Depression is among the most prevalent psychiatric disorders, with an upward trend in its manifestation in younger individuals. In contrast to adult depression, adolescent depression often presents with longer attack durations, higher recurrence rates, chronicity, and elevated disability rates. At present, treatment options for adolescent depression encompass pharmacological, physical, and psychological therapies. However, current evidence suggests that no antidepressant medication is entirely safe for youths, with only fluoxetine and escitalopram being FDA-approved for treating adolescent depression. Given the weight of interpersonal stressors faced by teenagers, the NICE guidelines recommend interpersonal therapy(IPT) as a first-line treatment. A 2020 meta-analysis in the Journal of the American Academy of Child and Adolescent Psychiatry reported that interpersonal therapy exhibited significantly greater improvements in depression symptoms than cognitive behavioral therapy(CBT), although psychotherapeutic effects were modest, achieving a remission rate of 60%. These results underscore the need for further research to enhance interpersonal therapy's effectiveness in treating adolescent depression. High-Definition Transcranial Direct Current Stimulation (HD-tDCS）is a highly secure non-invasive brain stimulation technique that produces sustained effects even after stimulation has discontinued, rendering it particularly valuable for therapeutic interventions. The proposed study aims to augment a single IPT treatment with HD-tDCS stimulation for adolescent depression. By enhancing the excitability of the cerebral cortex, HD-tDCS could potentially enhance IPT's therapeutic efficacy in treating adolescent depression while facilitating further investigation of its underlying neural circuit mechanisms.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
60
psychotherapy plus device
psychotherapy plus sham device
The First Affiliated Hospital of Zhejiang University
Hangzhou, Zhejiang, China
RECRUITING24-item Hamilton Depression Rating Scale
Assessment of depressive symptoms. Score\<8: normal; \>20: mild or moderate depression; \>35: severe depression.
Time frame: Baseline
24-item Hamilton Depression Rating Scale
Assessment of depressive symptoms. Score\<8: normal; \>20: mild or moderate depression; \>35: severe depression.
Time frame: 1-month
24-item Hamilton Depression Rating Scale
Assessment of depressive symptoms. Score\<8: normal; \>20: mild or moderate depression; \>35: severe depression.
Time frame: 2-month
24-item Hamilton Depression Rating Scale
Assessment of depressive symptoms. Score\<8: normal; \>20: mild or moderate depression; \>35: severe depression.
Time frame: 3-month
Child Depression Rating Scale-Revised
Assessment of depressive symptoms. Score\<40: normal; 40\~60: mild or moderate depression; \>60: severe depression.
Time frame: Baseline
Child Depression Rating Scale-Revised
Assessment of depressive symptoms. Score\<40: normal; 40\~60: mild or moderate depression; \>60: severe depression.
Time frame: 1-month
Child Depression Rating Scale-Revised
Assessment of depressive symptoms. Score\<40: normal; 40\~60: mild or moderate depression; \>60: severe depression.
Time frame: 2-month
Child Depression Rating Scale-Revised
Assessment of depressive symptoms. Score\<40: normal; 40\~60: mild or moderate depression; \>60: severe depression.
Time frame: 3-month
17-item Hamilton Anxiety Rating Scale
Score\<7:No anxiety; Score≥7:Possibly anxious; Score≥14:Definitely anxious; Score≥21:Definitely significantly anxious; Score≥29:Possibly severely anxious.
Time frame: Baseline
17-item Hamilton Anxiety Rating Scale
Score\<7:No anxiety; Score≥7:Possibly anxious; Score≥14:Definitely anxious; Score≥21:Definitely significantly anxious; Score≥29:Possibly severely anxious.
Time frame: 1-month
17-item Hamilton Anxiety Rating Scale
Score\<7:No anxiety; Score≥7:Possibly anxious; Score≥14:Definitely anxious; Score≥21:Definitely significantly anxious; Score≥29:Possibly severely anxious.
Time frame: 2-month
17-item Hamilton Anxiety Rating Scale
Score\<7:No anxiety; Score≥7:Possibly anxious; Score≥14:Definitely anxious; Score≥21:Definitely significantly anxious; Score≥29:Possibly severely anxious.
