Investigation of TVNS Administration on Postpartum Mental Health

NCT ID: NCT06682689

Last Updated: 2024-11-12

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

Get a concise snapshot of the trial, including recruitment status, study phase, enrollment targets, and key timeline milestones.

Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

120 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-11-30

Study Completion Date

2026-12-31

Brief Summary

Review the sponsor-provided synopsis that highlights what the study is about and why it is being conducted.

The aim of the study is to explore whether transcutaneous vagus nerve stimulation (tVNS) may be effective in preventing mood swings and depressive symptoms in the postpartum phase, as well as serving as a supplementary intervention in cases where mood symptoms develop. The study will investigate the effects of tVNS intervention during the first 12 weeks postpartum. Pregnant women will be recruited for the study, and the intervention will begin shortly after giving birth. Participants will receive different instructions on how to use the tVNS device. Additional parameters such as physiological functions, chronic stress, hormones, environment, and personality traits will also be assessed.

Detailed Description

Dive into the extended narrative that explains the scientific background, objectives, and procedures in greater depth.

The study uses a crossover, repeated-measures, within-subject, and between-subject placebo and active control design. Three groups of women who have recently given birth will receive either high-intensity tVNS, low-intensity tVNS, or no stimulation intervention for six weeks. After this period, the two tVNS groups will switch protocols for another six weeks. Participants will also undergo a battery of psychometric and neuropsychological tests at multiple time points. By applying a multilevel approach, the investigators will assess changes in postpartum mood and mental state from subjective (daily mood assessments, psychometric tests), cognitive (neuropsychological tests), physiological (heart rate, sleep patterns), and endocrine (cortisol, sex hormones) perspectives.

Throughout the study, all participants will answer app-based ecological momentary assessments (EMA) to monitor mood fluctuations after stimulation and compare outcomes. Participants' partners will be invited to take part in the study if they wish; they will complete questionnaires regarding their mental health and the perceived support they provide. During the initial screening, participants will receive detailed information about the study, and inclusion and exclusion criteria will be evaluated.

At the first meeting (T1), informed broad consent will be obtained, and the study will be explained in detail. Instructions for using the tVNS devices will be provided based on group assignments. Participants will complete questionnaires, undergo a short neuropsychological test, and provide hair samples for cortisol concentration analysis.

After giving birth, participants (or their partners, with permission) will notify the researchers, and each woman in the experimental tVNS groups will receive a package containing the stimulator and access to usage tutorials and instructions. All participants will also receive smartwatches with usage instructions.

The main study will include 120 women who have recently given birth, randomly assigned to one of three groups:

Group one (High-low tVNS) will first receive an active, high-intensity tVNS stimulation protocol for six weeks at a self-chosen level below the pain threshold and will be advised to use it for up to four hours a day (as per the device manual's full and maximal stimulation session). Precise instructions and protocols to assess the stimulation intensity will be given beforehand. After six weeks (T2), they will switch to the low-intensity tVNS protocol used by group two.

Group two (Low-high tVNS) will use the device at the lowest possible intensity of 0,1 milliampere. This intensity equals the intensity of stimulation during the "OFF" Phase, for more details see "Arms and interventions"". After six weeks, participants will switch protocol for the one provided at the begging for group one for the remaining six weeks.

The device is pre-programmed to stimulate with constant parameters (except for intensity), and to minimize placebo effects, participants will be informed that different protocols with varying sensations are being tested.

Group three (No stimulation) will not receive any tVNS stimulation. Their mood and symptoms will be assessed similarly to the other two groups, and physiological measures will be monitored via smartwatch and hair sampling.

At week six (T2; around the 6th-7th week postpartum), participants from all groups will visit the lab to complete questionnaires, provide hormone samples, and undergo neuropsychological assessments.

During the experimental phase, participants will report daily on their current mood. They will continue to complete repeated questionnaires assessing their mental health, quality of life, sleep quality, and symptoms of depression and anxiety. At two postpartum time points (T2 and T3; weeks 6 and 12 after parturition), participants will be asked to return for additional sessions where blood will be drawn for hormonal analysis, questionnaires will be repeated, and neuropsychological testing will be performed. At week 12, hair samples will again be collected for cortisol concentration analysis.

