- ICH GCP
- US Clinical Trials Registry
- Klinisk utprøving NCT01701284
Gjentatt transkraniell magnetisk stimulering hos kreftpasienter med depresjon og angst (rTMSinCP)
En randomisert åpen pilotforsøk for å evaluere sikkerheten og effekten av repeterende transkraniell magnetisk stimulering hos kreftpasienter med depresjon og angst
Studieoversikt
Status
Intervensjon / Behandling
Studietype
Registrering (Faktiske)
Fase
- Ikke aktuelt
Kontakter og plasseringer
Studiesteder
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Illinois
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Chicago, Illinois, Forente stater, 60611
- Northwestern University
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Deltakelseskriterier
Kvalifikasjonskriterier
Alder som er kvalifisert for studier
Tar imot friske frivillige
Beskrivelse
Inklusjonskriterier:
- Hunn
- Alder 22-80
- Hadde en tidligere diagnose av kreft (enhver type eller stadium) bekreftet av offisielle medisinske journaler
- Har en DSM IV diagnose av alvorlig depressiv lidelse
- Har en HAM-D 24-elements poengsum på mer enn 20
- Kunne ikke motta tilfredsstillende forbedring fra én tidligere antidepressiv medisin ved eller over den minimale effektive dosen og varigheten i den nåværende depressive episoden
- Alle deltakere må ha gitt signert, informert samtykke før registrering i studien
Ekskluderingskriterier:
- Deltakeren hadde brystkreft med hjernemetastaser
- Det er bevis for sykdommen på tidspunktet for inntreden i rettssaken
Tilstedeværelse eller nylig historie av andre samtidige kreftformer, med følgende unntak:
- Deltakere med fullstendig behandlet basal- eller plateepitelkreft kan inkluderes i studien hvis legen deres vurderer at de er medisinsk stabile
- Deltakere med fullstendig behandlet in situ karsinom i brystet eller livmorhalsen kan inkluderes i studien hvis de ikke har hatt kjemoterapi i løpet av den siste måneden og legene vurderer at de er medisinsk stabile.
- Deltakere med pre-cancerøse lesjoner i tykktarmen kan inkluderes i studien hvis de ikke har hatt cellegift i løpet av den siste måneden og deres leger vurderer at de er medisinsk stabile
- Deltakeren ble nylig operert (innen to uker)
- Deltakeren gjennomgår cellegiftbehandling
- Deltakeren er gravid eller ammer
- Deltakeren har en metallgjenstand i eller rundt hodet
- Deltaker har pacemaker
- Har ustabile selvmordstanker som bestemt av pasientens behandlende psykiater
- Rusmisbruk de siste seks månedene
- Betydelig historie med hodeskade/traume som definert ved tap av bevissthet i mer enn 1 time
- Tilbakevendende anfall som følge av hodeskaden
- Tydelige kognitive følgetilstander fra hodeskaden og kognitiv rehabilitering etter skaden
- Enhver lidelse som vil disponere deltakeren for anfall
- Bruk av samtidig medisin som øker anfallsrisikoen betydelig. Slike legemidler kan omfatte nevroleptika (f.eks. haloperidol, droperidol), klozapin, trisykliske antidepressiva (f.eks. amoksapin, klomipramin), bupropion (spesielt umiddelbar frigjøring - IR - formulering) donepezil, psykostimulerende midler (f.eks. metylfenidat), teofyllin og/eller andre legemidler som reduserer krampeterskelen. For individer som bruker noen av disse medisinene, vil en studiekliniker evaluere stoffene og dosene for å bestemme risikoene og fordelene. Disse vil deretter bli diskutert med den enkeltes primærlege for å avgjøre om personen bør ekskluderes fra studien.
Studieplan
Hvordan er studiet utformet?
Designdetaljer
- Primært formål: Behandling
- Tildeling: Randomisert
- Intervensjonsmodell: Parallell tildeling
- Masking: Ingen (Open Label)
Våpen og intervensjoner
Deltakergruppe / Arm |
Intervensjon / Behandling |
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Eksperimentell: Høyresidig lavfrekvent rTMS
Deltakerne vil få rTMS administrert ved 1 Hz til høyre dorsolateral Prefrontal Cortex (dlPFC) en gang daglig i 40 minutter, 5 dager i uken, i totalt seks uker.