Time frame: 3-month
Beck Scale for Suicide Ideation
Assessment of suicidal ideation. The test taker first completes the initial five questions. If the responses to both the fourth and fifth items are "no," it is considered that there is no suicidal ideation, and the questionnaire concludes. Suicidal risk is evaluated based on items six to nineteen of the scale, which assess the likelihood of actual suicidal behavior among individuals with suicidal ideation. The calculation formula for the total score is \[(sum of scores for items six to nineteen) - 9) / 33\] \* 100, resulting in a score ranging from 0 to 100. A higher score indicates a greater risk of suicide.
Time frame: Baseline
Beck Scale for Suicide Ideation
Assessment of suicidal ideation. The test taker first completes the initial five questions. If the responses to both the fourth and fifth items are "no," it is considered that there is no suicidal ideation, and the questionnaire concludes. Suicidal risk is evaluated based on items six to nineteen of the scale, which assess the likelihood of actual suicidal behavior among individuals with suicidal ideation. The calculation formula for the total score is \[(sum of scores for items six to nineteen) - 9) / 33\] \* 100, resulting in a score ranging from 0 to 100. A higher score indicates a greater risk of suicide.
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Time frame: 1-month
Beck Scale for Suicide Ideation
Assessment of suicidal ideation. The test taker first completes the initial five questions. If the responses to both the fourth and fifth items are "no," it is considered that there is no suicidal ideation, and the questionnaire concludes. Suicidal risk is evaluated based on items six to nineteen of the scale, which assess the likelihood of actual suicidal behavior among individuals with suicidal ideation. The calculation formula for the total score is \[(sum of scores for items six to nineteen) - 9) / 33\] \* 100, resulting in a score ranging from 0 to 100. A higher score indicates a greater risk of suicide.
Time frame: 2-month
Beck Scale for Suicide Ideation
Assessment of suicidal ideation. The test taker first completes the initial five questions. If the responses to both the fourth and fifth items are "no," it is considered that there is no suicidal ideation, and the questionnaire concludes. Suicidal risk is evaluated based on items six to nineteen of the scale, which assess the likelihood of actual suicidal behavior among individuals with suicidal ideation. The calculation formula for the total score is \[(sum of scores for items six to nineteen) - 9) / 33\] \* 100, resulting in a score ranging from 0 to 100. A higher score indicates a greater risk of suicide.
Time frame: 3-month
the Chinese version of the Snaith-Hamilton Pleasure Scale
A total of 14 items, each with a score of 1 to 4, will be used to calculate the total score. The higher the score The higher the score, the more severe the pleasure deficit
Time frame: Baseline
the Chinese version of the Snaith-Hamilton Pleasure Scale
A total of 14 items, each with a score of 1 to 4, will be used to calculate the total score. The higher the score The higher the score, the more severe the pleasure deficit
Time frame: 1-month
the Chinese version of the Snaith-Hamilton Pleasure Scale
A total of 14 items, each with a score of 1 to 4, will be used to calculate the total score. The higher the score The higher the score, the more severe the pleasure deficit
Time frame: 2-month
the Chinese version of the Snaith-Hamilton Pleasure Scale
A total of 14 items, each with a score of 1 to 4, will be used to calculate the total score. The higher the score The higher the score, the more severe the pleasure deficit
Time frame: 3-month
Interpersonal Relationship Scale
A score of 0-8 indicates that interpersonal relationship is good, a score of 9-14 indicates that there is a certain degree of interpersonal relationship distress, and a score of 15-28 indicates that interpersonal relationship distress is more serious, that is, the lower the score of the comprehensive diagnostic scale of interpersonal relationship, the better the interpersonal relationship.
Time frame: Baseline
Interpersonal Relationship Scale
A score of 0-8 indicates that interpersonal relationship is good, a score of 9-14 indicates that there is a certain degree of interpersonal relationship distress, and a score of 15-28 indicates that interpersonal relationship distress is more serious, that is, the lower the score of the comprehensive diagnostic scale of interpersonal relationship, the better the interpersonal relationship.