A voluntary online follow-up is planned after the study. At 6 and 9 months postpartum, participants will be invited to complete some of the standardised questionnaires, previously administered earlier in the study. These questionnaires will assess various aspects of their current state, including mental health, physical well-being, and parenting stress

The study utilizes the CE-certified tVNS® E device to non-invasively stimulate the vagus nerve, in compliance with European safety and performance standards (Class IIa, based on (EU) 2017/745 for medical devices, classified as a short-term, active therapeutic, non-invasive medical device under rule 9). This device stimulates the vagus nerve non-surgically by targeting the auricular branch of the vagus nerve, which interfaces with the skin at the cymba conchae of the external ear. The tVNS® E is approved for use in healthy participants, as well as for the following conditions (without restrictions for healthy participants, provided tVNS exclusion criteria are followed): treatment of seizures in pharmaco-resistant epilepsy with focal and/or generalized seizures (to reduce seizure frequency); adjunctive treatment of depression; treatment of emotional outbursts in Prader-Willi syndrome (to reduce frequency); adjunctive treatment of chronic migraine (to reduce headache frequency); and prophylactic migraine therapy for patients with chronic migraines who refuse or do not tolerate prophylactic medication (tVNS® E Instruction for Use, Version 1.6, 2023-01-30).

Conditions

See the medical conditions and disease areas that this research is targeting or investigating.

Postpartum Depression (PPD) Postpartum Anxiety Postpartum Sadness Postpartum Blues

Study Design

Understand how the trial is structured, including allocation methods, masking strategies, primary purpose, and other design elements.

Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

Primary Study Purpose

PREVENTION

Blinding Strategy

SINGLE

Participants

Study Groups

Review each arm or cohort in the study, along with the interventions and objectives associated with them.

High-low tVNS

Participants in this group will be instructed to use the tVNS device every day for the first six weeks according to the manufacturer's guidelines, at an intensity where they can feel a tingling sensation but below the pain threshold. After six weeks (T2) of intervention, they will be asked to switch to a different protocol for the next six weeks, using the device at the lowest possible intensity. Additional instructions will be provided, and they will be informed that this stimulation uses different parameters set by the research team.

Group Type EXPERIMENTAL

transcutaneous vagus nerve stimulation

Intervention Type DEVICE

Two groups will use a tVNS stimulator for 12 weeks. Group 1 will apply active stimulation for up to 4 hours daily at a comfortable level for 6 weeks, while Group 2 will use it at the lowest intensity (0.1 mA). After 6 weeks (T2), the groups will switch. Participants will be instructed to use the device for at least 1 hour a day, with a recommendation of 4 hours, following guidelines and recent studies. The CE-certified tVNS® E device non-invasively stimulates the vagus nerve via the ear. It is approved for treating a.o.depression. Device parameters (intensity, pulse length, frequency) mimic invasive VNS techniques, ensuring safe and effective signal transmission. Stimulation will be applied to the left ear, with intensity adjusted to a tingling sensation, avoiding discomfort. The study follows an approved protocol, with low-intensity stimulation as a control. The device delivers biphasic impulses at 25 Hz, with 28 seconds ON and 32 seconds OFF, and is safe for extended use.

Low-high tVNS

Participants in this group will receive the inverted intervention, with the first six weeks of stimulation at the lowest possible intensity (0.1 mA) with the same instructions regarding duration of stimulations, followed by six weeks of high-intensity stimulation as instructed by the manufacturer.

Group Type ACTIVE_COMPARATOR

transcutaneous vagus nerve stimulation

Intervention Type DEVICE

Two groups will use a tVNS stimulator for 12 weeks. Group 1 will apply active stimulation for up to 4 hours daily at a comfortable level for 6 weeks, while Group 2 will use it at the lowest intensity (0.1 mA). After 6 weeks (T2), the groups will switch. Participants will be instructed to use the device for at least 1 hour a day, with a recommendation of 4 hours, following guidelines and recent studies. The CE-certified tVNS® E device non-invasively stimulates the vagus nerve via the ear. It is approved for treating a.o.depression. Device parameters (intensity, pulse length, frequency) mimic invasive VNS techniques, ensuring safe and effective signal transmission. Stimulation will be applied to the left ear, with intensity adjusted to a tingling sensation, avoiding discomfort. The study follows an approved protocol, with low-intensity stimulation as a control. The device delivers biphasic impulses at 25 Hz, with 28 seconds ON and 32 seconds OFF, and is safe for extended use.