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Andre navn:
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Eksperimentell: Venstresidig høyfrekvent rTMS
Deltakerne vil få rTMS administrert ved 10 Hz til venstre dorsolateral Prefrontal Cortex (dlPFC) en gang daglig i 40 minutter, 5 dager i uken, i totalt seks uker.
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Andre navn:
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Hva måler studien?
Primære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
|---|---|---|
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Overall Change in Depression Severity (HDRS-17) at Weeks 2, 4, and 6
Tidsramme: Baseline (Week 0), Week 2, Week 4 and Week 6.
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This measure reports the overall change in depression severity(HDRS-17) from baseline (Week 0) at each follow-up assessment. Overall Change is defined as the score at each subsequent time point minus the score at Baseline. Scale Information: Name: Hamilton Depression Rating Scale (HDRS-17). Construct: The HDRS-17 is a clinician-administered assessment of depressive symptom severity. Total Score Calculation: The total score is calculated by summing the individual scores of all 17 items. Range: Total scores range from 0 to 52. Directionality: Higher values represent a worse outcome (more severe depression), while lower values represent a better outcome. Calculation Logic: The values reported are the absolute difference of outcomes for each treatment arm. For each participant, the relative change is calculated as: Score at Visit - Baseline Score. Negative numbers indicates a reduction in symptom severity (improvement) and a positive number indicates worsening in symptom severity |
Baseline (Week 0), Week 2, Week 4 and Week 6.
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Relative Change in Depression Severity (HDRS-17) at Weeks 2, 4, and 6
Tidsramme: Baseline (Week 0), Week 2, Week 4 and Week 6
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Measure Description: This measure reports the relative (percentage) change in depression severity from baseline (Week 0) at each follow-up assessment. Scale Information: Name: Hamilton Depression Rating Scale (HDRS-17). Construct: The HDRS-17 is a clinician-administered assessment of depressive symptom severity. Total Score Calculation: The total score is calculated by summing the individual scores of all 17 items. Range: Total scores range from 0 to 52. Directionality: Higher values represent a worse outcome (more severe depression), while lower values represent a better outcome. Calculation Logic: The values reported are the mean percentage changes for each treatment arm. For each participant, the relative change is calculated as: ((Score at Visit - Baseline Score) / Baseline Score) * 100. A negative percentage indicates a reduction in symptom severity (improvement). |
Baseline (Week 0), Week 2, Week 4 and Week 6
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Number of Participants With Treatment-Emergent Side Effects (UKU)
Tidsramme: Baseline (Week 0), Week 2, Week 4, and Week 6
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Side effects assessed at Weeks 2, 4, 6 via Udvalg for Kliniske Undersøgelser (UKU) scale (48 items, 0=none to 3=severe; higher=worse). 'Treatment-emergent' worsening is a score increase ≥1 from baseline (Tx #1) on any item with possible/probable relation to intervention. Data reported is the count of participants meeting criteria for any of the clusters. Psychic Cluster: concentration, asthenia, sedation, memory, depression, unrest, sleep/dream changes, emotional indifference. Neurological Cluster: dystonia, rigidity, hypokinesia, hyperkinesia, tremor, akathisia, seizures, paresthesia, headache. Autonomic Cluster: accommodation, salivation, nausea/vomiting, diarrhea, constipation, micturition, polyuria, dizziness, tachycardia, sweating. Other Cluster: rash, pruritus, photosensitivity, weight change, menses changes, galactorrhea, gynecomastia, libido changes, erectile dysfunction. |
Baseline (Week 0), Week 2, Week 4, and Week 6
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Sekundære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
|---|---|---|
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Overall Change in Anxiety Severity (HAM-A) at Weeks 1, 2, 3, 4, 5, and 6
Tidsramme: Baseline (Week 0), Week 1- Week 6 (Weekly assessments)
