Stimulation of Parieto-hippocampal Connectivity in Patients With Major Depressive Disorder
Study Details
Study Description
Brief Summary
This study aims to investigate the effects of individualized repetitive transcranial magnetic stimulation (rTMS) of parieto-hippocampal functional connectivity in patients with major depressive disorder (MDD). Specifically, patients will be randomized to one of three groups and will receive 15 days of rTMS over three weeks. Each day they will receive one active session of rTMS over the dorsolateral parietal cortex (DLPFC) and depending on group assignment another session either A) active rTMS over DLPFC, B) active rTMS over left and right lateral parietal cortex (LPC), or C) sham rTMS over DLPFC or LPC. Stimulation targets in the LPC will be individualized for each patient based on their resting-state functional connectivity between the hippocampus and LPC. Clinical, neuropsychological and fMRI data will be acquired before and after the treatment course.
Condition or Disease | Intervention/Treatment | Phase |
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N/A |
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
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Active Comparator: DLPFC-DLPFC 15 sessions of active rTMS over DLPFC + 15 sessions of active rTMS over DLPFC |
Device: active rTMS over DLPFC
15 sessions of active rTMS over DLPFC
Device: Add-on active rTMS over DLPFC
15 additional sessions of active rTMS over DLPFC
|
Experimental: DLPFC-LPC 15 sessions of active rTMS over DLPFC + 15 sessions of active rTMS over LPC |
Device: active rTMS over DLPFC
15 sessions of active rTMS over DLPFC
Device: Add-on active rTMS over LPC
15 additional sessions of active rTMS over LPC
|
Sham Comparator: DLPFC-SHAM 15 sessions of active rTMS over DLPFC + 15 sessions of sham rTMS over DLPFC or LPC |
Device: active rTMS over DLPFC
15 sessions of active rTMS over DLPFC
Device: Add-on sham rTMS
15 additional sessions of sham rTMS over DLPFC or LPC
|
Outcome Measures
Primary Outcome Measures
- Change in depression severity as measured by the Hamilton Depression Rating Scale (HAMD-17) [Four measurement time points with a seven-day interval starting on the first day of stimulation, and ending three days after the last day of stimulation]
Remission defined as HAMD-17 score (range: 0 to 52, lower scores represent better outcome) of less than or equal to 8 after the rTMS course. Response defined as a reduction of at least 50% from baseline in HAMD-17 score after treatment.
- Change in functional connectivity coefficients based on resting-state fMRI [3 days prior to first rTMS session and 3 days after last rTMS session]
Seed-to-voxel and ROI-to-ROI functional connectivity analysis of rs-fMRI data.
- Change in task-based fMRI activation during associative memory paradigm [3 days prior to first rTMS session and 3 days after last rTMS session]
Functional magnetic resonance imaging (fMRI) will be performed to measure blood-oxygen-level dependent signal encoding and retrieval with a focus on hippocampal regions.
Secondary Outcome Measures
- Change in depression severity as measured by the Beck's Depression Inventory (BDI-II) [3 days prior to first rTMS session and 3 days after last rTMS session, follow-up after 4, 8 and 12 weeks]
Remission defined as BDI-II score (range: 0 to 63, lower scores represent better outcome) of less than or equal to 12 after the rTMS course. Response defined as a reduction of at least 50% from baseline in BDI-II score after treatment.
- Change in visual memory as assessed by the Delayed Matching to Sample test (DMS) [3 days prior to first rTMS session and 3 days after last rTMS session]
Subjects will be assessed in the domain of visual memory by undergoing computorized neurological testing. Outcome varible is percentage of correct answers.
- Change in spatial planning as assessed by the One Touch Stockings of Cambridge (OTS) [3 days prior to first rTMS session and 3 days after last rTMS session]
Subjects will be assessed in the domain of spatial planning by undergoing computorized neurological testing. Outcome varible is the mean number of choices to correct answer.
- Change in visual sustained attention as assessed by the Rapid Visual Information Processing (RVP) [3 days prior to first rTMS session and 3 days after last rTMS session]
Subjects will be assessed in the domain of visual sustained attention by undergoing computorized neurological testing. Outcome varible is the target sensitivity A'.
