Effect of Behavioral Intervention on Cannabinoid Receptors in BAD (WHM_BAD)
Primary Purpose
Bipolar Affective Disorder, Currently in Remission, Bipolar Disorder I, Bipolar Disorder II
Status
Unknown status
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Wim Hof method
Sponsored by
About this trial
This is an interventional basic science trial for Bipolar Affective Disorder, Currently in Remission
Eligibility Criteria
Inclusion Criteria:
- BAD type I or II, in clinical remission of acute mood episode at least 3 months prior to study
- Having experienced an acute affective episode in the past 3 years
- Having suffered at least two lifetime depressive episodes
- Monotherapy or combination with a mood stabilizer (lithium, valproate, carbamazepine or lamotrigine) at optimal doses, quetiapine monotherapy or in combination with the aforementioned stabilizers, any oral atypical antipsychotic in combination with an antidepressant
- Hamilton Depression Rating Scale (HDRS) score (>8 and <19) and Young Mania Rating Scale (YMRS) score <10
- Being able to understand and agree with requirements of study protocol
Exclusion Criteria:
- (i) Any acute mood episode in the 12 weeks before the start of the trial
- Any current DSM-IV diagnosis different from BAD (including substance or alcohol use disorder at the time of study entry, except if it is under complete remission. Not applicable to nicotine or caffeine)
- Risk of suicide or self/hetero aggressiveness
- Pregnancy
- Severe and unstable medical disease
- Mental retardation.
Sites / Locations
- Children's Hospital of Michigan
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Experimental
Arm Label
Controls
BAD
Arm Description
Control subjects undergoing an 8-week behavioral modification technique consisting of a combination of breathing exercises, cold exposure and meditation
Patients with bipolar affective disorder (BAD) undergoing an 8-week behavioral modification technique consisting of a combination of breathing exercises, cold exposure and meditation
Outcomes
Primary Outcome Measures
Cannabinoid PET imaging
Changes in cannabinoid receptor density measured using F18-FMPEP-d2 PET/CT imaging pre and post behavioral intervention
Secondary Outcome Measures
Full Information
NCT ID
NCT04168697
First Posted
November 15, 2019
Last Updated
November 18, 2019
Sponsor
Wayne State University
1. Study Identification
Unique Protocol Identification Number
NCT04168697
Brief Title
Effect of Behavioral Intervention on Cannabinoid Receptors in BAD
Acronym
WHM_BAD
Official Title
The Effect of Behavioral Intervention on the Cannabinoid Receptor System in Patients With Bipolar Affective Disorder
Study Type
Interventional
2. Study Status
Record Verification Date
November 2019
Overall Recruitment Status
Unknown status
Study Start Date
February 1, 2020 (Anticipated)
Primary Completion Date
August 1, 2020 (Anticipated)
Study Completion Date
February 1, 2021 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Wayne State University
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
The objective of this study is to determine whether the practice of a non-drug related intervention technique (behavioral modification technique consisting of a combination of breathing exercises, cold exposure and meditation) has an effect on long-term cannabinoid receptor function in a control group as well as in a group of patients suffering from bipolar affective disorder (BAD). Specifically, the objective of this study is to test whether the applied behavioral modification technique is able to alter cannabinoid receptor density in brain areas that modulate mood and motivational drive (such as vmPFC, PAG, VTA, amygdala and OFC). The investigators believe that these studies will form the impetus for a better understanding and deployment of non-drug related treatment methods in patients with various depressive symptoms. In particular, it appears that the proposed behavioral modification technique might be a powerful, currently under-appreciated, method to positively modulate the brain's own cannabinoid system.