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Measure Description: The overall change in anxiety severity is assessed using the total score of the Hamilton Anxiety Rating Scale (HAM-A) at each protocol-specified follow-up visit compared to the baseline score at baseline(Week 0) Scale Information: Hamilton Anxiety Rating Scale (HAM-A) Construct: A clinician-rated scale used to measure the severity of a patient's anxiety symptoms, including both psychic anxiety (mental agitation and psychological distress) and somatic anxiety (physical complaints). Total Score Calculation: The total score is calculated by summing the individual scores of all 14 items. Range: Total scores range from 0 to 56. Directionality: Higher values represent a worse outcome (greater anxiety severity), while lower values represent a better outcome. Calculation Logic: The values reported represent the absolute difference in scores for each treatment arm at every assessment interval minus the score at baseline. |
Baseline (Week 0), Week 1- Week 6 (Weekly assessments)
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Relative Change in Anxiety Severity (HAM-A) at Weeks 1, 2, 3, 4, 5, and 6
Tidsramme: Baseline(Week 0), Week 1- Week 6 (Weekly assessments)
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This measure reports the relative (percentage) change in anxiety severity from baseline (Week 0) at each follow-up assessment. Scale name: Hamilton Anxiety Rating Scale (HAM-A). It is a clinician-rated scale used to measure the severity of a patient's anxiety symptoms. The scale consists of 14 items, each defined by a series of symptoms, measuring both psychic anxiety (mental agitation and psychological distress) and somatic anxiety (physical complaints related to anxiety). Each item is scored on a scale of 0 (not present) to 4 (severe). Total score is calculated by summing all 14 items. The total Score ranges from 0 to 56. Higher values represent a worse outcome (greater severity of anxiety), while lower values represent a better outcome. For each protocol-specified time point (Weeks 1-6), the relative change is calculated for as: ((Score at Visit - Baseline Score(Week 0) /Baseline Score)*100. A negative percentage indicates a reduction in symptoms (better outcome). |
Baseline(Week 0), Week 1- Week 6 (Weekly assessments)
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Correlation Between Baseline Anxiety (HAM-A) and Change in Depression Severity (HDRS-17, HAM-D)
Tidsramme: Baseline (Week 0) and Week 6
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This measure assesses the relationship between the severity of anxiety symptoms at the start of treatment and the magnitude of depression improvement at Week 6. Scale 1: Hamilton Anxiety Rating Scale (HAM-A). Measures anxiety severity. Total range: 0 to 56. Higher values = worse outcome. Scale 2: Hamilton Depression Rating Scale (HDRS-17, HAM-D). Measures depression severity. Total range: 0 to 50. Higher values = worse outcome. Statistical Analysis & Interpretation: Change Calculation: Depression change is calculated as (Week 6 Score - Baseline Score). A more negative value represents greater improvement. Coefficient: Spearman's rank correlation coefficient (rho) is used. Interpretation: A positive correlation indicates that higher baseline anxiety is associated with higher (less negative) change scores, meaning less improvement. A negative correlation indicates that higher baseline anxiety is associated with lower (more negative) change scores, meaning greater improvement. |
Baseline (Week 0) and Week 6
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Correlation Between Baseline Anxiety (HAM-A) and Harm Avoidance (TCI-R)
Tidsramme: Baseline
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This measure assesses the relationship between clinical anxiety symptoms and the personality trait of Harm Avoidance at baseline. Scale Information: Scale 1: Hamilton Anxiety Rating Scale (HAM-A). Measures anxiety severity. Total range: 0 to 56. Higher values = worse outcome. Scale 2: Temperament and Character Inventory-Revised (TCI-R) - Harm Avoidance Subscale. Measures the personality trait of Harm Avoidance. Results are reported as standardized T-scores (mean of 50, standard deviation of 10). The typical range for T-scores is 20 to 80. Outcome Direction: For both scales, higher values represent higher levels of the construct (more anxiety and higher harm avoidance). Statistical Analysis & Interpretation: Coefficient: Spearman's rank correlation coefficient (rho). Interpretation: A positive correlation indicates that individuals with higher clinical anxiety symptoms also tend to score higher on the personality trait of Harm Avoidance. |
Baseline
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Samarbeidspartnere og etterforskere
Sponsor
Samarbeidspartnere
Etterforskere
- Hovedetterforsker: Mehmet Dokucu, MD, PhD, Northwestern University
Publikasjoner og nyttige lenker
Generelle publikasjoner
- George MS, Lisanby SH, Avery D, McDonald WM, Durkalski V, Pavlicova M, Anderson B, Nahas Z, Bulow P, Zarkowski P, Holtzheimer PE 3rd, Schwartz T, Sackeim HA. Daily left prefrontal transcranial magnetic stimulation therapy for major depressive disorder: a sham-controlled randomized trial. Arch Gen Psychiatry. 2010 May;67(5):507-16. doi: 10.1001/archgenpsychiatry.2010.46.
