The Antidepressant Effect of Repetitive Transcranial Magnetic Stimulation (rTMS)Compared to ECT

NCT ID: NCT00299403

Last Updated: 2008-07-02

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE2/PHASE3

Total Enrollment

60 participants

Study Classification

INTERVENTIONAL

Study Start Date

2002-05-31

Study Completion Date

2007-05-31

Brief Summary

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The aim of the present study is to compare the antidepressant effect of electroconvulsive therapy ( ECT) with that of low frequency repetitive transcranial magnetic stimulation of the right prefrontal cortex.

In the same study we investigate the value of saliva cortisol as a predictor of treatment outcome.

Detailed Description

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Previous clinical controlled trials indicate that repetitive transcranial magnetic stimulation (rTMS) of the prefrontal cortex may relieve antidepressant symptoms. Most of these studies have used high frequency stimulation of the left frontal cortex. A few investigations have found that right frontal low frequency rTMS, which constitute a more gentle stimulus design has an antidepressant effective at the same level. Compared to ECT rTMS has obvious advantages. The new method implies focal stimulation of the brain, is not inducing epileptic seizures and does not require anesthesia. In addition rTMS does not seem to induce cognitive disturbances. Few studies have compared the antidepressant effect of rTMS with that of ECT. The main outcome indicates that high frequency rTMS of the left frontal cortex has an antidepressant effect which is comparable to that of ECT in the treatment of non-psychotic patients. It is difficult to draw definite conclusions from these studies, first of all because of small and highly selected study populations. In addition different stimulus designs make most of the mentioned studies incomparable.

The aim of the present study is to compare the antidepressant effect of low frequency rTMS of the right dorsolateral prefrontal cortex with ECT in a hospitalized population of major depressed patients (ICD-10/DSM-IV) in a randomized open noninferiority study.

About fifty percent of depressed patients have shown to be associated with an increased plasma cortisol concentration and HPA-axis activity expressed in non-suppression of plasma cortisol in association with the dexamethasone (DX-test) suppression test. Some studies have shown that the presence or absence of normalization of the HPA-axis activity and the DX-test during antidepressant treatment may be a predictor of recurrence. Other studies have shown that the physiological increase in the concentration of saliva cortisol during the first half an hour after awakening in the morning is accentuated in depressed patients and constitute a more simple expression of the HPA-.axis activity and predictor of outcome than the the dx-test.

Therefore we want to investigate the value of the increase in the morning cortisol concentration during the first half an hour after awakening as a predictor of antidepressant effect and outcome.

Conditions

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Depressive Disorder

Keywords

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Depressive disorder, Antidepressant effect, rTMS, ECT, cognition, Saliva cortisol noninferiority trial

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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1

Right frontal low frequency rTMS

Group Type ACTIVE_COMPARATOR

Right prefrontal lowfrequency ( 1 hz) rTMS.

Intervention Type PROCEDURE

Right prefrontal low frequency (1 hz) rTMS. 15 sessions with one daily session during 3 weeks (weekends excluded). Each session covering 2 x 60 minutes of stimulation separated with an intertrain interval of 3 minutes

Arms: 2

2

electroconvulsive therapy (ECT). Right unilateral ECT 3 time a week in 3 weeks

Group Type ACTIVE_COMPARATOR

Electroconvulsive therapy (ECT)

Intervention Type PROCEDURE

9 ECT ( 3 each week) during 3 weeks

Interventions

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Right prefrontal lowfrequency ( 1 hz) rTMS.

Right prefrontal low frequency (1 hz) rTMS. 15 sessions with one daily session during 3 weeks (weekends excluded). Each session covering 2 x 60 minutes of stimulation separated with an intertrain interval of 3 minutes

Arms: 2

Intervention Type PROCEDURE

Electroconvulsive therapy (ECT)

9 ECT ( 3 each week) during 3 weeks

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Admission to Psychiatric Hospital in Aarhus.
* The patient should be candidate for ECT.
* Moderate or severely depressed/Major depressed (ICD-10/DSM-IV)
* A total score on the Hamilton (17-item) rating scale for depression of 20 or above, or a subscale score of 10 ore above.
* Right handed,
* Age 18-80 years

Exclusion Criteria

* Organic brain disease
* Epilepsy
* Metal devices in operated into the brain or chest.
* The patient is wearing cardiac pacemaker.
* Medical illness associated with disturbed CNS function
* Pregnancy
* Serious suicidality
* Severe agitation or delirium
* Alcoholic or drug dependency
* The patients exposed to coercive measures
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Aarhus

OTHER

Sponsor Role lead

Responsible Party

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Aarhus University Hospital , Risskov. Denmark

Principal Investigators

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Poul Erik Buchholtz Hansen, senior phys.

Role: PRINCIPAL_INVESTIGATOR

Aarhus University Hospital, Risskov, Denmark

Locations

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University hospital of Aarhus, Risskov

Aarhus, Risskov, Denmark

Site Status

Countries

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Denmark

References

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Klein E, Kreinin I, Chistyakov A, Koren D, Mecz L, Marmur S, Ben-Shachar D, Feinsod M. Therapeutic efficacy of right prefrontal slow repetitive transcranial magnetic stimulation in major depression: a double-blind controlled study. Arch Gen Psychiatry. 1999 Apr;56(4):315-20. doi: 10.1001/archpsyc.56.4.315.

Reference Type BACKGROUND
PMID: 10197825 (View on PubMed)

Hansen PE, Ravnkilde B, Videbech P, Clemmensen K, Sturlason R, Reiner M, Parner E, Rosenberg R, Vestergaard P. Low-frequency repetitive transcranial magnetic stimulation inferior to electroconvulsive therapy in treating depression. J ECT. 2011 Mar;27(1):26-32. doi: 10.1097/YCT.0b013e3181d77645.

Reference Type DERIVED
PMID: 20351570 (View on PubMed)

Other Identifiers

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20010072

Identifier Type: -

Identifier Source: org_study_id