Time frame: 1-month
Interpersonal Relationship Scale
A score of 0-8 indicates that interpersonal relationship is good, a score of 9-14 indicates that there is a certain degree of interpersonal relationship distress, and a score of 15-28 indicates that interpersonal relationship distress is more serious, that is, the lower the score of the comprehensive diagnostic scale of interpersonal relationship, the better the interpersonal relationship.
Time frame: 2-month
Interpersonal Relationship Scale
A score of 0-8 indicates that interpersonal relationship is good, a score of 9-14 indicates that there is a certain degree of interpersonal relationship distress, and a score of 15-28 indicates that interpersonal relationship distress is more serious, that is, the lower the score of the comprehensive diagnostic scale of interpersonal relationship, the better the interpersonal relationship.
Time frame: 3-month
Emotion Regulation Questionnaire
A total of 10 items were scored at 7 points. The higher the score, the higher the frequency of using emotion regulation strategies.
Time frame: Baseline
Emotion Regulation Questionnaire
A total of 10 items were scored at 7 points. The higher the score, the higher the frequency of using emotion regulation strategies.
Time frame: 1-month
Emotion Regulation Questionnaire
A total of 10 items were scored at 7 points. The higher the score, the higher the frequency of using emotion regulation strategies.
Time frame: 2-month
Emotion Regulation Questionnaire
A total of 10 items were scored at 7 points. The higher the score, the higher the frequency of using emotion regulation strategies.
Time frame: 3-month
Toronto Alexithymia Scale-20
It consists of 3 factors, difficulty identifying feelings (DIF), difficulty describing feelings (DDF), and externally oriented thinking (EOT), which are called F1, F2, and F3 factors, containing 20 items, each scored within a 5-point scale (1: completely disagree to 5: completely agree), 20-100 points, the higher the score, the more pronounced the dysfunction in describing feelings.
Time frame: Baseline
Toronto Alexithymia Scale-20
It consists of 3 factors, difficulty identifying feelings (DIF), difficulty describing feelings (DDF), and externally oriented thinking (EOT), which are called F1, F2, and F3 factors, containing 20 items, each scored within a 5-point scale (1: completely disagree to 5: completely agree), 20-100 points, the higher the score, the more pronounced the dysfunction in describing feelings.
Time frame: 1-month
Toronto Alexithymia Scale-20
It consists of 3 factors, difficulty identifying feelings (DIF), difficulty describing feelings (DDF), and externally oriented thinking (EOT), which are called F1, F2, and F3 factors, containing 20 items, each scored within a 5-point scale (1: completely disagree to 5: completely agree), 20-100 points, the higher the score, the more pronounced the dysfunction in describing feelings.
Time frame: 2-month
Toronto Alexithymia Scale-20
It consists of 3 factors, difficulty identifying feelings (DIF), difficulty describing feelings (DDF), and externally oriented thinking (EOT), which are called F1, F2, and F3 factors, containing 20 items, each scored within a 5-point scale (1: completely disagree to 5: completely agree), 20-100 points, the higher the score, the more pronounced the dysfunction in describing feelings.
Time frame: 3-month
The Reflective Function Questionnaire for Youths
Assesses the degree of agreement or disagreement with narratives about reflective functioning, with higher scores representing higher levels of reflective functioning.
Time frame: Baseline
The Reflective Function Questionnaire for Youths
Assesses the degree of agreement or disagreement with narratives about reflective functioning, with higher scores representing higher levels of reflective functioning.
Time frame: 1-month
The Reflective Function Questionnaire for Youths
Assesses the degree of agreement or disagreement with narratives about reflective functioning, with higher scores representing higher levels of reflective functioning.
Time frame: 2-month
The Reflective Function Questionnaire for Youths
Assesses the degree of agreement or disagreement with narratives about reflective functioning, with higher scores representing higher levels of reflective functioning.
Time frame: 3-month
Comfort Rating Questionnaire
Evaluating adverse reactions of tdcs.
Time frame: Baseline
Comfort Rating Questionnaire
Evaluating adverse reactions of tdcs.
Time frame: 1-month
Comfort Rating Questionnaire
Evaluating adverse reactions of tdcs.