No tVNS

This group of participants will be included in all measurements (T1-T3) and check-ups, except for the tVNS stimulation.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

Learn about the drugs, procedures, or behavioral strategies being tested and how they are applied within this trial.

transcutaneous vagus nerve stimulation

Two groups will use a tVNS stimulator for 12 weeks. Group 1 will apply active stimulation for up to 4 hours daily at a comfortable level for 6 weeks, while Group 2 will use it at the lowest intensity (0.1 mA). After 6 weeks (T2), the groups will switch. Participants will be instructed to use the device for at least 1 hour a day, with a recommendation of 4 hours, following guidelines and recent studies. The CE-certified tVNS® E device non-invasively stimulates the vagus nerve via the ear. It is approved for treating a.o.depression. Device parameters (intensity, pulse length, frequency) mimic invasive VNS techniques, ensuring safe and effective signal transmission. Stimulation will be applied to the left ear, with intensity adjusted to a tingling sensation, avoiding discomfort. The study follows an approved protocol, with low-intensity stimulation as a control. The device delivers biphasic impulses at 25 Hz, with 28 seconds ON and 32 seconds OFF, and is safe for extended use.

Intervention Type DEVICE

Eligibility Criteria

Check the participation requirements, including inclusion and exclusion rules, age limits, and whether healthy volunteers are accepted.

Inclusion Criteria

* No malformation of fetal organs (no abnormalities detected during "organ screening").
* Ability to provide written consent for themselves.
* Sufficient German language skills to communicate and understand study procedures.

Exclusion Criteria

* Cardiac arrhythmias or coronary heart disease.
* Neurological disorders.
* Current diagnosis or episode of a mood disorder.
* Diagnosed schizophrenia spectrum and other psychotic disorders.
* Severe substance use disorders.
* Individual exclusion may also occur based on other health issues if the study clinician determines that participation in the study may pose a disadvantage for the participant or the child.
Minimum Eligible Age

18 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

Yes

Sponsors

Meet the organizations funding or collaborating on the study and learn about their roles.

German Center for Mental Health (DZPG)

UNKNOWN

Sponsor Role collaborator

University Hospital Tuebingen

OTHER

Sponsor Role lead

Responsible Party

Identify the individual or organization who holds primary responsibility for the study information submitted to regulators.

Responsibility Role SPONSOR

Principal Investigators

Learn about the lead researchers overseeing the trial and their institutional affiliations.

Birgit Derntl, Prof., PhD

Role: PRINCIPAL_INVESTIGATOR

University Hospital Tübingen

Nils Kroemer, Prof., Dr. rer. nat.

Role: PRINCIPAL_INVESTIGATOR

University Hospital Tübingen

Locations

Explore where the study is taking place and check the recruitment status at each participating site.

University Hospital Tuebingen; Department of Psychiatry and Psychotherapy

Tübingen, Baden-Wurttemberg, Germany

Site Status RECRUITING

Countries

Review the countries where the study has at least one active or historical site.

Germany

Central Contacts

Reach out to these primary contacts for questions about participation or study logistics.

Julia Siodmiak, M.sc.

Role: CONTACT

+49 (0)7071 29-85736

Facility Contacts

Find local site contact details for specific facilities participating in the trial.

Julia Siodmiak, M.sc.

Role: primary

+49 07071 29-86119

Birgit Derntl, Prof., PhD, M.sc.

Role: backup

Julia Siodmiak, M.sc.

Role: backup

Other Identifiers

Review additional registry numbers or institutional identifiers associated with this trial.

TUE/858/2023BO2

Identifier Type: -

Identifier Source: org_study_id

More Related Trials

Additional clinical trials that may be relevant based on similarity analysis.

Maternal Mental Health Trial
NCT04685148 RECRUITING PHASE1/PHASE2
Art Therapy in Obstetric Patients
NCT05503056 COMPLETED NA