Compressed Intermittent Theta Burst Stimulation

N/AActive Not RecruitingNCT04684706

University of Pennsylvania40 enrolled

Overview

In this proposal the investigators will use an accelerated TMS protocol that concentrates the magnetic stimulation that would usually occur over 6 weeks into 10 treatment sessions per days, for 5 consecutive days in patient with treatment-refractory depression. This protocol will build on a previously published study demonstrating clinical efficacy of intermittent theta-burst stimulation (iTBS) on left dorsolateral prefrontal cortex (L-dlPFC) in a treatment refractory population.

Major depressive disorder (MDD) is a disabling mental disorder with a lifetime prevalence of up to16% . Approximately 30% of MDD patients suffer treatment resistant depression (TRD), with at least 2 failed adequate trials of pharmacotherapy. Repetitive transcranial magnetic stimulation (rTMS) has been shown to be a safe treatment for TRD, yet the standard clinical technique for using it as treatment depressive disorders is associated with limited efficacy to date. Among the potential causes of limited efficacy have been the scalp based targeting technique that is currently the most common targeting method rather than techniques that incorporate functional magnetic resonance imaging (fMRI) neuronavigation, which have been shown to have greater efficacy. Image guided TMS can target specific functional brain networks with greater resolution that takes into account individual differences in brain anatomy. Another technique for improving treatment efficacy, shown to modulate cortical excitability, may be the application of intermittent theta-burst stimulation in regular intervals, which has been shown to be no different than a longer-in-time application of rTMS. Paired with the evidence that iTBS has produced significant antidepressant responses in severely depressed individuals, and that relapse in depressive states predicts diminished efficacy of treatment as well as increased quantity of TBS pulses to have a beneficial effect, these recent iTBS findings suggest that iTBS may offer a valid treatment alternative to options that have proven otherwise ineffective in treating TRD. Therefore, the investigators aim to administer iTBS to severely-depressed participant in a shorter amount of time, in order to improve their antidepressant outcome. Significance: This protocol builds on different notions: 1. iTBS is not different in treatment outcome than rTMS while applying the same amount of pulses in shorter amount of time; 2. The degree of treatment resistance is indicative of iTBS quantity needed to obtain an antidepressant treatment 3. Repeated iTBS produces a significant effect in treating refractory depression 4. Decreasing the interval between iTBS applications enhanced positive treatment outcomes. Therefore, the compression of iTBS pulses with shorter intervals between sessions is hypothesized to have an increased beneficial effect on individuals affected by treatment-resistant depression.

Study Type

INTERVENTIONAL

Allocation

Purpose

OTHER

Masking

NONE

Enrollment

Conditions

Treatment Resistant Depression

Interventions

intermittent Theta Burst StimulationDEVICE

The present study will utilize TMS dosage of iTBS of 18 000 pulses a day for 5 consecutive days.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 70 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Gender, inclusive * 18 - 70 years of age * Meets Diagnostic and Statistical Manual of Mental Disorders criteria for primary diagnosis of MDD * Patients must be fluent in English * Participants must have the ability to provide consent * Montgomery Asberg Depression Rating Scale score ≥20 * Failed 2+ prior treatments (treatment-refractory) * May be on current anti-depressant medication at the discretion of PI, if not exceeding doses that would make TMS an increased risk Exclusion Criteria: * Pregnancy (Female participants) * MRI contraindication * Medical condition that interferes with the collection or interpretation of MRI data * Implanted devices such as: aneurysm clip or cardiac pacemaker * Diagnosis of stroke, epilepsy, or other neurological disorders interfering with treatment at PI discretion * Any factor the investigator believe may affect participant safety or compliance (ex: ≥100 miles from clinic) * Current alcohol or substance use disorder in last 3 months

Locations (2)

Department of Interventional Psychiatry, University of California San Diego

La Jolla, California, United States

Center for Neuromodulation in Depression and Stress

Philadelphia, Pennsylvania, United States

Outcomes

Primary Outcomes

Depressive Symptoms Change

Depressive symptoms will be measured before and after treatment by means of the clinician-administered Montgomery Asberg Depression Rating Scale (MADRS) (0-60, lower scores indicate lower depressive symptoms) and the self report Beck Depression Inventory (BDI II) (0-30, lower scores indicate lower depressive symptoms). Change will be measured by comparing measurements pre- and post- on the same measures. The bigger the change, the bigger the reduction in depressive symptoms.

Time frame: 2 Weeks

Secondary Outcomes

Self report Symptom Change

Depressive symptoms will be measured before and after treatment by means of the self report Beck Depression Inventory (BDI II) (0-30, lower scores indicate lower depressive symptoms). Change will be measured by comparing measurements pre- and post- on the same measures. The bigger the change, the bigger the reduction in depressive symptoms.

Time frame: 2 weeks

Data from ClinicalTrials.gov

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