- Change in working memory as assessed by the Spatial Working Memory (SWM) [3 days prior to first rTMS session and 3 days after last rTMS session]
Subjects will be assessed in the domain of working memory by undergoing computorized neurological testing. Outcome varible is the total number of errors.
- Change in task-based fMRI activation during social touch paradigm [3 days prior to first rTMS session and 3 days after last rTMS session]
Functional magnetic resonance imaging (fMRI) will be performed to measure blood-oxygen-level dependent signal while participants receive tactile stimulation.
- Change in task-based fMRI activation during emotional processing paradigm [3 days prior to first rTMS session and 3 days after last rTMS session]
Functional magnetic resonance imaging (fMRI) will be performed to measure blood-oxygen-level dependent signal while participants perform an emotional processing task.
Eligibility Criteria
Criteria
Inclusion Criteria:
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fulfilled criteria for unipolar major depressive disorder for at least four weeks
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did not respond to a minimum of one or did not tolerate a minimum of two antidepressants in the current episode
Exclusion Criteria:
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metal in the brain or the skull
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cardiac pacemaker or intracardiac lines
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medication infusion devices
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heart or brain surgery
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pregnancy
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substance induced depression
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history of substance abuse
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psychotic episodes
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bipolar disorder
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anorexia
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posttraumatic stress disorder (current or within the last 12 months)
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claustrophobia
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any condition resulting in increased intracranial pressure
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traumatic brain injury
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history of epilepsy
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cerebral aneurysms
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dementia
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Morbus Parkinson
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Chorea Huntington
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multiple sclerosis
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stroke or transient ischemic attack (within the last 2 years)
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previous antidepressive treatment with rTMS, electroconvulsive therapy (within the last 3 months), vagus nerve stimulation or deep brain stimulation
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
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1 | Klinik und Poliklinik für Psychiatrie und Psychotherapie | Bonn | Germany |
Sponsors and Collaborators
- University Hospital, Bonn
- Clemens Mielacher, University Hospital, Bonn
Investigators
- Principal Investigator: René Hurlemann, Prof., University Hospital, Bonn
Study Documents (Full-Text)
None provided.More Information
Publications
- 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. Erratum in: Lancet. 2018 Jun 23;391(10139):e24.
- Daumann J, Fischermann T, Heekeren K, Henke K, Thron A, Gouzoulis-Mayfrank E. Memory-related hippocampal dysfunction in poly-drug ecstasy (3,4-methylenedioxymethamphetamine) users. Psychopharmacology (Berl). 2005 Aug;180(4):607-11. Epub 2005 Sep 14.
- Fox MD, Buckner RL, White MP, Greicius MD, Pascual-Leone A. Efficacy of transcranial magnetic stimulation targets for depression is related to intrinsic functional connectivity with the subgenual cingulate. Biol Psychiatry. 2012 Oct 1;72(7):595-603. doi: 10.1016/j.biopsych.2012.04.028. Epub 2012 Jun 1.
- Lefaucheur JP, André-Obadia N, Antal A, Ayache SS, Baeken C, Benninger DH, Cantello RM, Cincotta M, de Carvalho M, De Ridder D, Devanne H, Di Lazzaro V, Filipović SR, Hummel FC, Jääskeläinen SK, Kimiskidis VK, Koch G, Langguth B, Nyffeler T, Oliviero A, Padberg F, Poulet E, Rossi S, Rossini PM, Rothwell JC, Schönfeldt-Lecuona C, Siebner HR, Slotema CW, Stagg CJ, Valls-Sole J, Ziemann U, Paulus W, Garcia-Larrea L. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS). Clin Neurophysiol. 2014 Nov;125(11):2150-2206. doi: 10.1016/j.clinph.2014.05.021. Epub 2014 Jun 5. Review.
- Wang JX, Rogers LM, Gross EZ, Ryals AJ, Dokucu ME, Brandstatt KL, Hermiller MS, Voss JL. Targeted enhancement of cortical-hippocampal brain networks and associative memory. Science. 2014 Aug 29;345(6200):1054-7. doi: 10.1126/science.1252900.
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