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Study on iTBS Regulating the Reward Circuit Function to Improve Anhedonia in Depression (iTMMDD)

8 september 2026 bijgewerkt door: Guo Wenbin

Study on the Efficacy of iTBS Targeting NAc and sgACC in Regulating the Reward Circuit Function to Improve Anhedonia in Depression

The goal of this clinical trial is to learn if the proposed intermittent theta burst stimulation (iTBS) protocol can effectively improve anhedonia symptoms in depressed patients. The stimulation targets in our protocol include (1) dual-target stimulation at the left dorsolateral prefrontal cortex (DLPFC) and orbitofrontal cortex (OFC). (2) single-target stimulation at the left DLPFC.

The main questions it aims to answer are:

  • Whether iTBS of dual-target stimulation (left DLPFC and OFC) can improve the symptoms of anhedonia and better than single-target stimulation at the left DLPFC?
  • Whether iTBS of the dual targets of left DLPFC and OFC can improve the symptoms of anhedonia by correcting the abnormal functional connectivity of DLPFC-NAc and OFC-sgACC, regulating the functional abnormalities of NAc and sgACC, and indirectly repairing the overall dysfunction of the reward circuit.
  • Researchers will compare dual-target stimulation to single-target stimulation and sham dual-target stimulation (a dedicated sham coil is utilized which produces an identical audible click and physical sensation) to see if the proposed iTBS protocol works to treat anhedonia.

Participants will:

  • Take 6 sessions of dual-target iTBS or single-target iTBS every day, for 5 consecutive days.
  • Visit our hospital at 1 week, 4 weeks, and 8weeks after the iTBS treatment completion, for clinical evaluation and brain image examination.

Studie Overzicht

Toestand

Werving

Conditie

Interventie / Behandeling

Gedetailleerde beschrijving

Anhedonia, defined as the diminished capacity to experience pleasure, is a core symptom of Major Depressive Disorder (MDD). Patients with anhedonia exhibit a pervasive loss of interest or pleasure in all or almost all previously enjoyable activities, which frequently leads to a profound reduction in the desire to engage in rewarding behaviors. Previous studies have reported that anhedonia occurs in 37% to 72% of depressed individuals. Patients with depression accompanied by anhedonia tend to respond poorly to medication and psychotherapy but show relatively better responses to conventional physical treatments such as electroconvulsive therapy (ECT). Research has shown that improving anhedonia significantly enhances social functioning in depressed patients. Therefore, more effective treatments targeting anhedonia are needed. Achieving breakthroughs in therapeutic approaches and understanding their underlying mechanisms will contribute substantially to progress in this field.

Theta-burst stimulation (TBS) utilizes a stimulation pattern that closely mimics the natural firing frequencies of cerebral neurons. Accumulating evidence has demonstrated the clinical efficacy of intermittent TBS (iTBS) in alleviating depressive symptoms. Thus, this study aims to investigate and evaluate whether the proposed iTBS protocol can effectively improve anhedonia symptoms in depressed patients by regulating functional abnormalities.

The stimulation targets in our protocol include (1) dual-target stimulation at the left dorsolateral prefrontal cortex (DLPFC) and orbitofrontal cortex (OFC). (2) single-target stimulation at the left DLPFC.

The main questions it aims to answer are:

  1. Whether iTBS of dual-target stimulation (left DLPFC and OFC) can improve the symptoms of anhedonia and better than single-target stimulation?
  2. Whether iTBS of the dual targets of left DLPFC and OFC can improve the anhedonia symptom by correcting the abnormal functional connectivity of DLPFC-NAc and OFC-sgACC, regulating the functional abnormalities of NAc and sgACC, and indirectly repairing the overall dysfunction of the reward circuit?

Studietype

Ingrijpend

Inschrijving (Geschat)

60

Fase

  • Niet toepasbaar

Contacten en locaties

In dit gedeelte vindt u de contactgegevens van degenen die het onderzoek uitvoeren en informatie over waar dit onderzoek wordt uitgevoerd.

Studiecontact

Studie Locaties

  • China
    • Hunan
      • Changsha, Hunan, China, 410000
        • Werving
        • The Second Xiangya Hospital of Central South University
        • Contact:

Deelname Criteria

Onderzoekers zoeken naar mensen die aan een bepaalde beschrijving voldoen, de zogenaamde geschiktheidscriteria. Enkele voorbeelden van deze criteria zijn iemands algemene gezondheidstoestand of eerdere behandelingen.

