcohol withdrawal). Alcohol/nicotine/ caffeine/cannabis use (below SCID-5 SUD, binge levels) will be allowed, and used as covariates
- MRI exclusion: metallic objects, e.g., surgical implants; claustrophobia; positive pregnancy test for females (at the MRRC) or self-report pregnancy *Unable to understand English
- Scoring greater than or equal to 8 on HRSD at screen visit and depressive episode is confirmed on SCID-5
- Scoring greater than or equal to 18 on HRSD at any study visit
- Psychosis
- Using psychotropic medications other than those allowed in inclusion criteria
- Scoring greater than or equal to 38 on the YMRS at any study visit
- Does not provide the contact information of a medical provider (including but not limited to a PCP) that we may communicate with for any concerns of escalating symptoms of mania
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Basic Science
- Allocation: Randomized
- Interventional Model: Crossover Assignment
- Masking: Quadruple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Left vLPFC cTBS/right dlPFC iTBS/left Som cTBS
A random number sequence will be generated for randomization of the 3 EEG/TBS session order to which each participant is assigned: left vlPFC cTBS (cTBS applied to the left ventrolateral prefrontal cortex) right dlPFC iTBS (iTBS applied to the right dorsolateral prefrontal cortex) left Som cTBS (cTBS applied to the left somatosensory cortex) |
cTBS is a brief stimulation of a part of the brain with a magnetic field that passes through the scalp and skull safely that can decrease the excitability of cortical neurons.
It is FDA-approved as a treatment for psychological conditions including depression; however, this device is not approved for the treatment of adults with Bipolar Disorder I or for use in healthy adults.
This research study is using the cTBS off label in all participants (those with and without Bipolar Disorder I) to examine research questions
Other Names:
iTBS is a brief stimulation of a part of the brain with a magnetic field that passes through the scalp and skull safely to increase the excitability of cortical neurons.
It is FDA-approved as a treatment for psychological conditions including depression; however, this device is not approved for the treatment of adults with Bipolar Disorder I or for use in healthy adults.
This research study is using the cTBS off label in all participants (those with and without Bipolar Disorder I) to examine research questions.
Other Names:
|
Experimental: Left vLPFC cTBS/left Som cTBS/right dlPFC iTBS
A random number sequence will be generated for randomization of the 3 EEG/TBS session order to which each participant is assigned: left vlPFC cTBS (cTBS applied to the left ventrolateral prefrontal cortex) left Som cTBS (cTBS applied to the left somatosensory cortex) right dlPFC iTBS (iTBS applied to the right dorsolateral prefrontal cortex) |
cTBS is a brief stimulation of a part of the brain with a magnetic field that passes through the scalp and skull safely that can decrease the excitability of cortical neurons.
It is FDA-approved as a treatment for psychological conditions including depression; however, this device is not approved for the treatment of adults with Bipolar Disorder I or for use in healthy adults.
This research study is using the cTBS off label in all participants (those with and without Bipolar Disorder I) to examine research questions
Other Names:
iTBS is a brief stimulation of a part of the brain with a magnetic field that passes through the scalp and skull safely to increase the excitability of cortical neurons.
It is FDA-approved as a treatment for psychological conditions including depression; however, this device is not approved for the treatment of adults with Bipolar Disorder I or for use in healthy adults.
This research study is using the cTBS off label in all participants (those with and without Bipolar Disorder I) to examine research questions.
Other Names:
|
Experimental: left Som cTBS/right dlPFC iTBS/Left vLPFC cTBS
A random number sequence will be generated for randomization of the 3 EEG/TBS session order to which each participant is assigned: left Som cTBS (cTBS applied to the left somatosensory cortex) right dlPFC iTBS (iTBS applied to the right dorsolateral prefrontal cortex) left vlPFC cTBS (cTBS applied to the left ventrolateral prefrontal cortex) |
cTBS is a brief stimulation of a part of the brain with a magnetic field that passes through the scalp and skull safely that can decrease the excitability of cortical neurons.
