Neurocardiac Predictors of Treatment Response to RTMS in Depression

NCT ID: NCT05139862

Last Updated: 2024-12-24

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

NOT_YET_RECRUITING

Clinical Phase

NA

Total Enrollment

110 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-05-01

Study Completion Date

2028-12-01

Brief Summary

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Heartbeat is controlled by the brain and is regular but flexible to change in response to environmental and internal stimuli. This feature is known as heart rate variability (HRV). Major depressive disorder (MDD) has been associated with diminished HRV and this is a reflection of abnormal brain function caused by MDD. Repetitive transcranial magnetic stimulation (rTMS) is a treatment that stimulates specific areas of the brain. The goal of this study is to test the hypothesis that rTMS induces changes in connectivity between the area of the brain stimulated with rTMS and deeper areas in the brain associated to heart rate regulation. 110 patients with TRD will be recruited and will undergo a concurrent TMS-fMRI session before receiving a course of iTBS to the L-DLPFC for 30 sessions at 120% rMT.

Detailed Description

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Conditions

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Depression Treatment Resistant Depression

Keywords

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Repetitive Transcranial Magnetic Stimulation rTMS Neurostimulation Heart Rate Variability fMRI

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

For MDD patients, the study will consist of six weeks of rTMS treatment using intermittent theta burst stimulation (iTBS) rTMS to the left DLPFC. Treatment will be administered daily, 5 days per week (i.e., 30 treatments).
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Active iTBS

Active intermittent theta-burst stimulation (iTBS) rTMS session on the left dorsolateral prefrontal cortex (L-DLPFC)

Group Type EXPERIMENTAL

Repetitive Transcranial Magnetic Stimulation

Intervention Type DEVICE

This study utilizes intermittent theta burst stimulation (iTBS) to the left DLPFC.

Interventions

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Repetitive Transcranial Magnetic Stimulation

This study utilizes intermittent theta burst stimulation (iTBS) to the left DLPFC.

Intervention Type DEVICE

Other Intervention Names

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rTMS

Eligibility Criteria

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Inclusion Criteria

Patients will be included if they:

1. are female or male;
2. are outpatients;
3. are voluntary and competent to consent to treatment;
4. have a DSM 5 diagnosis of MDD, single or recurrent confirmed by Mini-International Neuropsychiatric Interview (MINI) version 6.0;
5. are between the ages of 18 and 65 years;
6. have failed to achieve a clinical response to an adequate dose of an antidepressant based on an Antidepressant Treatment History Form (ATHF) score of \> 3 in the current episode OR have been unable to tolerate at least two separate trials of antidepressants at less than the minimum adequate dose and/or duration (ATHF 1 or 2);
7. A score ≥ 18 on the Hamilton Depression Rating Scale (HDRS-17 item);
8. Have had no increase or initiation of any psychotropic medication in the 4 weeks prior to screening;
9. Able to adhere to the treatment schedule;
10. pass the TMS and MRI adult safety screening questionnaires.

Exclusion Criteria

Patients are excluded if they:

1. have a history of substance use within the last 3 months;
2. have a concomitant major unstable medical illness;
3. have active suicidal intent;
4. are pregnant;
5. have a lifetime (MINI) diagnosis of any psychotic or bipolar disorder;
6. have a MINI anxiety disorder or personality disorder assessed by a study investigator to be primary and causing greater impairment than MDD;
7. have ever failed a course of ECT;
8. have previously received rTMS;
9. have any significant neurological disorder, any history of seizure (except those therapeutically induced by ECT), significant head trauma with loss of consciousness for \> 5 min;
10. have any intracranial implant (e.g., aneurysm clips, shunts, stimulators, cochlear implants, or electrodes) or any other metal object within or near the head, excluding the mouth, that cannot be safely removed;
11. if participating in psychotherapy, must have been in stable treatment for at least 3 months prior to study entry, with no anticipated change in the frequency of therapeutic sessions, or focus of therapeutic sessions over the duration of the study;
12. have a clinically significant laboratory abnormality, in the opinion of the one of the principal investigators;
13. are currently taking lorazepam greater than 2 mg daily (or equivalent) or any dose of an anticonvulsant, due to the potential to limit rTMS efficacy;
14. have a non-correctable clinically significant sensory impairment (i.e., cannot hear well enough to cooperate with interview);
15. have failed more than three adequate trials (ATHF \> 3) of medication in the current episode.
Minimum Eligible Age

19 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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University of British Columbia

OTHER

Sponsor Role lead

Canadian Institutes of Health Research (CIHR)

OTHER_GOV

Sponsor Role collaborator

Responsible Party

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Fidel Vila-Rodriguez, MD, PhD, FRCPC, DFAPA

Principle Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Fidel Vila-Rodriguez, M.D., Ph.D.

Role: PRINCIPAL_INVESTIGATOR

Department of Psychiatry, UBC

Locations

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Non-Invasive Neurostimulation Therapies (NINET) Laboratory, UBC Department of Psychiatry

Vancouver, British Columbia, Canada

Site Status

Countries

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Canada

Central Contacts

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Jessica Layton

Role: CONTACT

Phone: 604-822-7308

Email: [email protected]

Fidel Vila-Rodriguez, M.D., Ph.D.

Role: CONTACT

Phone: 604-827-1361

Email: [email protected]

Facility Contacts

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Quincy Beck, B.Sc.

Role: primary

Fidel Vila-Rodriguez, M.D., Ph.D.

Role: backup

Other Identifiers

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H19-00648

Identifier Type: -

Identifier Source: org_study_id