Linear Asymmetric rTMS in Adolescent Treatment-Resistant Depression: Tolerability of Treatment Durations Ranging From Ten Days to One Day
Treatment Resistant Depression
About this trial
This is an interventional treatment trial for Treatment Resistant Depression focused on measuring Major Depressive Disorder, Repetitive Transcranial Magnetic Stimulation (rTMS), Treatment-Resistant Depression, Adolescents
Eligibility Criteria
Inclusion:
- Meets criteria for DSM-5 MDD, as determined by a structured psychiatric interview.
Meets criteria for TRD:
- failed two adequate courses of antidepressant medication OR
- failed adequate course of medication AND one course of psychotherapy.
- Score of > 40 on Child Depression Rating Scale-Revised OR score of > 20 on Child Depression Inventory-2.
- Fluent in speaking and reading English.
Exclusion:
- Positive pregnancy test.
- Current or past: bipolar disorder, psychotic disorder, autism spectrum disorder, intellectual disability, substance use disorder, conduct disorder, as determined by a structured psychiatric interview.
- Medical illness that could lower the seizure threshold, e.g., epilepsy from any cause.
- Medications that could lower the seizure threshold or affect brain function.
- Psychotropic medications changed in two weeks prior to enrollment.
- Fails the TMS safety screening questionnaire.
- Fails fMRI screening process.
- Left-handed (may indicate different cortical lateralization which could affect outcomes).
- Involuntarily committed to the hospital.
Sites / Locations
- Children's Hospital of Eastern Ontario
Arms of the Study
Arm 1
Experimental
Adolescents
Device: First Dawn rTMS System used in 18 patients divided into groups of 3. Each group will receive a different and gradually increasing frequency of treatment sessions/day (1-10) over a decreasing number of days (10-1). The total number of pulses for all levels will be 30,000. The use of each level will be dependent on tolerability and safety of the previous lower level, i.e., if one level is not tolerated well by a group, progression to the next level will not occur.