Cost-utility Analysis of Maintenance rTMS for Treatment-resistant Depression (ACOUSTIM)
Treatment-resistant Depression
About this trial
This is an interventional other trial for Treatment-resistant Depression focused on measuring Major Depressive Disorder, Unipolar depression, Chronic depression, Recurrent depression, Depressive disorder, Magnetic stimulation, Non-invasive brain stimulation, 1 Hertz (Hz) rTMS, Maintenance rTMS, Cost-utility, Efficiency, Medico-economic, Antidepressants
Eligibility Criteria
Inclusion Criteria:
- Major depressive disorder according to Diagnostic and Statistical Manual of Mental Disorders (DSM) 5 MADRS >19
- Episode duration: 12 weeks to 3 years.
- 2 to 4 unsuccessful treatment lines (including antidepressants, and potentialization agents lithium and quetiapine) despite adequate dosage and duration (6 weeks stable posology)
- Ability to consent and express informed consent, to answer questionnaires and to go to follow-up visits.
- Affiliation to social security
Exclusion Criteria:
- Bipolar disorder
- Schizophrenia and other psychotic disorders
- Mental retardation or developmental disorder
- Substance abuse or dependence
- Depression symptoms better explained by medical conditions
- Neurologic conditions (e.g.,previous epilepsy or unexplained seizures, stroke, trauma, infection, metabolic disease, severe migraines, multiple sclerosis, brain tumor)
- Presence of at least one contra-indication to rTMS
- Pregnancy/breast-feeding
- Patient who previously received 5 lines or more pharmacological treatment for the current episode (excluding symptomatic psychotropic drugs, e.g. benzodiazepines and hypnotics)
- Former use of electroconvulsive therapy or rTMS within the current episode.
- Previous failure of adequate ECT (at least 12 well conducted sessions) or rTMS course (at least 20 well conducted sessions) in the medical history.
- History of at least two courses of ECT, previous need for maintenance ECT.
- Protection measure : maintenance of justice, tutelage, legal guardianship
- Woman of childbearing age without effective contraception
- Liberty deprivation (e.g. incarceration, therapeutic injunction)
Sites / Locations
- CHU d'Angers
- CHRU de Besançon
- CH le Vinatier Lyon
- CHU de Caen
- CHU de Clermont-Ferrand
- CHU de Dijon
- Clinique de Vontes
- EPSM de Lille
- CH Esquirol - Limoges
- CHU de Montpellier
- Nantes University Hospital
- EPS de Ville-Evrard
- GH PItié Salpétrière
- GHU Psychiatrie Ste Anne
- CH Henri Laborit (Poitiers)
- Centre hospitalier Guillaume Regnier Rennes
- CH du Rouvray - Rouen
- CHU de Toulouse
- CHU de Tours / CHRU de Tours
Arms of the Study
Arm 1
Arm 2
Arm 3
Experimental
Experimental
Sham Comparator
Systematic maintenance rTMS (arm A)
rTMS course in case of relapse (arm B)
Sham rTMS (arm C)
Active rTMS treatment followed, for responders, by systematic maintenance rTMS Depression usual medical treatment (psychosocial approach and/or pharmacotherapy and/or, ECT…)
Active rTMS treatment followed, for responders, by additional rTMS courses, in case of relapse Depression usual medical treatment (psychosocial approach and/or pharmacotherapy and/or, ECT…)
sham rTMS followed, for responders, by either systematic sham mTMS (50%) or additional sham rTMS course in case of relapse(50%) Depression usual medical treatment (psychosocial approach and/or pharmacotherapy and/or, ECT…)