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Repetitive Magnetic Transcranial Stimulation (rTMS) in the Treatment of Generalized Anxiety Disorder (GAD)

Primary Purpose

Generalized Anxiety Disorder

Status
Completed
Phase
Phase 3
Locations
United States
Study Type
Interventional
Intervention
Repetitive transcranial magnetic stimulation (rTMS)
Sponsored by
University of California, Los Angeles
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Generalized Anxiety Disorder focused on measuring repetitive magnetic transcranial stimulation (rTMS), functional magnetic resonance imaging (fMRI)

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • The subject is male or female outpatients age 18 to 65 years, inclusive
  • The subject meets DSM-IV criteria for Generalized Anxiety Disorder as determined by the MINI.
  • Sexually active female patients of childbearing potential must be practicing at least one or more the following methods of contraception during the study: intrauterine device (IUD), barrier method in combination with a spermicide, oral/hormonal contraception or abstinence. Female patients of childbearing potential must have a negative pregnancy test prior to receiving study drug.
  • Written informed consent must be obtained from the subject prior to study participation.
  • The subject is in good medical health or with chronic medical conditions which are currently stable.
  • No current abuse of alcohol or other substance.
  • The subject has a total score of 20 or more on the SIGH-A at screening.
  • The subject has a Clinical Global Impression (CGI) Severity score of 4 or more at screening.

Exclusion Criteria:

  • The subject meets DSM-IV criteria for an Axis I diagnosis (other than GAD) as the primary diagnosis (i.e., schizophrenia, mood disorder, psychosis, anorexia nervosa) as determined by the MINI.
  • The subject is clinically judged by the investigator to be at risk for suicide or is acutely suicidal as objectively measured by the MINI and MSE.
  • The subject is clinically judged by the investigator to be at risk for homicide or is acutely homicidal as objectively measured by the MINI and MSE.
  • The subject has a psychiatric condition that would require inpatient, or partial psychiatric hospitalization.
  • Seizure disorders.
  • Significant history of medical disease (i.e. cardiovascular, hepatic (e.g. cirrhosis, hepatitis B or C) renal, gynecological, musculoskeletal, neurological, gastrointestinal, metabolic, hematological, endocrine, cancer with a metastatic potential or progressive neurological disorders) which could impair reliable participation in the trial or necessitate the use of medication not allowed by this protocol.
  • The subject is pregnant, planning to become pregnant, or nursing. If a subject becomes pregnant, she will be discontinued immediately and followed appropriately.
  • Concomitant therapy with another investigational drug, or participation in an investigational drug study within one month prior to entering this study.
  • Current psychotherapeutic treatment except for treatment with Specific Reuptake Inhibitor (SSRIs) medications which include: Fluoxetine (Prozac), Paroxetine (Paxil), Sertraline (Zoloft), Luvox (Fluvoxamine), and Citalopram. Potential subjects may remain on one of the SSRI medications provided that he or she has been on a stable dose for at least 4 weeks prior to entering this study; this dose remains stable throughout the remainder of this study; and it can be determined that this medication is not exacerbating the anxiety symptoms.
  • History of poor compliance or in the Investigator's judgment patients any subject whose treatment as an outpatient would be clinically contraindicated
  • The subject has attempted suicide one or more times within the past twelve months
  • The subject has a Structured Hamilton Depression Rating Scale (SIGH-D) score above 38 which suggests a moderate to severe clinical level of depressive symptoms

Sites / Locations

  • UCLA

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

1

Arm Description

This was an open-label study - all subjects received the intervention (rTMS treatment)

Outcomes

Primary Outcome Measures

Structured Interview for the Hamilton Anxiety Rating Scale (SIGH-A)
The Clinical Global Impression (CGI) Scale of Severity/Improvement

Secondary Outcome Measures

Structured Interview for the Hamilton Depression Rating Scale (SIGH-D)
The Side-Effects Questionnaire

Full Information

First Posted
April 14, 2008
Last Updated
August 17, 2016
Sponsor
University of California, Los Angeles
Collaborators
Phillis and Brian Harvey Foundation, Saban Family Foundation
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1. Study Identification

Unique Protocol Identification Number
NCT00662584
Brief Title
Repetitive Magnetic Transcranial Stimulation (rTMS) in the Treatment of Generalized Anxiety Disorder (GAD)
Official Title
The Efficacy of Functional Magnetic Resonance Imaging (fMRI) Guided Low Frequency Repetitive Magnetic Transcranial Stimulation (rTMS) Therapy on Symptoms of Generalized Anxiety Disorder (GAD)
Study Type
Interventional

2. Study Status

Record Verification Date
August 2016
Overall Recruitment Status
Completed
Study Start Date
August 2006 (undefined)
Primary Completion Date
March 2007 (Actual)
Study Completion Date
April 2007 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of California, Los Angeles
Collaborators
Phillis and Brian Harvey Foundation, Saban Family Foundation

