- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05855850
Deep rTMS for Depression in Older Adults (DIVINE)
DIfferential Feasibility and Tolerability of Deep repetitiVe transcranIal MagNEtic Stimulation for Depression in Older Adults (DIVINE Trial): A Pilot Study
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Jane De Jesus, BSc
- Phone Number: 905-522-1155
- Email: dejesuj@mcmaster.ca
Study Contact Backup
- Name: Dante Duarte, MD, MSc, PhD
- Phone Number: 36782 905 522-1155
- Email: duartedante@mcmaster.ca
Study Locations
-
-
Ontario
-
Hamilton, Ontario, Canada, L9C 0E3
- Recruiting
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
A) 60 - 85 years old
B) Able to provide informed consent to participate in the study
C) MDD diagnosis, single or recurrent episode, assessed using Evaluation of the Diagnostic Assessment Research Tool (DART) Screener for DSM-5 Mood Disorder Module
D) Total score of at least 20 on the 24-item Hamilton Depression Rating Scale (HDRS-24) at screening visit
E) Treatment resistance to antidepressant pharmacotherapy during the current episode as indexed by Antidepressant Treatment History Form - Short Form (ATHF - SF). Specifically, participants will be required to have failed at least one or to have had an inadequate trial (including intolerance) to at least two antidepressants in the current episode
F) Participants will be required to be on stable dosages of other psychotropic medications for at least 4 weeks prior to screening
Exclusion Criteria:
A) Primary diagnosis of bipolar I or II disorder; psychotic disorder; obsessive-compulsive, post-traumatic stress, anxiety, or personality disorder; participants with anxiety or personality disorders will be eligible if is not their primary diagnosis
B) Active suicidal behavior
C) Substance dependence/abuse in the past 3 months before entering the study (this will be screened via self-report and verified by urine screening test)
D) Possible dementia diagnosis based on a Mini Mental Status Exam (MMSE) score of <24 and clinical presentation of dementia
E) Unsuccessful ECT treatment on the current episode
F) Traditional contraindications to rTMS: Intracranial or metal implants in the head or nearby regions, excluding the mouth, that cannot be safely removed; History of epilepsy or seizures; Active unstable medical condition (recent laboratory and neuroimaging alterations); Pacemaker and/or implantable cardioverter-defibrillators; current use of bupropion >300 mg/day as it is associated with risk of seizures, treatment with equivalent benzodiazepine dose to lorazepam >2 mg/day
G) People with severe literacy, visual, or hearing issues that affect their ability to engage in the interviews
H) People with recurring migraines or headaches (weekly or more).
I) Individuals residing beyond the borders of the Greater Hamilton Area and its neighbouring vicinities.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Health Services Research
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Active H4-coil dTMS treatment
|
Participants assigned to this arm will complete a 4-week course of 5 dTMS sessions per week (using the Brainsway H4-coil), for a total of 20 stimulation sessions.
We will follow the standard Health Canada and FDA-approved protocol for depression: 18 Hz and 55 trains, for a total of 1980 pulses.
|
Experimental: Active H7-coil dTMS treatment
|
Participants assigned to this arm will complete a 4-week course of 5 dTMS sessions per week (using the Brainsway H7-coil), for a total of 20 stimulation sessions.
We will follow the standard Health Canada and FDA-approved protocol for depression: 18 Hz and 55 trains, for a total of 1980 pulses.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Feasibility criteria 1: Protocol completion
Time Frame: 4 weeks
|
Percentage of intervention sessions completed
|
4 weeks
|
Feasibility criteria 2: Retention rate
Time Frame: 4 weeks
|
Percentage of participants who complete study once enrolled
|
4 weeks
|
Feasibility criteria 3: Screening rates and capacity
Time Frame: 4 weeks
|
Number of participants (n) screened; n enrolled as a percentage of n screened monthly
|
4 weeks
|
Feasibility criteria 4: Recruitment rate and capacity
Time Frame: 4 weeks
|
Total number of participants recruited and enrolled per month.
|
4 weeks
|
Feasibility criteria 5: Duration of intervention and assessment processes
Time Frame: 4 weeks
|
Compared to estimated times, the actual mean times (in min) from start to finish for each dTMS intervention session and mean time (in hours) from start to finish for each visit.
|
4 weeks
|
Feasibility criteria 5: Safety of H-coil dTMS treatment
Time Frame: 4 weeks
|
Total number of adverse events reported during the treatment sessions assessed by the Side Effects Questionnaire for dTMS (custom-developed for study).