Time frame: 2-month
Comfort Rating Questionnaire
Evaluating adverse reactions of tdcs.
Time frame: 3-month
IL-6 level
Detection of serum IL-6 levels using flow cytometry. The normal value is 0-5.30 pg/ml. There is a goodcorrelation between depression and elevated serum IL-6 levels.
Time frame: Baseline
IL-6 level
Detection of serum IL-6 levels using flow cytometry. The normal value is 0-5.30 pg/ml. There is a goodcorrelation between depression and elevated serum IL-6 levels.
Time frame: 2-month
MRI data
Reflecting brain structure and function
Time frame: Baseline
MRI data
Reflecting brain structure and function
Time frame: 2-month
EEG data
Reflecting brain function. It will be used for analysing Left-right asymmetry of forehead Alpha wave energy，mapping the brainnetworks.
Time frame: Baseline
EEG data
Reflecting brain function. It will be used for analysing Left-right asymmetry of forehead Alpha wave energy，mapping the brainnetworks.
Time frame: 2-month
TMS-evoked potentials(TEPs)
Reflecting cortical excitability. N15, P30, N45, P55, N100, P180 and N280 components were evoked during single-pulse TMS stimulation of motor cortex (M1). Early components of TEPs (N15-P30) reflect cortical excitatory activity, while other components (N45-N100) are associated with cortical inhibitory activity.
Time frame: Baseline
TMS-evoked potentials(TEPs)
Reflecting cortical excitability. N15, P30, N45, P55, N100, P180 and N280 components were evoked during single-pulse TMS stimulation of motor cortex (M1). Early components of TEPs (N15-P30) reflect cortical excitatory activity, while other components (N45-N100) are associated with cortical inhibitory activity.
Time frame: 2-month
Thinc-integrated Tools(THINC-it)
THINC-it（https://progress.im/en/）is the first tool to assess cognitive functioning in MDD using both subjective and objective tests and is available as a free download for use on tablets, smartphones or computers. The tool's four objective test sections use recognized cognitive paradigms to assess subjects' performance in the key cognitive domains of attention, working memory, and executive function. The Choice Reaction Time (CRT) focuses on attention and executive function, the 1-Back Memory Task (1-Back) examines memory, attention/concentration, and executive function, the Digit Symbol Substitution Test (DSST) examines processing speed, attention, and executive function, and the Test of Connectivity B (TMT-B) assesses executive function. The 5-item Cognitive Impairment Questionnaire (PDQ⁃5⁃D) is the subjective component of the instrument and can be used to assess patients' performance in attention/concentration, planning/organization, retrospection, and prospective memory.
Time frame: Baseline
Thinc-integrated Tools(THINC-it)
THINC-it（https://progress.im/en/）is the first tool to assess cognitive functioning in MDD using both subjective and objective tests and is available as a free download for use on tablets, smartphones or computers. The tool's four objective test sections use recognized cognitive paradigms to assess subjects' performance in the key cognitive domains of attention, working memory, and executive function. The Choice Reaction Time (CRT) focuses on attention and executive function, the 1-Back Memory Task (1-Back) examines memory, attention/concentration, and executive function, the Digit Symbol Substitution Test (DSST) examines processing speed, attention, and executive function, and the Test of Connectivity B (TMT-B) assesses executive function. The 5-item Cognitive Impairment Questionnaire (PDQ⁃5⁃D) is the subjective component of the instrument and can be used to assess patients' performance in attention/concentration, planning/organization, retrospection, and prospective memory.
Time frame: 2-month
Perceptual judgment test
Assess subjects' perception of interpersonal information.
Time frame: Baseline
Perceptual judgment test
Assess subjects' perception of interpersonal information.
Time frame: 2-month
Distance memory test
Assessment of Working memory.
Time frame: Baseline
Distance memory test
Assessment of Working memory.
Time frame: 2-month
ERP experiment
The participants are instructed to watch the animations，while EEG data is recorded. Event-related Mu-wave will be used for evaluating social interaction ability.
Time frame: Baseline
ERP experiment
The participants are instructed to watch the animations，while EEG data is recorded. Event-related Mu-wave will be used for evaluating social interaction ability.
Time frame: 2-month