Transcranial Magnetic Stimulation: Evaluation of Improvement of Transdiagnostic Psychiatric Symptoms and Changes in Functional Neuroiming in Young Adults Patients With Major Depressive Disorder and Non-suicidal Self-injury
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 发起方
- 入组人数
- 40
- 试验地点
- 2
- 主要终点
- fMRI-assessed resting connectivity
研究概览
简要总结
This clinical trial aims to investigate the effects of Transcranial Magnetic Stimulation (TMS) as an adjunctive treatment for young adult patients with depression and non-suicidal self-injury (NSSI).
The main questions this study aims to answer are:
- Does adjunctive TMS reduce psychiatric symptoms in young adults with major depressive disorder and non-suicidal self-injury?
- Does adjunctive TMS cause any changes in neuroimaging markers in young adults with major depressive disorder and non-suicidal self-injury?
- Does adjunctive TMS cause any effects on blood biomarkers in young adults with major depressive disorder and non-suicidal self-injury?
Participants in this study will undergo an extensive clinical evaluation, functional neuroimaging tests (MRI and fNIRS), and peripheral blood collection. They will be randomly assigned to one of two interventions: (1) 20 sessions of TMS using the intermittent theta burst stimulation (iTBS) protocol, or (2) 20 sham sessions using a placebo procedure with the TMS equipment. After the 20 sessions, additional clinical assessments, neuroimaging and blood tests will be conducted. The data analysis will compare the two groups in terms of response and remission of internalizing and externalizing psychiatric symptoms, as well as neuroimaging and blood tests outcomes.
详细描述
This comprehensive clinical trial seeks to explore the potential therapeutic benefits of Transcranial Magnetic Stimulation (TMS) when used as an adjunctive treatment for young adult patients grappling with both depression and non-suicidal self-injury (NSSI). The overarching objectives of this study are multifaceted and aim to address critical questions regarding the efficacy and underlying mechanisms of TMS in this particular demographic.
The primary research inquiries guiding this investigation are:
Psychiatric Symptom Reduction: Does the incorporation of adjunctive TMS lead to a significant reduction in psychiatric symptoms among young adults diagnosed with major depressive disorder and non-suicidal self-injury?
Neuroimaging Markers: Does adjunctive TMS induce any discernible changes in neuroimaging markers among young adults with major depressive disorder and non-suicidal self-injury? This involves employing sophisticated functional neuroimaging techniques such as MRI (Magnetic Resonance Imaging) and fNIRS (functional Near-Infrared Spectroscopy).
Blood Biomarkers: Are there observable effects on blood biomarkers in young adults with major depressive disorder and non-suicidal self-injury following adjunctive TMS treatment?
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Double (Participant, Outcomes Assessor)
入排标准
- 年龄范围
- 18 Years 至 29 Years（Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Current diagnosis of major depressive disorder by the operational criteria of DSM-5 and non-suicidal self-injury behavior, defined by "engagement in and intentionally self-inflicted harm to the surface of one's body, likely resulting in bleeding, bruising, or pain (e.g., cutting, burning, puncturing, hitting, excessive rubbing), with the expectation that the injury will only lead to minor or moderate physical harm (i.e., no suicidal intent)". (at least one episode in the past year);
- •Depression severity score ≥17 points (moderate depression criteria) on the 17-item Hamilton Depression Rating Scale (HAM-D-17);
- •Currently receiving psychiatric treatment and/or engaged in psychotherapy with a minimum biweekly frequency;
- •Consent to voluntary participation in the study, confirmed by signing the Informed Consent Form;
- •Expressed willingness to comply with all study procedures, including imaging examinations and blood tests, with availability during the study, and to communicate with the study team regarding adverse events and other clinically important information;
- •Commitment to access continuous psychiatric care before and after study completion;
- •In good general health, as evidenced by medical history.
排除标准
- •Participants who present pre-established contraindications for undergoing EMT, based on positive responses in the "TMS Adult Safety Screen (TASS)" questionnaire, such as: cochlear implants, brain stimulators (DBS), electrode implants or aneurysm clips, history of previous seizures, use of pacemakers, presence of implantable defibrillators, brain injury (whether vascular, neoplastic, traumatic, infectious, or metabolic);
- •Patients who present a moderate to severe suicide risk, as determined by clinical evaluation or requiring psychiatric hospitalization during the recruitment or EMT application period;
- •Patients with severe clinical comorbidities or any other reason that impedes self-mobility, preventing attendance at daily EMT sessions;
- •Pregnant patients or those of childbearing age who are sexually active without using contraceptive methods.
结局指标
主要结局
fMRI-assessed resting connectivity
时间窗: Week 1 prior to TMS treatment and week 1 after completion of TMS treatment
Change (e.g. normalization) of baseline network-level deficits.
Hamilton Depression Rating Scale
时间窗: Week 1 prior to TMS treatment and week 1 after completion of TMS treatment
Proportion of individuals with a 50% or more score reduction between before and after intervention
Patient Health Questionnaire-9
时间窗: Week 1 prior to TMS treatment and week 1 after completion of TMS treatment
Proportion of individuals with a 50% or more score reduction between before and after intervention
Montgomery-Asberg Depression Rating Scale
时间窗: Week 1 prior to TMS treatment and week 1 after completion of TMS treatment
Proportion of individuals with a 50% or more score reduction between before and after intervention
fMRI assessed neural network connectivity
时间窗: Week 1 prior to TMS treatment and week 1 after completion of TMS treatment
Change on functional connectivity
次要结局
- Hamilton Depression Rating Scale(1, 3 , 6 and 12 months after completion of TMS treatment)
- fNIRS- assessed changes in blood oxygenation levels in the brain(Week 1 prior to TMS treatment and week 1 after completion of TMS treatment)
- Functional Assessment of Self-Mutilation (FASM)(Week 1 prior to TMS treatment and week 1 after completion of TMS treatment)
- Montgomery-Asberg Depression Rating Scale(1, 3 , 6 and 12 months after completion of TMS treatment)
- Patient Health Questionnaire-9(1, 3 , 6 and 12 months after completion of TMS treatment)
- Brain-Derived Neurotrophic Factor (BDNF)(Week 1 prior to TMS treatment and week 1 after completion of TMS treatment)
- Ciliary Neurotrophic Factor (CNTF)(Week 1 prior to TMS treatment and week 1 after completion of TMS treatment)
- Glial Cell-Derived Neurotrophic Factor (GDNF)(Week 1 prior to TMS treatment and week 1 after completion of TMS treatment)
- Nerve Growth Factor (NGF)(Week 1 prior to TMS treatment and week 1 after completion of TMS treatment)