It is FDA-approved as a treatment for psychological conditions including depression; however, this device is not approved for the treatment of adults with Bipolar Disorder I or for use in healthy adults.
This research study is using the cTBS off label in all participants (those with and without Bipolar Disorder I) to examine research questions
Other Names:
iTBS is a brief stimulation of a part of the brain with a magnetic field that passes through the scalp and skull safely to increase the excitability of cortical neurons.
It is FDA-approved as a treatment for psychological conditions including depression; however, this device is not approved for the treatment of adults with Bipolar Disorder I or for use in healthy adults.
This research study is using the cTBS off label in all participants (those with and without Bipolar Disorder I) to examine research questions.
Other Names:
|
Experimental: left Som cTBS/Left vLPFC cTBS/right dlPFC iTBS
A random number sequence will be generated for randomization of the 3 EEG/TBS session order to which each participant is assigned: left Som cTBS (cTBS applied to the left somatosensory cortex) left vlPFC cTBS (cTBS applied to the left ventrolateral prefrontal cortex) right dlPFC iTBS (iTBS applied to the right dorsolateral prefrontal cortex) |
cTBS is a brief stimulation of a part of the brain with a magnetic field that passes through the scalp and skull safely that can decrease the excitability of cortical neurons.
It is FDA-approved as a treatment for psychological conditions including depression; however, this device is not approved for the treatment of adults with Bipolar Disorder I or for use in healthy adults.
This research study is using the cTBS off label in all participants (those with and without Bipolar Disorder I) to examine research questions
Other Names:
iTBS is a brief stimulation of a part of the brain with a magnetic field that passes through the scalp and skull safely to increase the excitability of cortical neurons.
It is FDA-approved as a treatment for psychological conditions including depression; however, this device is not approved for the treatment of adults with Bipolar Disorder I or for use in healthy adults.
This research study is using the cTBS off label in all participants (those with and without Bipolar Disorder I) to examine research questions.
Other Names:
|
Experimental: right dlPFC iTBS/left Som cTBS/Left vLPFC cTBS
A random number sequence will be generated for randomization of the 3 EEG/TBS session order to which each participant is assigned: right dlPFC iTBS (iTBS applied to the right dorsolateral prefrontal cortex) left Som cTBS (cTBS applied to the left somatosensory cortex) left vlPFC cTBS (cTBS applied to the left ventrolateral prefrontal cortex) |
cTBS is a brief stimulation of a part of the brain with a magnetic field that passes through the scalp and skull safely that can decrease the excitability of cortical neurons.
It is FDA-approved as a treatment for psychological conditions including depression; however, this device is not approved for the treatment of adults with Bipolar Disorder I or for use in healthy adults.
This research study is using the cTBS off label in all participants (those with and without Bipolar Disorder I) to examine research questions
Other Names:
iTBS is a brief stimulation of a part of the brain with a magnetic field that passes through the scalp and skull safely to increase the excitability of cortical neurons.
It is FDA-approved as a treatment for psychological conditions including depression; however, this device is not approved for the treatment of adults with Bipolar Disorder I or for use in healthy adults.
This research study is using the cTBS off label in all participants (those with and without Bipolar Disorder I) to examine research questions.
Other Names:
|
Experimental: right dlPFC iTBS/Left vLPFC cTBS/left Som cTBS
A random number sequence will be generated for randomization of the 3 EEG/TBS session order to which each participant is assigned: right dlPFC iTBS (iTBS applied to the right dorsolateral prefrontal cortex) left vlPFC cTBS (cTBS applied to the left ventrolateral prefrontal cortex) left Som cTBS (cTBS applied to the left somatosensory cortex) |
cTBS is a brief stimulation of a part of the brain with a magnetic field that passes through the scalp and skull safely that can decrease the excitability of cortical neurons.
It is FDA-approved as a treatment for psychological conditions including depression; however, this device is not approved for the treatment of adults with Bipolar Disorder I or for use in healthy adults.