Detailed Description
Bipolar affective disorder (BAD) is often poorly controlled by prescribed drugs. Clinical observations suggest that the endocannabinoid system is dysfunctional in BAD and fails to control the level of cortical excitation and inhibition in the brain. Thus, excessively high endocannabinoid tone (mania) or excessively low endocannabinoid tone (depression) may manifest itself in BAD patients. Interestingly, cannabis use is common in patients with this disorder and anecdotal reports suggest that some patients take it to alleviate symptoms of both mania and depression. The investigators have recently studied brain activations during a cold stress paradigm in a 57 year old Dutch national (Wim Hof), the so-called "Iceman", who has the ability to withstand frequent prolonged periods of extreme cold exposure using a self-developed technique that includes a combination of breathing exercises, cold exposure and meditation (referred to as the WH technique). The WH technique allows the "Iceman" to regulate his own autonomic nervous system in the presence of severe cold and to perform remarkable acts of survival under extreme thermal conditions. Moreover, it has been shown that the WH technique can be successfully taught to novice users. Preliminary studies performed by the investigators have examined CNS mechanisms associated with the practice of the WH technique and the obtained findings unequivocally demonstrated activation of autonomic brainstem areas that are implicated in stress-induced analgesia as well as cognitive cortical areas that are associated with self-reflection (such as the anterior insula). In particular, a strong activation of the periaqueductal gray (PAG) was determined, which is implicated in the release of endogenous opiates/cannabinoids that mediate decreased sensitivity to cold exposure and (via connections to higher-order cortical areas) promote a feeling of euphoria and well-being. This finding suggests that the WH technique might allow practitioners to assert increased level of control over key components of the affective system and as a result might be a viable, non-drug related approach for patients with pathological mood swings. The investigators believe that this method might be particularly effective in patients suffering from BAD, as the practice of the WH technique can be implemented during both remission and at the onset of highly motivational manic episodes, which will then help to limit the effects of negative mood swings during depressive (and manic) episodes. The investigators will study the effects of the WH technique on cannabinoid receptor density using the cannabinoid PET tracer (F18-FMPEP-d2) by determining regional changes in cannabinoid receptor density in various brain regions prior and post behavioral intervention.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Bipolar Affective Disorder, Currently in Remission, Bipolar Disorder I, Bipolar Disorder II
7. Study Design
Primary Purpose
Basic Science
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Model Description
Patient group vs a control group
Masking
None (Open Label)
Masking Description
no masking
Allocation
Non-Randomized
Enrollment
20 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
Controls
Arm Type
Experimental
Arm Description
Control subjects undergoing an 8-week behavioral modification technique consisting of a combination of breathing exercises, cold exposure and meditation
Arm Title
BAD
Arm Type
Experimental
Arm Description
Patients with bipolar affective disorder (BAD) undergoing an 8-week behavioral modification technique consisting of a combination of breathing exercises, cold exposure and meditation
Intervention Type
Behavioral
Intervention Name(s)
Wim Hof method
Intervention Description
8-week behavioral modification intervention instructing the participants in a combination of breathing exercises, cold exposure and meditation
Primary Outcome Measure Information:
Title
Cannabinoid PET imaging
Description
Changes in cannabinoid receptor density measured using F18-FMPEP-d2 PET/CT imaging pre and post behavioral intervention
Time Frame
12 weeks
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria:
BAD type I or II, in clinical remission of acute mood episode at least 3 months prior to study
Having experienced an acute affective episode in the past 3 years
Having suffered at least two lifetime depressive episodes
Monotherapy or combination with a mood stabilizer (lithium, valproate, carbamazepine or lamotrigine) at optimal doses, quetiapine monotherapy or in combination with the aforementioned stabilizers, any oral atypical antipsychotic in combination with an antidepressant
Hamilton Depression Rating Scale (HDRS) score (>8 and <19) and Young Mania Rating Scale (YMRS) score <10
Being able to understand and agree with requirements of study protocol
Exclusion Criteria:
(i) Any acute mood episode in the 12 weeks before the start of the trial
Any current DSM-IV diagnosis different from BAD (including substance or alcohol use disorder at the time of study entry, except if it is under complete remission. Not applicable to nicotine or caffeine)
Risk of suicide or self/hetero aggressiveness
Pregnancy
Severe and unstable medical disease
Mental retardation.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Otto Muzik
Phone
3139932616
Email
otto@pet.wayne.edu
First Name & Middle Initial & Last Name or Official Title & Degree
Vaibhav Diwadkar
Phone
3135770164
Email
vaibhav.diwadkar@wayne.edu
Facility Information:
Facility Name
Children's Hospital of Michigan
City
Detroit
State/Province
Michigan
ZIP/Postal Code
48201
Country
United States
12. IPD Sharing Statement
Plan to Share IPD
No
IPD Sharing Plan Description
At this to we plan to share only summary data that will be published in peer-reviewed journals.
Learn more about this trial
Effect of Behavioral Intervention on Cannabinoid Receptors in BAD
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