Effects of TBS on 5-HT1A Receptor Binding
Primary Purpose
Treatment Resistant Depression
Status
Unknown status
Phase
Not Applicable
Locations
Austria
Study Type
Interventional
Intervention
theta-burst stimulation using a MagPro X1000
sham stimulation using a MagPro X1000
Sponsored by
About this trial
This is an interventional treatment trial for Treatment Resistant Depression
Eligibility Criteria
Inclusion Criteria:
- DSM-5 diagnosis of single or recurrent major depression
- HAMD-17 total score of ≥ 18 and a Clinical Global Impression Scale (CGI-S) of ≥ 4
- Failure of at least two adequate antidepressant treatments
- Age 18-65 years
- Right-handedness (assessed with the Edinburgh Handedness Inventory)
Exclusion Criteria:
- Seizures in medical history
- Lifetime medical history of major systemic illness, neurological disorders and previous brain injuries
- Ferromagnetic implants, cardiac pacemaker, deep brain stimulation and other common MRI exclusion criteria
- Lifetime history of psychotic disorders or current psychotic symptoms
- Substance abuse or dependence within the last 3 months
- Borderline personality disorder (based on DSM-5 criteria)
- Pregnancy
- Active suicidal intent
- Benzodiazepines other than Lorazepam > 2mg/d or any dose of an anticonvulsant
- for participants who participated in an earlier neuroimaging study using ionizing radiation, the total radiation exposure dose of 20 mSv over the last 10 years must not be exceeded, as specified in the legislation on radiation protection.
- failure to comply with the study protocol or to follow the instructions of the investigating team
Sites / Locations
- Department of Psychiatry and Psychotherapy, Medical University of ViennaRecruiting
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Sham Comparator
Arm Label
active TBS
sham TBS
Arm Description
40 patients with TRD will receive active theta-burst stimulation using a MagPro X1000 between the two PET measurements
40 patients with TRD will receive sham stimulation using a MagPro X1000 between the two PET measurements. After the second PET scan they will receive active TBS
Outcomes
Primary Outcome Measures
Regional 5-HT1A receptor binding
5-HT1A receptor binding using the radioligand [carbonyl-11C]WAY100635
Secondary Outcome Measures
Regional white matter microstructure using DWI-TBSS
The analysis will be performed using tract-based spatial statistics
Regional white matter microstructure using DWI-Tractography
Tractography will be performed
Regional grey matter volume using MRI
The analysis will be done using voxel-based morphometry
Regional brain perfusion
Regional brain perfusion will be evaluated using Arterial Spin Labeling, ASL
Functional connectivity at rest and during tasks
Functional connectivity will be evaluated using resting state and task fMRI
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT02810717
Brief Title
Effects of TBS on 5-HT1A Receptor Binding
Official Title
Effects of Theta-burst Transcranial Magnetic Stimulation on Serotonin-1A Receptor Binding in Treatment Resistant Depression
Study Type
Interventional
2. Study Status
Record Verification Date
August 2018
Overall Recruitment Status
Unknown status
Study Start Date
December 2016 (undefined)
Primary Completion Date
November 2019 (Anticipated)
Study Completion Date
November 2019 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Rupert Lanzenberger
4. Oversight
Data Monitoring Committee
No
5. Study Description
Brief Summary
Background:
Theta-burst stimulation (TBS), a form of repetitive transcranial magnetic stimulation (rTMS) holds promise as an effective treatment for treatment resistant depression (TRD). rTMS has been linked to neuroplastic changes as shown using magnetic resonance imaging (MRI) and positron emission tomography (PET). Alterations in serotonin-1A receptor expression (5-HT1A) have been linked to major depression. Moreover, changes in 5-HT1A receptor binding - observed after pharmacological treatment, as well as after electroconvulsive therapy - has been linked to neuronal adaptations in response to these antidepressant treatments.
Objectives of the study:
Here, the aim is to investigate the effects of TBS over left and right dorsolateral prefrontal cortex on the 5-HT1A receptor binding in patients with TRD using PET. In addition, effects of iTBS on brain structure and function will be determined using functional, structural and perfusion MRI.
Study population:
80 patients with TRD who maintain their original medication regimen will be recruited.
Study design:
Longitudinal, randomized and double-blind clinical trial. 40 patients will receive active TBS, 40 patients will receive sham TBS for treatment duration of three weeks. Before and after three weeks of treatment, patients will be scanned using MRI and PET with the highly specific and selective radiotracer [carbonyl-11C]WAY100635. A follow-up visit and final examination will be performed 2 and 4 weeks after treatment for the active TBS group, respectively. Patients in the sham TBS arm will receive active TBS treatment immediately after the second MRI and PET scan.