This research study is using the cTBS off label in all participants (those with and without Bipolar Disorder I) to examine research questions
Other Names:
iTBS is a brief stimulation of a part of the brain with a magnetic field that passes through the scalp and skull safely to increase the excitability of cortical neurons.
It is FDA-approved as a treatment for psychological conditions including depression; however, this device is not approved for the treatment of adults with Bipolar Disorder I or for use in healthy adults.
This research study is using the cTBS off label in all participants (those with and without Bipolar Disorder I) to examine research questions.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Beta power in left vlPFC
Time Frame: Change in magnitude immediately before and immediately after each TBS condition at EEG/TBS visits (15-30 mins)
|
The difference in Beta power in left vLPFC from pre TBS to post TBS
|
Change in magnitude immediately before and immediately after each TBS condition at EEG/TBS visits (15-30 mins)
|
Beta power in right vlPFC
Time Frame: Change in magnitude immediately before and immediately after each TBS condition at EEG/TBS visits (15-30 mins)
|
The difference in Beta power in right vLPFC from pre TBS to post TBS
|
Change in magnitude immediately before and immediately after each TBS condition at EEG/TBS visits (15-30 mins)
|
Beta power in left dlPFC
Time Frame: Change in magnitude immediately before and immediately after each TBS condition at EEG/TBS visits (15-30 mins)
|
The difference in Beta power in left dLPFC from pre TBS to post TBS
|
Change in magnitude immediately before and immediately after each TBS condition at EEG/TBS visits (15-30 mins)
|
Beta power in right dlPFC
Time Frame: Change in magnitude immediately before and immediately after each TBS condition at EEG/TBS visits (15-30 mins)
|
The difference in Beta power in right dLPFC from pre TBS to post TBS
|
Change in magnitude immediately before and immediately after each TBS condition at EEG/TBS visits (15-30 mins)
|
Beta functional connectivity between left and right vlPFC
Time Frame: Change in magnitude immediately before and immediately after each TBS condition at EEG/TBS visits (15-30 mins)
|
The difference in Beta functional connectivity among left and right vLPFC from pre TBS to post TBS
|
Change in magnitude immediately before and immediately after each TBS condition at EEG/TBS visits (15-30 mins)
|
Beta functional connectivity between vlPFC and other RNet regions
Time Frame: Change in magnitude immediately before and immediately after each TBS condition at EEG/TBS visits (15-30 mins)
|
The difference in Beta functional connectivity among vLPFC and other RNet regions from pre TBS to post TBS
|
Change in magnitude immediately before and immediately after each TBS condition at EEG/TBS visits (15-30 mins)
|
Beta functional connectivity between dlPFC with other CEN regions
Time Frame: Change in magnitude immediately before and immediately after each TBS condition at EEG/TBS visits (15-30 mins)
|
The difference in Beta functional connectivity among dlPFC and other RNet regions from pre TBS to post TBS
|
Change in magnitude immediately before and immediately after each TBS condition at EEG/TBS visits (15-30 mins)
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Beta power in other RNet and CEN regions
Time Frame: Change in magnitude immediately before and immediately after each TBS condition at EEG/TBS visits (15-30 mins)
|
The difference in Beta power among other RNet and CEN regions from pre TBS to post TBS
|
Change in magnitude immediately before and immediately after each TBS condition at EEG/TBS visits (15-30 mins)
|
Functional connectivity among other RNet and CEN regions
Time Frame: Change in magnitude immediately before and immediately after each TBS condition at EEG/TBS visits (15-30 mins)
|
The difference in Beta functional connectivity among other RNet and CEN regions from pre TBS to post TBS
|
Change in magnitude immediately before and immediately after each TBS condition at EEG/TBS visits (15-30 mins)
|
Number of immediate choices made on the delay discounting task
Time Frame: 15-30 minutes
|
The sum of the immediate choices made on the delay discounting task
|
15-30 minutes
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Fabio Ferrarelli, MD, PhD, University of Pittsburgh
- Principal Investigator: Mary L Phillips, MD, MD, University of Pittsburgh
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
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
- STUDY21110077
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Access Criteria
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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