Accelerated Bilateral rTMS on Geriatric Depression

NCT ID: NCT04486222

Last Updated: 2023-01-04

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

TERMINATED

Clinical Phase

NA

Total Enrollment

2 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-11-23

Study Completion Date

2022-12-21

Brief Summary

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This study aims to evaluate the efficacy of accelerated bilateral repetitive transcranial magnetic stimulation (rTMS) on major depression, anxiety, cognitive function and physiological parameters in elderly depressive patients.

Detailed Description

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Repeated transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation treatment, showing good therapeutic effect to medicine treatment-refractory patients. Recent studies suggested bilateral DLPFC might be effective to geriatric depression. Accelerated treatment course was reported to have similar therapeutic effect and safety profile with traditional course. The investigators hypothesize accelerated bilateral rTMS is effective to geriatric depression and comorbid anxiety.

Cognitive impairment and decreased parasympathetic tone are common in patients with major depression. The investigators hypothesize cognitive function and physiological indicators improve after accelerated bilateral rTMS.

In this single-center, prospective double-blind, randomized, active-controlled trial, the investigators aim to recruit 100 patients older than 60 years, without neurocognitive disorders, and refractory to one or more antidepressants. The experimental group would receive an rTMS course with high-frequency stimulation at left DLPFC followed by low-frequency inhibition at right DLPFC, two sessions daily, five days a week, and two weeks in total. The standard treatment group would receive an rTMS course with high-frequency stimulation at left DLPFC as standard treatment parameters. Mood, cognition and physiological markers would be monitored every week. The primary outcome is response and remission rate of major depression measured by Hamilton Rating Scale for Depression.

Conditions

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Transcranial Magnetic Stimulation Depressive Disorder, Major

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Investigators Outcome Assessors

Study Groups

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Experimental Group

The experimental group would receive an rTMS course with high-frequency stimulation (10Hz) at left DLPFC (120% motor threshold, 40 trains, 1600 pulses) followed by low-frequency (1Hz) inhibition at right DLPFC (120% motor threshold, 10 trains, 1200 pulses), two sessions daily with a 1.5-hour inter-session interval (L't active-R't active-1.5 hr-L't active-R't active), five days a week, and two weeks in total.

Group Type EXPERIMENTAL

Repeated Transcranial Magnetic Stimulation

Intervention Type DEVICE

Magstim® Super Rapid² Transcranial Magnetic Stimulation System

Standard Treatment Group

The standard treatment group would receive an rTMS course with high-frequency stimulation (10Hz) at left DLPFC (120% motor threshold, 40 trains, 1600 pulses) followed by sham inhibition at right DLPFC (1Hz, 10 trains, 1200 pulses); after a 1.5-hour inter-session interval, a sham session would be administered at left and right DLPFC (L't active-R't sham-1.5 hr-L't sham-R't sham. The course would be applied five days a week, and two weeks in total.

Group Type ACTIVE_COMPARATOR

Repeated Transcranial Magnetic Stimulation

Intervention Type DEVICE

Magstim® Super Rapid² Transcranial Magnetic Stimulation System

Interventions

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Repeated Transcranial Magnetic Stimulation

Magstim® Super Rapid² Transcranial Magnetic Stimulation System

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* age between 60-85 years
* literate and received basic education for at least 2 years
* diagnosis of major depressive disorder, without psychotic features, according to DSM-5
* have a score of 20 or greater on the 17-item Hamilton Depression Rating Scale
* failed to achieve clinical response by at least 1 antidepressant trial of sufficient dosage for at least 4 weeks
* psychoactive agents were in stable doses before randomization

Exclusion Criteria

* active suicide plans or attempts; or suicide attempts in the last 12 months
* diagnosis of schizophrenia or bipolar disorder according to DSM-5
* have DSM-5-confirmed substance use disorder (excluding tobacco) in the last 3 months
* have delirium, major neurocognitive disorder or MMSE \< 24
* current use of bupropion \>300 mg/day, tricyclic antidepressant, clozapine, chlorpromazine, foscarnet, ganciclovir, ritonavir, theophylline or anti-epileptic agents excluding benzodiazepines
* history of severe head trauma, epilepsy, multiple sclerosis, stroke, brain tumors, intracranial aneurysm, active intracranial infection, increased intracranial pressure, metallic implants in the brain, major brain surgery or major neurological diseases
* with a cardiac pacemaker or defibrillator
* received rTMS treatment before
Minimum Eligible Age

60 Years

Maximum Eligible Age

85 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Taiwan University Hospital, Yun-Lin Branch

OTHER

Sponsor Role collaborator

National Taiwan University Hospital

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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Department of Psychiatry, National Taiwan University Hospital, Yun-Lin Branch

Douliu, , Taiwan

Site Status

Countries

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Taiwan

Other Identifiers

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201910101RIND

Identifier Type: -

Identifier Source: org_study_id

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