Depression-Reduction by Accelerated Personalized NeuroModulation and Its Effects on Sleep

NCT ID: NCT04832750

Last Updated: 2024-12-11

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

Total Enrollment

102 participants

Study Classification

OBSERVATIONAL

Study Start Date

2021-05-03

Study Completion Date

2024-07-26

Brief Summary

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Advances in repetitive transcranial magnetic stimulation (rTMS) protocols with intermittent theta-burst stimulation (iTBS) have significantly decreased the duration for one single session and thereby enabled accelerated treatment plans with multiple sessions per day, potentially reducing the total treatment duration. This randomized, placebo-controlled study investigates the effects of accelerated iTBS treatment with connectivity-informed neuronavigation on symptom severity, sleep, interoception, and cognitive control in patients with major depressive disorder and with or without comorbid borderline personality disorder using magnetic resonance imaging (MRI).

Detailed Description

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Repetitive transcranial magnetic stimulation (rTMS) is a safe and efficacious treatment option for treatment-resistant depression. Advances in rTMS protocols with intermittent theta-burst stimulation (iTBS) have significantly decreased the duration for one single session and thereby enabled accelerated treatment plans with multiple sessions per day, potentially reducing the total treatment duration. Major depressive disorder (MDD) is characterized by impairments in various domains including sleep, impulse control, and interoception. Borderline personality disorder (BPD) is characterized by fear of abandonment, mood swings, and an unstable perception of self and often occurs with comorbid MDD. This comorbidity frequently impedes treatment of the BPD.

In this randomized, placebo-controlled study, 60 patients with treatment-resistant MDD (30 verum group, 30 sham group) and 60 patients with treatment-resistant MDD and comorbid BPD (30 verum group, 30 sham group) will receive two weeks of connectivity-informed iTBS of the left dorsolateral prefrontal cortex (DLPFC; 3 sessions per day, 5 days per week). Before and after the treatment phase, (functional) magnetic resonance imaging (fMRI) will be performed. The effects of iTBS will be tested in four domains: (1) symptom severity (MDD and BPD symptoms), (2) sleep quality (sleep questionnaires and various sleep parameters monitored via an electroencephalography (EEG) headband), (3) neurocognitive effects (vigilance and response inhibition measured with behavioral and fMRI tasks), and (4) interoception (interoceptive attention measured with behavioral and fMRI tasks). Furthermore, before the start of the two-weeks treatment, a single iTBS session ("forecaster session") will be conducted to explore the validity of early symptom/mood responses and hormonal changes for the prediction of the the treatment outcome. Treatment effects will be analyzed within and across patient groups (MDD and MDD + BPD). In addition, domain-specific treatment effects will be analyzed as a function of distinct iTBS targets within the DLPFC.To evaluate pathological biases, the investigators will compare the patients' data with a control group of 30 healthy participants who will also be tested twice (without iTBS).

Conditions

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Major Depressive Episode Major Depressive Disorder Borderline Personality Disorder

Keywords

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rTMS Theta Burst Stimulation Neuronavigation Major Depressive Episode Borderline Personality Disorder Sleep Interoception Cognitive Control fMRI

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Major Depressive Episode

At least one failed pharmaco trial in current episode

intermittent theta burst stimulation (iTBS) or sham stimulation

Intervention Type DEVICE

30 sessions of iTBS over 2 weeks (3 sessions per day, 5 days per week)

Major Depressive Episode with comorbid Borderline Personality Disorder

At least one failed pharmaco trial in current episode

intermittent theta burst stimulation (iTBS) or sham stimulation

Intervention Type DEVICE

30 sessions of iTBS over 2 weeks (3 sessions per day, 5 days per week)

Healthy Controls

No psychiatric disorders

No interventions assigned to this group

Interventions

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intermittent theta burst stimulation (iTBS) or sham stimulation

30 sessions of iTBS over 2 weeks (3 sessions per day, 5 days per week)

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Participant is able to provide consent.
* Diagnosis of major depressive disorder (MDD) according to DSM-V criteria.
* During the current episode, treatment-resistant MDD (at least one failed pharmacological trial of adequate dose and duration)
* For the MDD group with comorbid borderline personality disorder (BPD): diagnosis of BPD according to the Diagnotic Statistical Manual V (DSM-V) criteria.
* For healthy controls: no psychiatric or neurological illness.

