Cognitive Behavioral Therapy for Insomnia with RTMS

Medical University of South Carolina2 enrolled

Overview

Depression and insomnia occur together in a substantial number of patients. Transcranial magnetic stimulation (TMS) is an effective treatment for depression, but does not help insomnia symptoms in depressed patients. A form of cognitive behavioral therapy (CBT) has been developed that specifically helps with insomnia (CBT-I). The study team will give CBT-I to patients who are being treated with TMS for depression, who also have insomnia, to determine if it helps insomnia symptoms.

Study Type

INTERVENTIONAL

Allocation

NON_RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Depression Insomnia

Interventions

CBT-I (Cognitive Behavioral Therapy for Insomnia) with rTMSBEHAVIORAL

Cognitive Behavioral Therapy for insomnia (CBT-I) with rTMS (repetitive Transcranial Magnetic Stimulation) will be performed as part of this study by the PI. This includes weekly, one hour sessions addressing sleep for 6 weeks.

Repetitive Transcranial Magnetic StimulationDEVICE

Participants in this study will be undergoing repetitive transcranial magnetic stimulation (rTMS) for major depressive disorder as part of their clinical treatment. This involves magnetic stimulation with specific settings to a specific region of the brain to help treat depression. Treatment time ranges, but is around 30 minutes per session and occurs 5 days a week for 6 weeks.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 85 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Adults aged 18-85 years old * Patients starting rTMS treatment for MDD * Co-morbid insomnia as determined by meeting the following criteria: (a) Requiring more than 30 minutes to fall asleep at the beginning of the night or more than 30 minutes of time awake after initially falling asleep for at least 3 nights per week for at least 3 months - - An insomnia severity index score of 15 or more * Manifested sleep disturbances or associated daytime symptoms causing significant distress or impairment in social, occupational or other areas of functioning * Reliable access to a computer with internet access. Exclusion Criteria: * Obligation to an irregular sleep schedule that prevents the adoption of intervention strategies such as shift workers * Participants who have received or are receiving CBT-I targeting insomnia in the past, or those who have initiated a new sedative medication, or sedating antidepressant within 2-weeks preceding enrollment * Comorbid psychiatric disorders, including bipolar disorder, psychotic disorders or depression with psychotic features * Presence of another untreated sleep disorder such as obstructive sleep apne * Pregnancy * Active substance use disorder within the past 3 months * Use of medications that reduce the seizure threshold including Buproprion, stimulants or augmenting thyroid medications (for those without history of hypothyroid)

Locations (1)

Medical University of South

Charleston, South Carolina, United States

Outcomes

Primary Outcomes

Number of Reported Unanticipated Adverse Events

Tolerability of CBT-I with TMS determined by patient reported adverse event as assessed by red cap form

Time frame: Baseline through post intervention (6 weeks)

Percentage of patients completing CBT-I program

Feasibility of implementation of CBT-I as assessed by completion percentage of patients enrolled.

Time frame: Determined post intervention (6 weeks)

Secondary Outcomes

Change in Epworth Sleepiness Scale

Assessing pre and post TMS treatment changes of ESS in TMS + CBT-I group vs no CBT-I group. The scale is scored 0-24 assessing degree of sleepiness. Cutoff scores are as follows: 0-7:It is unlikely that you are abnormally sleepy. 8-9:You have an average amount of daytime sleepiness; 10-15:You may be excessively sleepy depending on the situation. You may want to consider seeking medical attention;16-24:You are excessively sleepy and should consider seeking medical attention. This scale is often used clinically for obstructive sleep apnea, but can be useful to assess daytime impact of insomnia.

Time frame: Baseline and post intervention (6 weeks)

Change in Insomnia Severity Index Scale

Assessing pre and post TMS treatment changes of ISI in TMS + CBT-I group vs no CBT-I group. This scale is scored 0-28 and is used to assess severity of insomnia with cutoff scores as follows: 0-7 = No clinically significant insomnia; 8-14 = Subthreshold insomnia;15-21 = Clinical insomnia (moderate severity); 22-28 = Clinical insomnia (severe).

Time frame: Baseline through post intervention (6 weeks)

Change in Patient Health Questionnaire - 9

Assessing pre and post TMS treatment changes of PHQ-9 in TMS + CBT-I group vs no CBT-I group. This scale is used to assess depression severity. Cutoff scores are as follows: 0-4: Minimal or none; 5-9: Mild; 10-14: Moderate; 15-19: Moderately severe; 20-27: Severe.

Data from ClinicalTrials.gov

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