- Burgess C, Cornelius V, Love S, Graham J, Richards M, Ramirez A. Depression and anxiety in women with early breast cancer: five year observational cohort study. BMJ. 2005 Mar 26;330(7493):702. doi: 10.1136/bmj.38343.670868.D3. Epub 2005 Feb 4.
- Janicak PG, O'Reardon JP, Sampson SM, Husain MM, Lisanby SH, Rado JT, Heart KL, Demitrack MA. Transcranial magnetic stimulation in the treatment of major depressive disorder: a comprehensive summary of safety experience from acute exposure, extended exposure, and during reintroduction treatment. J Clin Psychiatry. 2008 Feb;69(2):222-32. doi: 10.4088/jcp.v69n0208.
- O'Reardon JP, Solvason HB, Janicak PG, Sampson S, Isenberg KE, Nahas Z, McDonald WM, Avery D, Fitzgerald PB, Loo C, Demitrack MA, George MS, Sackeim HA. Efficacy and safety of transcranial magnetic stimulation in the acute treatment of major depression: a multisite randomized controlled trial. Biol Psychiatry. 2007 Dec 1;62(11):1208-16. doi: 10.1016/j.biopsych.2007.01.018. Epub 2007 Jun 14.
- Machado S, Paes F, Velasques B, Teixeira S, Piedade R, Ribeiro P, Nardi AE, Arias-Carrion O. Is rTMS an effective therapeutic strategy that can be used to treat anxiety disorders? Neuropharmacology. 2012 Jan;62(1):125-34. doi: 10.1016/j.neuropharm.2011.07.024. Epub 2011 Jul 27.
- Paes F, Machado S, Arias-Carrion O, Velasques B, Teixeira S, Budde H, Cagy M, Piedade R, Ribeiro P, Huston JP, Sack AT, Nardi AE. The value of repetitive transcranial magnetic stimulation (rTMS) for the treatment of anxiety disorders: an integrative review. CNS Neurol Disord Drug Targets. 2011 Aug;10(5):610-20. doi: 10.2174/187152711796234943.
- Schutter DJ. Antidepressant efficacy of high-frequency transcranial magnetic stimulation over the left dorsolateral prefrontal cortex in double-blind sham-controlled designs: a meta-analysis. Psychol Med. 2009 Jan;39(1):65-75. doi: 10.1017/S0033291708003462. Epub 2008 Apr 30.
- Slotema CW, Blom JD, Hoek HW, Sommer IE. Should we expand the toolbox of psychiatric treatment methods to include Repetitive Transcranial Magnetic Stimulation (rTMS)? A meta-analysis of the efficacy of rTMS in psychiatric disorders. J Clin Psychiatry. 2010 Jul;71(7):873-84. doi: 10.4088/JCP.08m04872gre. Epub 2010 Mar 9.
Studierekorddatoer
Studer hoveddatoer
Studiestart
Primær fullføring (Faktiske)
Studiet fullført (Faktiske)
Datoer for studieregistrering
Først innsendt
Først innsendt som oppfylte QC-kriteriene
Først lagt ut (Antatt)
Oppdateringer av studieposter
Sist oppdatering lagt ut (Faktiske)
Siste oppdatering sendt inn som oppfylte QC-kriteriene
Sist bekreftet
Mer informasjon
Begreper knyttet til denne studien
Ytterligere relevante MeSH-vilkår
Andre studie-ID-numre
- NU 12CC12
- NCI-2012-01691 (Registeridentifikator: NCI Clinical Trials Reporting Program (CTRP))
Plan for individuelle deltakerdata (IPD)
Planlegger du å dele individuelle deltakerdata (IPD)?
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