Geschiktheidscriteria

Leeftijden die in aanmerking komen voor studie

  • Volwassen

Accepteert gezonde vrijwilligers

Nee

Beschrijving

Inclusion Criteria:

  1. Aged 18-45 years, and right-handed;
  2. Diagnosed with major depressive disorder (MDD) by at least two qualified psychiatrists, according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), with a Montgomery-Åsberg Depression Rating Scale (MADRS) score ≥ 20 or a 17-item Hamilton Depression Rating Scale (HAMD-17) score ≥ 17;
  3. Evaluated by a psychiatrist as having prominent anhedonia, and meeting the cutoff criteria on two self-report anhedonia scales, including a Snaith-Hamilton Pleasure Scale, Chinese version (SHAPS-C) score ≥ 20, or a Temporal Experience of Pleasure Scale, Chinese version (TEPS-C) score ≤ 76;
  4. Medication type and dosage remained unchanged for at least 4 weeks prior to treatment initiation and throughout the study period;
  5. MADRS item 10 score ≤ 4.

Exclusion Criteria:

  1. A history of epilepsy, seizures, stroke, or other serious organic brain diseases;
  2. Presence of severe infectious diseases, malignant tumors, or other major unstable medical conditions;
  3. Intellectual disability or developmental delay, presence of psychotic symptoms, or meeting the diagnostic criteria for other psychiatric disorders;
  4. A history of substance abuse or psychoactive substance use;
  5. Presence of intracranial implants (e.g., aneurysm clips, shunts, stimulators, cochlear implants, or electrodes), or any other metallic objects in or near the head that cannot be safely removed (excluding dental fillings);
  6. Contraindications to MRI or structural intracranial abnormalities detected on MRI;
  7. Pregnant or breastfeeding women;
  8. Receipt of electroconvulsive therapy (ECT) within the past 6 months, or transcranial magnetic stimulation (TMS) within the past 3 months;
  9. Current daily use of lorazepam > 2 mg (or an equivalent dose), or use of antiepileptic drugs at any dose;
  10. Presence of strong suicidal ideation, or a MADRS item 10 score > 4.

Studie plan

Dit gedeelte bevat details van het studieplan, inclusief hoe de studie is opgezet en wat de studie meet.

Hoe is de studie opgezet?

Ontwerpdetails

  • Primair doel: Behandeling
  • Toewijzing: Gerandomiseerd
  • Interventioneel model: Parallelle opdracht
  • Masker: Geen (open label)

Wapens en interventies

Deelnemersgroep / Arm
Interventie / Behandeling
Experimenteel: Left DLPFC + OFC iTBS Group

iTBS Parameter Specifications: 60 cycles of 10 bursts of three pulses at 50 Hz were delivered in 2-second trains (5 Hz) with an 8-second intertrain interval. The total duration of a single session is 10 minutes, comprising 60 trains and yielding a total of 1,800 pulses per session.

Treatment Protocol for Left DLPFC+OFC iTBS Group:

Stimulations are first delivered to the left DLPFC-NAc functional region using the specified iTBS parameters (1,800 pulses per session), performed 3 sessions daily with a 50-minute interval between sessions. Subsequently, stimulation was applied to the left OFC-sgACC functional region with the identical parameters (1,800 pulses per session), also performed 3 sessions daily with a 50-minute interval. This yields a cumulative total of 10,800 pulses over 5 consecutive days, for a total of 54,000 pulses.
Apparaat: Left DLPFC + OFC iTBS
iTBS Parameter Specifications: 60 cycles of 10 bursts of three pulses at 50 Hz were delivered in 2-second trains (5 Hz) with an 8-second intertrain interval. The total duration of a single session is 10 minutes, comprising 60 trains and yielding a total of 1,800 pulses per session. For the Left DLPFC + OFC iTBS Group, stimulation is first delivered to the left DLPFC-NAc functional region using the specified iTBS parameters (1,800 pulses per session), performed 3 sessions daily with a 50-minute interval between sessions. Subsequently, stimulation is applied to the left OFC-sgACC functional region with the identical parameters (1,800 pulses per session), also performed 3 sessions daily with a 50-minute interval. This yields a cumulative total of 10,800 pulses over 5 consecutive days, for a total of 54,000 pulses.
Andere namen:
  • intermitterende theta-burst-stimulatie (iTBS)
Experimenteel: Left DLPFC iTBS Group

iTBS Parameter Specifications: 60 cycles of 10 bursts of three pulses at 50 Hz were delivered in 2-second trains (5 Hz) with an 8-second intertrain interval. The total duration of a single session is 10 minutes, comprising 60 trains and yielding a total of 1,800 pulses per session.

