rTMS for Depressed Teens: A Sham-Controlled Trial, Part 2

Not Applicable

Terminated

Brief Summary: This research proposal aims to better understand the neurobiology of depression in adolescents and how repetitive transcranial magnetic stimulation (rTMS) may therapeutically impact brain function and mood. This investigation also proposes the first study to examine the efficacy of rTMS maintenance therapy in adolescents who have met clinical criteria following acute rTMS treatment. The magnetic resonance (MR) spectroscopy pattern of rTMS response will be analyzed according to previously established protocols.

Detailed Description: Part 2 of the study aims to:

* Evaluate the benefit of daily, active, open-label rTMS in Part 1 non-responders.

* Evaluate the benefits of bi-weekly, active, open-label maintenance rTMS treatment for Part 1 responders over the course of 12 months post acute treatment.

* Evaluate, by proton magnetic resonance spectroscopy (1H-MRS) at 3 Tesla(3T), neurometabolic biomarkers at the beginning and end of each study phase.

* Define regional specificity \[anterior cingulate (AC) and left dorsolateral prefrontal cortex (L-DLPFC)\] of cerebral metabolites (i.e. glutamate and glutamine) in adolescent depression.

* Study whether specific neurochemical resonances are associated with response, remission, and/or maintenance of improvement of clinical depressive symptoms when rTMS is used to treat adolescent depression.

Recruitment & Eligibility

Inclusion Criteria

Successful completion of Part 1 of study
Diagnosis of unipolar major depressive disorder, in a current major depressive episode, without psychotic features
Age is at least 12 and less than 22 years
Ongoing, stable dose antidepressant therapy for at least 6 weeks to include the following antidepressants (with dosing range):
- Celexa (citalopram hydrobromide) - 10 to 60mg
- Cymbalta (duloxetine) - 40mg to 120mg
- Desyrel (trazodone HCl) - 12.5mg to 150mg
- Effexor (venlafaxine HCl) - 37.5mg to 300mg
- Luvox (fluvoxamine maleate) - 25mg to 200mg
- Lexapro (escitalopram oxalate) - 10mg to 40mg
- Paxil (paroxetine HCl) - 10mg to 50mg
- Pristiq (desvenlafaxine) - 50mg to 100mg
- Prozac (fluoxetine HCl) - 10mg to 80mg
- Remeron (mirtazapine) - 7.5mg to 45mg
- Savella (milnacipran HCl) - 25mg to 200mg
- Zoloft (sertraline HCl) - 25mg to 200mg
Subjects able to attend all study visits at study site.
Willing to provide informed assent (adolescent) and informed consent (family)

Exclusion Criteria

Withdrew from treatment of study Part 1
Subjects currently on stimulant, antipsychotic, bupropion or tricyclic antidepressant medications.
Prior vagus nerve stimulation (VNS) or electroconvulsive therapy (ECT)
Contraindication to MRI
Contraindication to rTMS (history of neurological disorder such as seizures, increased intracranial pressure, brain surgery, or head trauma with loss of consciousness for >15 minutes, history of stroke, family history of epilepsy, intracardiac lines, Anticoagulant, immune suppressive and/or chemotherapy, or those who received any of these therapies within 3 months before enrollment in the study Unstable medication conditions such as hematological or infectious (e.g., human immunodeficiency virus-HIV) disorders, implanted electronic device, metal in the head, or pregnancy)
History of schizophrenia, schizoaffective disorder, other [non mood disorder] psychosis, depression secondary to a medical condition, mental retardation, substance dependence or abuse within the past year (except nicotine), bipolar disorder, psychotic features in this or previous episodes, amnestic disorder, obsessive compulsive disorder, post-traumatic stress disorder, panic disorder
History of autoimmune, endocrine, viral, or vascular disorder.
Unstable cardiac disease, uncontrolled hypertension, or sleep apnea
Active suicidal intent or plan, or history of attempt within the past 6 months

Arm && Interventions

Group	Intervention	Description
Part 2 Active	Repetitive transcranial magnetic stimulation (rTMS)	Open-label, active repetitive transcranial magnetic stimulation

Primary Outcome Measures

Name	Time	Method
Mean Change From Baseline in Clinical Global Impression - Severity (CGI-S) Post Treatment 30 or Last Treatment (in the Case of Early Withdrawal)	Within 5 days after Treatment 30 or Last Treatment	The Clinical Global Impression - Severity (CGI-S) is a standardized assessment utilizing a 7-point scale with which the clinician rates the severity of the subject's depressive illness at the time of assessment relative to the clinician's past experience with patients who have the same diagnosis.
Mean Change From Baseline in Children's Depression Rating Scale-Revised (CDRS-R) Post Treatment 30 or Last Treatment (in the Case of Early Withdrawal)	Within 5 days after Treatment 30 or Last Treatment	The Children's Depression Rating Scale-Revised (CDRS-R) is a validated, 17-item, semi-structured clinician rating tool to assess severity of depression with subject and parental input for 14 of the 17 items.
Mean Clinical Global Impression - Improvement (CGI-I) Score Post Treatment 30 or Last Treatment (in the Case of Early Withdrawal)	Within 5 days after Treatment 30 or Last Treatment	The Clinical Global Impression - Improvement (CGI-I) is a standardized assessment utilizing a 7-point scale with which the clinician rates the degree to which the severity of the subject's depressive illness has improved or worsened compared to baseline severity.

Secondary Outcome Measures

Name	Time	Method

Locations (2): Mayo Clinic
🇺🇸
Rochester, Minnesota, United States
Medical University of South Carolina
🇺🇸
Charleston, South Carolina, United States