Relevance and implications of the study:
This will be the worldwide first multimodal imaging study to investigate the effects of TBS on serotonin-1A receptor binding in TRD using PET. Thus, the study will add crucial knowledge to the existing literature on the effects of TMS on brain structure and function, related to antidepressant efficacy. Moreover, by combining molecular imaging of serotonergic neurotransmission with structural and functional MRI, the proposed study will increase the investigators knowledge on the serotonergic role in shaping brain morphology, microstructure and structural/functional connectivity. Taken together, the study has the potential to contribute to the development of personalized treatment, the reduction of personal suffering and the reduction of costs and occupational disability.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Treatment Resistant Depression
7. Study Design
Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare Provider
Allocation
Randomized
Enrollment
80 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
active TBS
Arm Type
Experimental
Arm Description
40 patients with TRD will receive active theta-burst stimulation using a MagPro X1000 between the two PET measurements
Arm Title
sham TBS
Arm Type
Sham Comparator
Arm Description
40 patients with TRD will receive sham stimulation using a MagPro X1000 between the two PET measurements. After the second PET scan they will receive active TBS
Intervention Type
Device
Intervention Name(s)
theta-burst stimulation using a MagPro X1000
Other Intervention Name(s)
repetitive transcranial magnetic stimulation
Intervention Description
TBS over left and right dorsolateral prefrontal cortex for a period of three weeks. iTBS over left DLPFC: 3-pulse 50 Hz bursts will be given every 200ms (at 5 Hz) in 2-second trains with an inter-train interval of 8 seconds. Trains will be repeated 20 to reach a total number of 600 pulses per session. cTBS over right DLPFC: cTBS will comprise uninterrupted bursts to reach a total number of 600 pulses per session. Two sessions per day, separated by 60 minutes; 30 Sessions in total over 3 weeks.
Intervention Type
Device
Intervention Name(s)
sham stimulation using a MagPro X1000
Other Intervention Name(s)
sham transcranial magnetic stimulation
Intervention Description
Sham TBS with the coil set at 45° against the skull will be performed over left and right dorsolateral prefrontal cortex for a period of three weeks
Primary Outcome Measure Information:
Title
Regional 5-HT1A receptor binding
Description
5-HT1A receptor binding using the radioligand [carbonyl-11C]WAY100635
Time Frame
before and after 3 weeks of TBS treatment
Secondary Outcome Measure Information:
Title
Regional white matter microstructure using DWI-TBSS
Description
The analysis will be performed using tract-based spatial statistics
Time Frame
before and after 3 weeks of TBS treatment
Title
Regional white matter microstructure using DWI-Tractography
Description
Tractography will be performed
Time Frame
before and after 3 weeks of TBS treatment
Title
Regional grey matter volume using MRI
Description
The analysis will be done using voxel-based morphometry
Time Frame
before and after 3 weeks of TBS treatment
Title
Regional brain perfusion
Description
Regional brain perfusion will be evaluated using Arterial Spin Labeling, ASL
Time Frame
before and after 3 weeks of TBS treatment
Title
Functional connectivity at rest and during tasks
Description
Functional connectivity will be evaluated using resting state and task fMRI
Time Frame
before and after 3 weeks of TBS treatment
Other Pre-specified Outcome Measures:
Title
Depression score using the Hamilton Depression Rating Scale
Description
Depression will be evaluated using the Hamilton Depression Rating Scale
Time Frame
before and after 3 weeks of TBS treatment
Title
Depression score using the Beck Depression Inventory
Description
Depression will be evaluated using the Beck Depression Inventory
Time Frame
before and after 3 weeks of TBS treatment
Title
Global physical activity
Description
assessed using the WHO global physical assessment GPAQ
Time Frame
before and after 3 weeks of TBS treatment
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
DSM-5 diagnosis of single or recurrent major depression
HAMD-17 total score of ≥ 18 and a Clinical Global Impression Scale (CGI-S) of ≥ 4
Failure of at least two adequate antidepressant treatments
Age 18-65 years
Right-handedness (assessed with the Edinburgh Handedness Inventory)
Exclusion Criteria:
Seizures in medical history
Lifetime medical history of major systemic illness, neurological disorders and previous brain injuries
Ferromagnetic implants, cardiac pacemaker, deep brain stimulation and other common MRI exclusion criteria
Lifetime history of psychotic disorders or current psychotic symptoms
Substance abuse or dependence within the last 3 months
Borderline personality disorder (based on DSM-5 criteria)
Pregnancy
Active suicidal intent
Benzodiazepines other than Lorazepam > 2mg/d or any dose of an anticonvulsant
for participants who participated in an earlier neuroimaging study using ionizing radiation, the total radiation exposure dose of 20 mSv over the last 10 years must not be exceeded, as specified in the legislation on radiation protection.
failure to comply with the study protocol or to follow the instructions of the investigating team
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Rupert Lanzenberger, MD
Phone
+43 40400 35760
Email
rupert.lanzenberger@meduniwien.ac.at
First Name & Middle Initial & Last Name or Official Title & Degree
Georg Kranz, PhD
Phone
+43 40400 38250
Email
georg.kranz@meduniwien.ac.at
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Siegfried Kasper, MD
Organizational Affiliation
Department of Psychiatry and Psychotherapy, Medical University of Vienna
Official's Role
Principal Investigator
Facility Information:
Facility Name
Department of Psychiatry and Psychotherapy, Medical University of Vienna
City
Vienna
ZIP/Postal Code
A-1090
Country
Austria
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Siegfried Kasper, MD, Prof.
Phone
+43-1-40400-3568
Email
sci-biolpsy@meduniwien.ac.at
12. IPD Sharing Statement
Plan to Share IPD
Yes
IPD Sharing Plan Description
A database that also includes data from this study will be created
Links:
URL
http://www.meduniwien.ac.at/neuroimaging/
Description
NEUROIMAGING LABs
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Effects of TBS on 5-HT1A Receptor Binding
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