Exclusion Criteria

* For the MDD group without BPD: BPD diagnosis
* The participant does not fulfill requirements for iTBS treatment according to safety guidelines.
* The participant does not fulfill requirements for MRI measurements according to safety guidelines.
* Pregnancy or breast-feeding.
* Acute suicidality.
* Neurological illness (e.g. dementia, Parkinson's disease, chorea huntington, multiple sclerosis).
* increased current risk for epileptic seizure.
* comorbid diagnosis of schizophrenia or psychotic symptoms, bipolar disorder, and substance use disorder within the last 6 months.
* Conditions related to increased intracranial pressure.
* Brain injury or stroke.
Minimum Eligible Age

18 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Marc Onken, M.Sc.

UNKNOWN

Sponsor Role collaborator

Christina Mueller, M.Sc.

UNKNOWN

Sponsor Role collaborator

University of Oldenburg

OTHER

Sponsor Role lead

Responsible Party

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Dirk Scheele

Deputy Lab Head

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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René Hurlemann, Prof.

Role: PRINCIPAL_INVESTIGATOR

Department of Psychiatry, University of Oldenburg

Dirk Scheele, Dr.

Role: PRINCIPAL_INVESTIGATOR

Department of Psychiatry, University of Oldenburg

Christina Mueller, M.Sc.

Role: STUDY_DIRECTOR

Department of Psychiatry, University of Oldenburg

Marc Onken, M.Sc.

Role: STUDY_DIRECTOR

Department of Psychiatry, University of Oldenburg

Locations

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Department of Psychiatry, University of Oldenburg

Bad Zwischenahn, , Germany

Site Status

Countries

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Germany

References

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Blumberger DM, Vila-Rodriguez F, Thorpe KE, Feffer K, Noda Y, Giacobbe P, Knyahnytska Y, Kennedy SH, Lam RW, Daskalakis ZJ, Downar J. Effectiveness of theta burst versus high-frequency repetitive transcranial magnetic stimulation in patients with depression (THREE-D): a randomised non-inferiority trial. Lancet. 2018 Apr 28;391(10131):1683-1692. doi: 10.1016/S0140-6736(18)30295-2. Epub 2018 Apr 26.

Reference Type BACKGROUND
PMID: 29726344 (View on PubMed)

Franzen PL, Buysse DJ. Sleep disturbances and depression: risk relationships for subsequent depression and therapeutic implications. Dialogues Clin Neurosci. 2008;10(4):473-81. doi: 10.31887/DCNS.2008.10.4/plfranzen.

Reference Type BACKGROUND
PMID: 19170404 (View on PubMed)

Mutz J, Vipulananthan V, Carter B, Hurlemann R, Fu CHY, Young AH. Comparative efficacy and acceptability of non-surgical brain stimulation for the acute treatment of major depressive episodes in adults: systematic review and network meta-analysis. BMJ. 2019 Mar 27;364:l1079. doi: 10.1136/bmj.l1079.

Reference Type BACKGROUND
PMID: 30917990 (View on PubMed)

Rock PL, Roiser JP, Riedel WJ, Blackwell AD. Cognitive impairment in depression: a systematic review and meta-analysis. Psychol Med. 2014 Jul;44(10):2029-40. doi: 10.1017/S0033291713002535. Epub 2013 Oct 29.

Reference Type BACKGROUND
PMID: 24168753 (View on PubMed)

Tsuno N, Besset A, Ritchie K. Sleep and depression. J Clin Psychiatry. 2005 Oct;66(10):1254-69. doi: 10.4088/jcp.v66n1008.

Reference Type BACKGROUND
PMID: 16259539 (View on PubMed)

Other Identifiers

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DREAMS

Identifier Type: -

Identifier Source: org_study_id