Treatment Protocol for Left DLPFC iTBS Group:

For Group B, stimulations are delivered solely to the left DLPFC-NAc functional region using the specified iTBS parameters, performed 6 sessions daily with a 50-minute interval between sessions. This yields a cumulative total of 10,800 pulses over 5 consecutive days, for a total of 54,000 pulses.
Apparaat: Left DLPFC iTBS
iTBS Parameter Specifications: 60 cycles of 10 bursts of three pulses at 50 Hz were delivered in 2-second trains (5 Hz) with an 8-second intertrain interval. The total duration of a single session is 10 minutes, comprising 60 trains and yielding a total of 1,800 pulses per session. For the left DLPFC iTBS Group, stimulation is delivered solely to the left DLPFC-NAc functional region using the specified iTBS parameters, with 6 sessions performed daily, each with a 50-minute interval between sessions. This yields a cumulative total of 10,800 pulses over 5 consecutive days, for a total of 54,000 pulses.
Andere namen:
  • intermitterende theta burst-stimulatie

Wat meet het onderzoek?

Primaire uitkomstmaten

Uitkomstmaat
Maatregel Beschrijving
Tijdsspanne
Total score of Montgomery-Åsberg Depression Rating Scale (MADRS)
Tijdsspanne: *Baseline; * Day 2- Day 6 (every treatment day); *1 week post-treatment; *4 weeks post-treatment; *8 weeks post-treatment.
The Montgomery-Åsberg Depression Rating Scale (MADRS) scores will be evaluated before and after treatment. Total score: 0-60. A higher score means worse depressive symptoms.
*Baseline; * Day 2- Day 6 (every treatment day); *1 week post-treatment; *4 weeks post-treatment; *8 weeks post-treatment.
Remission Rate of Montgomery-Åsberg Depression Rating Scale (MADRS) scores
Tijdsspanne: * Day 2- Day 6 (every treatment day); *1 week post-treatment; *4 weeks post-treatment; *8 weeks post-treatment.
The proportion of patients in each group achieving remission. Remission is defined as a MADRS score < 11 points.
* Day 2- Day 6 (every treatment day); *1 week post-treatment; *4 weeks post-treatment; *8 weeks post-treatment.
Response Rate of Montgomery-Åsberg Depression Rating Scale (MADRS) scores
Tijdsspanne: * Day 2- Day 6 (every treatment day); *1 week post-treatment; *4 weeks post-treatment; *8 weeks post-treatment.
The percentage change in MADRS scores from baseline, calculated as [(MADRSpre - MADRSpost) / MADRSpre] * 100%.
* Day 2- Day 6 (every treatment day); *1 week post-treatment; *4 weeks post-treatment; *8 weeks post-treatment.

Secundaire uitkomstmaten

Uitkomstmaat
Maatregel Beschrijving
Tijdsspanne
Total score of the Temporal Experience of Pleasure Scale - Chinese Version (TEPS-C)
Tijdsspanne: *Baseline; *Day 6; *1 week post-treatment; *4 weeks post-treatment; *8 weeks post-treatment.
Total score: 20-120. The lower score means worse anhedonia.
*Baseline; *Day 6; *1 week post-treatment; *4 weeks post-treatment; *8 weeks post-treatment.
Remission rate of Temporal Experience of Pleasure Scale - Chinese Version (TEPS-C) score
Tijdsspanne: *Day 6; *1 week post-treatment; *4 weeks post-treatment; *8 weeks post-treatment.
Remission means the TEPS-C score > 76. The TEPS-C remission rate is the proportion of patients in each group whose TEPS-C scores increased to >76 after treatment.
*Day 6; *1 week post-treatment; *4 weeks post-treatment; *8 weeks post-treatment.