At each dTMS stimulation session, participants will complete a questionnaire to evaluate potential adverse effects of dTMS (headache, neck pain, itching and redness at the site of stimulation) according to a 4-point scale.
|
4 weeks
|
Tolerability of H-coil dTMS treatment
Time Frame: 4 weeks
|
Percentage of participants withdrawn or terminated following enrollment due to adverse events
|
4 weeks
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Changes from baseline in resting-state EEG
Time Frame: 4 weeks
|
Using electroencephalography (EEG), we will assess alpha, theta and gamma rhythms in fronto-temporo-parietal region, including assessment of connectivity and coherence.
We will additionally measure cross-frequency coupling named theta (4-8Hz)-gamma (>25Hz) phase-amplitude coupling (PAC).
We will also investigate phase synchronization in upper theta frequency band between prefrontal and temporal areas.
Changes in these EEG parameters will be correlated with changes in mood severity and cognitive status, with a focus on working memory improvements.
EEG will be performed before dTMS sessions at baseline (V1) and at the end of each week (V5, V10, V15 and V20) by using a wireless dry electrode portable EEG system (CGX Quick 20r).
Resting state connectivity, coherence, PAC, and synchronization assessed by EEG will use standardized data processing pipelines in EEG Lab.
|
4 weeks
|
Changes from baseline in neurocognitive functioning (Repeatable Battery of Neuropsychological Status [RBANS])
Time Frame: 4 weeks
|
Neurocognitive performance will be assessed with the Repeatable Battery of Neuropsychological Status.
Assessments will be completed at baseline (V1) and at post-treatment (V20).
|
4 weeks
|
Change from baseline on the Hamilton Depression Rating Scale- 24 item (HDRS-24).
Time Frame: 4-weeks + 2-week follow-up
|
The Hamilton Depression Rating Scale (24 item) will be used as the primary measure of depression.
Symptoms of depression will be assessed with the HDRS- 24 item (a 24-item depression checklist) at multiple visits: the in-person screen (V0), baseline (V1), end-of-week dTMS sessions (V5, V10, V15, V20), and the 2-week follow-up.
Scores range from 0 (min) to 75 (max), with a score of ≥ 20 indicating a moderate-to-severe depression.
Lower scores may indicate mild depression or remission.
|
4-weeks + 2-week follow-up
|
Changes from baseline on the Geriatric Depression 30-item Scale (GDS-30)
Time Frame: 4-weeks + 2-week follow-up
|
The Geriatric Depression 30-item Scale (GDS-30) will be used as a second measure of depression, a 30-item checklist, at the baseline (V1), midpoint (V10) and endpoint (V20) visits and at the 2-week follow-up.
Scores of 0-4 are considered normal, 5-8 indicate mild depression; 9-11 indicate moderate depression; and 12-15 indicate severe depression.
|
4-weeks + 2-week follow-up
|
Change from baseline on the General Anxiety Disorder- 7 item (GAD-7)
Time Frame: 4-weeks + 2-week follow-up
|
Symptoms of anxiety will be assessed using this 7-item questionnaire at the baseline (V1), midpoint (V10) and endpoint (V20) visits and at the 2-week follow-up.
Scores of 0-4 indicate minimal anxiety; 5-9: mild anxiety; 10-14: moderate anxiety; and 15 or greater: severe anxiety.
|
4-weeks + 2-week follow-up
|
Change from baseline on the Pittsburgh Sleeping Quality Index (PSQI)
Time Frame: 4-weeks + 2-week follow-up
|
Sleep will be monitored and assessed using the Pittsburgh Sleeping Quality Index (PSQI) at the baseline (V1), midpoint (V10) and endpoint (V20) visits and at the 2-week follow-up.
Each of component of the PSQI is issued a score ranging from 0 to 3, with 3 indicating the greatest dysfunction.
|
4-weeks + 2-week follow-up
|
Change from baseline on the Patient Health Questionnaire (PHQ - Somatic Symptoms)
Time Frame: 4-weeks + 2-week follow-up
|
Somatic symptoms will be evaluated using the Patient Health Questionnaire (PHQ) somatic inventory at the baseline (V1), midpoint (V10) and endpoint (V20) visits and at the 2-week follow-up.
Scores range from 0 to 30: ≥ 5 = mild, ≥ 10 = moderate, and ≥ 15 = severe levels of somatization.
|
4-weeks + 2-week follow-up
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Dante Duarte, MD, MSc, PhD, Peter Boris Centre for Addictions Research at St. Joseph's Healthcare, Hamilton
- Study Director: James MacKillop, PhD, Peter Boris Centre for Addictions Research at St. Joseph's Healthcare, Hamilton
- Study Chair: Emily MacKillop, PhD, ABPP-CN, Peter Boris Centre for Addictions Research at St. Joseph's Healthcare, Hamilton
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
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
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 15344
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.
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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