Intensive TMS for Rapid Relief of Bipolar Depression Symptoms
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 34
- 试验地点
- 2
- 主要终点
- Clinical Efficacy of High Dose Spaced Theta Burst (HDS-TBS)
研究概览
简要总结
The research study is being conducted to test whether using high dose spaced theta-burst rTMS (a form of transcranial magnetic stimulation) produces a significant reduction in depressive symptoms compared with sham. This project will recruit patients aged 18-70 with symptoms of bipolar depression who have failed (or not shown signs of improvement) after at least two prior treatments.
详细描述
The research study is being conducted to test whether using high dose spaced theta-burst rTMS (a form of transcranial magnetic stimulation) produces a significant reduction in depressive symptoms compared with sham. This project will recruit patients aged 18-70 with symptoms of bipolar depression who have failed (or not shown signs of improvement) after at least two prior treatments. The null hypothesis is that there will be no difference in reductions in depressive symptoms by the end of a five-day treatment period. The alternative hypothesis is that, compared with sham, active TMS will result in a greater reduction in depressive symptoms by the end of the treatment period. Participants will be randomly assigned to active or sham conditions: 50% to active and 50% to sham.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Other
- 盲法
- Triple (Participant, Investigator, Outcomes Assessor)
入排标准
- 年龄范围
- 18 Years 至 70 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Bipolar depression (BP I and BP II) by Diagnostic and Statistical Manual 5 (DSM 5) criteria
- •Age 18-70
- •Right or left handed
- •All genders
- •Treatment resistant depression, as in they must have treatment resistant depression with 2 or more prior antidepressant trials that have failed to produce a response (> 50% reduction in symptoms) using ATHF criteria
- •Able to provide informed consent to participate in the study
- •Must be on a stable medication regimen, requiring at least one mood stabilizer
- •Depression severity as represented by scoring at least 20 on Montgomery-Asberg Depression Rating Scale (MADRS)
排除标准
- •No current substance abuse disorder for the past 6 months (previous substance abuse not exclusionary)
- •Any psychotic disorder or current active psychotic symptoms (personality disorders not exclusionary unless in the opinion of the referring psychiatrist it would jeopardize participation)
- •No dementia or other major neurological disorders
- •Not having depression as primary disorder
- •No major medical illness, for example metastatic cancer, end stage renal disease
- •Not able to verify contact information. Participants must be able to follow through with the study & must have verified contact information and at least one verified contact
- •Pregnancy. While there are no known risks to a fetus this is a new use of TMS, which has not been tested, thus pregnancy is exclusionary
- •Score on Young Mania Rating Scale (YMRS) greater than 12 (patients with mixed features have been shown not to respond well to TMS treatment)
- •Rapid cycling Bipolar illness (patients with > 4 mood episodes within the past year will be excluded, as they have a higher risk of switch to mania)
- •Any implants, conditions, or contraindications that would be deemed unsafe for TMS or MRI
- •Currently using benzodiazepines (such as lorazepam) with a dose >1 mg per day or equivalent.
研究组 & 干预措施
Active Transcranial Magnetic Stimulation
Active Intensive iTBS involves intermittent theta-burst stimulation (iTBS), a patterned form of repetitive transcranial magnetic stimulation (rTMS) over the left dorsal lateral prefrontal cortex (L-DLPFC).
干预措施: Intensive intermittent theta-burst stimulation (iTBS) (Device)
Sham Transcranial Magnetic Stimulation
Sham Intensive iTBS involves using the coil's electric stimulation functionality that allows for the delivery of a brief electric pulse to the scalp simultaneous to the TMS pulse, which mimics the scalp sensation from active stimulation.
干预措施: Intensive intermittent theta-burst stimulation (iTBS) (Device)
结局指标
主要结局
Clinical Efficacy of High Dose Spaced Theta Burst (HDS-TBS)
时间窗: Through study completion, approximately 1 week
The primary outcome will be based on the set of repeated Montgomery Asberg Depression scores (10 items rated on a 0-6 scale, 0-60 possible score range, with higher scores indicating greater depressive symptomology), obtained at baseline, on each of the five treatment days and post TMS.
次要结局
- Relationship Between Change in Brain Resting State Functional Connectivity and Treatment Effects(Upon study completion, approximately 1 week)
研究者
Yvette Sheline
McLure Professor of Radiology, Neurology and Psychiatry
University of Pennsylvania