Andere uitkomstmaten

Uitkomstmaat
Maatregel Beschrijving
Tijdsspanne
Total score of the 17-item Hamilton Depression Rating Scale (HAMD-17)
Tijdsspanne: *Baseline; *Day 6; *1 week post-treatment; *4 weeks post-treatment; *8 weeks post-treatment.
Total score: 0-52. A higher score means worse depressive symptoms.
*Baseline; *Day 6; *1 week post-treatment; *4 weeks post-treatment; *8 weeks post-treatment.
Total scores of the Chinese version of the Snaith-Hamilton Pleasure Scale (SHAPS-C) score
Tijdsspanne: *Baseline; *Day 6; *1 week post-treatment; *4 weeks post-treatment; *8 weeks post-treatment.
Total score: 14-56. A higher score means worse anhedonia.
*Baseline; *Day 6; *1 week post-treatment; *4 weeks post-treatment; *8 weeks post-treatment.
Brain MRI
Tijdsspanne: *Baseline; *Day 6, up to 1day delay; *8 weeks post-treatment.
Resting-state magnetic resonance imaging scans will be conducted. Resting-state functional connectivity (rs-FC) changes before and after treatment will be assessed by fMRI. And its potential correlation with clinical symptom changes will be further explored.
*Baseline; *Day 6, up to 1day delay; *8 weeks post-treatment.
Questionnaire: The Beck Scale for Suicide Ideation (BSI) scores
Tijdsspanne: *Baseline; *Day 6; * 1 week post-treatment; * 4 weeks post-treatment; * 8 weeks post-treatment.
The Beck Scale for Suicide Ideation (BSI) scores will be evaluated before and after treatment. Total score: 0-38. Higher scores indicate greater severity of suicidal ideation.
*Baseline; *Day 6; * 1 week post-treatment; * 4 weeks post-treatment; * 8 weeks post-treatment.
Total Score of the Repeatable Battery for the Assessment of Neuropsychological Status Update (RBANS)
Tijdsspanne: *Baseline; *Day 6; * 8 weeks post-treatment.
The RBANS is an instrument used to assess cognitive functioning. The Total Scale Score will be evaluated. The standard score range is typically 40 to 160 (index score based). A higher score indicates better cognitive performance.
*Baseline; *Day 6; * 8 weeks post-treatment.
Wisconsin Card Sorting Test (WCST) Perseverative Errors scores
Tijdsspanne: *Baseline; *Day 6; *8 weeks post-treatment.
The WCST is an assessment of executive function and cognitive flexibility. This measure evaluates the number of perseverative errors, which occur when a participant continues to apply a previous sorting rule after the rule has changed. For this 48-card version, the theoretical score ranges from 0 to 48. A higher score indicates worse cognitive flexibility and greater executive dysfunction.
*Baseline; *Day 6; *8 weeks post-treatment.

Medewerkers en onderzoekers

Hier vindt u mensen en organisaties die betrokken zijn bij dit onderzoek.

Sponsor

Guo Wenbin

Onderzoekers

  • Hoofdonderzoeker: Wenbin Guo, PhD, Second Xiangya Hospital of Central South University

Studie record data

Deze datums volgen de voortgang van het onderzoeksdossier en de samenvatting van de ingediende resultaten bij ClinicalTrials.gov. Studieverslagen en gerapporteerde resultaten worden beoordeeld door de National Library of Medicine (NLM) om er zeker van te zijn dat ze voldoen aan specifieke kwaliteitscontrolenormen voordat ze op de openbare website worden geplaatst.

Bestudeer belangrijke data

Studie start (Werkelijk)

19 mei 2026

Primaire voltooiing (Geschat)

3 juli 2027

Studie voltooiing (Geschat)

3 juli 2027

Studieregistratiedata

Eerst ingediend

24 mei 2026

Eerst ingediend dat voldeed aan de QC-criteria

8 september 2026

Eerst geplaatst (Werkelijk)

10 september 2026

Updates van studierecords

Laatste update geplaatst (Werkelijk)

10 september 2026

Laatste update ingediend die voldeed aan QC-criteria

8 september 2026

Laatst geverifieerd

1 september 2026

Meer informatie

Termen gerelateerd aan deze studie

Aanvullende relevante MeSH-voorwaarden

Andere studie-ID-nummers

  • LYG20260013
  • ChiCTR2600125718 (Register-ID: Chinese Clinical Trial Registry)

Plan Individuele Deelnemersgegevens (IPD)

Bent u van plan om gegevens van individuele deelnemers (IPD) te delen?

NEE

Beschrijving IPD-plan

Individual participant data will not be shared to ensure strict confidentiality and protect participant privacy.

Informatie over medicijnen en apparaten, studiedocumenten

Bestudeert een door de Amerikaanse FDA gereguleerd geneesmiddel

Nee

Bestudeert een door de Amerikaanse FDA gereguleerd apparaatproduct

Nee

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