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive method that holds promise for treating several psychiatric disorders. Yet the most effective location and parameters for treatment need more exploration. Also, whether rTMS is an effective treatment for individuals with a DSM-IV diagnosis of Generalized Anxiety Disorder (GAD) has not been empirically tested. The goal of this pilot study is to evaluate whether fMRI guided rTMS is effective in reducing symptoms of GAD.
Detailed Description
This study utilized a 3-week open-label design to evaluate the efficacy of fMRI guided rTMS in the treatment of GAD. We first used functional magnetic resonance imaging (fMRI) during the gambling task to localize anxiety-related brain activations in each individual participant, and then used this information to guide treatment with repetitive transcranial magnetic stimulation (rTMS). TMS was delivered to the target site at a frequency of 1 Hz for 20 minutes (900 total pulses). The intensity of the TMS was set to 90% of the passive motor threshold for each participant. The primary efficacy measures include the Clinical Global Impression of Improvement (CGI-I) and the Hamilton Anxiety Rating Scale (HARS). Response to treatment was defined as a reduction of 50% or more on the HARS and symptom remission was defined as a CGI-I score of 1 or 2 ("much improved" or "very much improved" respectively) and a score ≤ 8 on the HARS. Data was entered anonymously into an Excel spreadsheet and analyzed by the UCLA Semel Institute Statistical Core. The analysis was done on the intent to treat sample using last observation carried forward (LOCF). A one-sample paired t-test was used to compare endpoint to baseline means on the HARS, with a significance level set at p= 0.05, two-tailed.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Generalized Anxiety Disorder
Keywords
repetitive magnetic transcranial stimulation (rTMS), functional magnetic resonance imaging (fMRI)

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
10 (Actual)

8. Arms, Groups, and Interventions

Arm Title
1
Arm Type
Experimental
Arm Description
This was an open-label study - all subjects received the intervention (rTMS treatment)
Intervention Type
Procedure
Intervention Name(s)
Repetitive transcranial magnetic stimulation (rTMS)
Intervention Description
transcranial magnetic stimulation (TMS) at .5 HZ for 20s
Primary Outcome Measure Information:
Title
Structured Interview for the Hamilton Anxiety Rating Scale (SIGH-A)
Time Frame
Week 0, 3, 6
Title
The Clinical Global Impression (CGI) Scale of Severity/Improvement
Time Frame
Week 0, 3, 6
Secondary Outcome Measure Information:
Title
Structured Interview for the Hamilton Depression Rating Scale (SIGH-D)
Time Frame
Week 0 and 6
Title
The Side-Effects Questionnaire
Time Frame
Week 0, 3, 6

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: The subject is male or female outpatients age 18 to 65 years, inclusive The subject meets DSM-IV criteria for Generalized Anxiety Disorder as determined by the MINI. Sexually active female patients of childbearing potential must be practicing at least one or more the following methods of contraception during the study: intrauterine device (IUD), barrier method in combination with a spermicide, oral/hormonal contraception or abstinence. Female patients of childbearing potential must have a negative pregnancy test prior to receiving study drug. Written informed consent must be obtained from the subject prior to study participation. The subject is in good medical health or with chronic medical conditions which are currently stable. No current abuse of alcohol or other substance. The subject has a total score of 20 or more on the SIGH-A at screening. The subject has a Clinical Global Impression (CGI) Severity score of 4 or more at screening. Exclusion Criteria: The subject meets DSM-IV criteria for an Axis I diagnosis (other than GAD) as the primary diagnosis (i.e., schizophrenia, mood disorder, psychosis, anorexia nervosa) as determined by the MINI. The subject is clinically judged by the investigator to be at risk for suicide or is acutely suicidal as objectively measured by the MINI and MSE. The subject is clinically judged by the investigator to be at risk for homicide or is acutely homicidal as objectively measured by the MINI and MSE. The subject has a psychiatric condition that would require inpatient, or partial psychiatric hospitalization. Seizure disorders. Significant history of medical disease (i.e. cardiovascular, hepatic (e.g. cirrhosis, hepatitis B or C) renal, gynecological, musculoskeletal, neurological, gastrointestinal, metabolic, hematological, endocrine, cancer with a metastatic potential or progressive neurological disorders) which could impair reliable participation in the trial or necessitate the use of medication not allowed by this protocol. The subject is pregnant, planning to become pregnant, or nursing. If a subject becomes pregnant, she will be discontinued immediately and followed appropriately. Concomitant therapy with another investigational drug, or participation in an investigational drug study within one month prior to entering this study. Current psychotherapeutic treatment except for treatment with Specific Reuptake Inhibitor (SSRIs) medications which include: Fluoxetine (Prozac), Paroxetine (Paxil), Sertraline (Zoloft), Luvox (Fluvoxamine), and Citalopram. Potential subjects may remain on one of the SSRI medications provided that he or she has been on a stable dose for at least 4 weeks prior to entering this study; this dose remains stable throughout the remainder of this study; and it can be determined that this medication is not exacerbating the anxiety symptoms. History of poor compliance or in the Investigator's judgment patients any subject whose treatment as an outpatient would be clinically contraindicated The subject has attempted suicide one or more times within the past twelve months The subject has a Structured Hamilton Depression Rating Scale (SIGH-D) score above 38 which suggests a moderate to severe clinical level of depressive symptoms
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Alexander Bystritsky, MD
Organizational Affiliation
University of California, Los Angeles
Official's Role
Principal Investigator
Facility Information:
Facility Name
UCLA
City
Los Angeles
State/Province
California
ZIP/Postal Code
90024
Country
United States

12. IPD Sharing Statement

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Repetitive Magnetic Transcranial Stimulation (rTMS) in the Treatment of Generalized Anxiety Disorder (GAD)

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