Cortical Excitability and Inhibition in MDD - Full Text View

Purpose

The purpose of this study is to learn if measures of brain chemicals and brain activity are different in children and adolescents with depression who are in different stages of treatment. This is important because it may identify a biological marker for depression that could one day be used to identify depressed children who would benefit from certain treatments (medications for example), or to monitor how well treatments are working. Brain activity measures(known as cortical excitability and inhibition) will be collected by Transcranial Magnetic Stimulation (TMS). TMS is a noninvasive (no surgery or implants) brain stimulation technology which can make parts of the brain work without putting any wires or chemicals into the body. Brain chemicals will be measured with a brain scan called magnetic resonance imaging and spectroscopy (MRI/MRS). MRI/MRS is a brain scan that uses magnetic fields to study the structure of the brain and brain chemicals. Measurements will take place over one 6-hour visit. This study does not provide any form of treatment.

Condition	Intervention
Major Depressive Disorder, Recurrent, Mild Depressive Disorder, Major	Device: Transcranial Magnetic Stimulation (TMS) Device: Magnetic Resonance Spectroscopy and Imaging

Study Type:	Observational
Study Design:	Observational Model: Case Control Time Perspective: Cross-Sectional
Official Title:	Cortical Excitability and Inhibition in Children and Adolescents With Major Depressive Disorder

Resource links provided by NLM:

MedlinePlus related topics: Depression

Drug Information available for: Gamma-aminobutyric acid

U.S. FDA Resources

Further study details as provided by Mayo Clinic:

Primary Outcome Measures:

Cortical Excitability and Inhibition at Motor Cortex [ Time Frame: Baseline ] [ Designated as safety issue: No ]
Motor Threshold (MT) is a single-pulse TMS measure of cortical excitability. A higher MT indicates decreased cortical excitability. Intracortical Facilitation (ICF) is a paired-pulse TMS measure of cortical excitability. A higher ICF indicates increased cortical excitability. Cortical Silent Period (CSP) is a single-pulse TMS measure of cortical inhibition. Longer CSP durations indicate greater cortical inhibition. Intracortical Inhibition (ICI) is a paired pulse TMS measure of cortical inhibition. A lower ICI indicates increased cortical inhibition, and a higher ICI indicates decreased cortical inhibition.

Secondary Outcome Measures:

Glutamate Concentrations in the Motor Cortex and Anterior Cingulate Cortex [ Time Frame: Baseline ] [ Designated as safety issue: No ]
Glutamate concentrations will be measured with proton magnetic resonance imaging at 3T.

Estimated Enrollment:	200
Study Start Date:	October 2012
Estimated Study Completion Date:	August 2017
Estimated Primary Completion Date:	August 2017 (Final data collection date for primary outcome measure)

Groups/Cohorts	Assigned Interventions
Mild depression Subjects with mild, but clinically significant depression	Device: Transcranial Magnetic Stimulation (TMS) Single and paired-pulse TMS applied to the motor cortex will collect measures of cortical excitability and inhibition. Other Name: Device: Magstim Model 200 Device: Magnetic Resonance Spectroscopy and Imaging MRS/MRI Scans will examine glutamate concentrations in the motor cortex and anterior cingulate cortex. Other Name: MRS/MRI
Moderate to Severe MDD Subjects with moderate to severe major depressive disorder who have not yet initiated treatment with an SSRI	Device: Transcranial Magnetic Stimulation (TMS) Single and paired-pulse TMS applied to the motor cortex will collect measures of cortical excitability and inhibition. Other Name: Device: Magstim Model 200 Device: Magnetic Resonance Spectroscopy and Imaging MRS/MRI Scans will examine glutamate concentrations in the motor cortex and anterior cingulate cortex. Other Name: MRS/MRI
MDD with response to SSRI Subjects with moderate to severe major depressive disorder that has responded to an SSRI	Device: Transcranial Magnetic Stimulation (TMS) Single and paired-pulse TMS applied to the motor cortex will collect measures of cortical excitability and inhibition. Other Name: Device: Magstim Model 200 Device: Magnetic Resonance Spectroscopy and Imaging MRS/MRI Scans will examine glutamate concentrations in the motor cortex and anterior cingulate cortex. Other Name: MRS/MRI
MDD without response to SSRI Subjects with moderate to severe major depressive disorder which has not responded to treatment with an SSRI	Device: Transcranial Magnetic Stimulation (TMS) Single and paired-pulse TMS applied to the motor cortex will collect measures of cortical excitability and inhibition. Other Name: Device: Magstim Model 200 Device: Magnetic Resonance Spectroscopy and Imaging MRS/MRI Scans will examine glutamate concentrations in the motor cortex and anterior cingulate cortex. Other Name: MRS/MRI

Detailed Description:

This study is focused on understanding the neurophysiology of major depressive disorder (MDD), and the impact of selective serotonin reuptake inhibitors (SSRIs) in children and adolescents. This is a cross-sectional study which will utilize single and paired-pulse transcranial magnetic stimulation (TMS) to collect measures of glutamatergic cortical excitability (the motor threshold and intracortical facilitation), and GABAergic cortical inhibition (the cortical silent period and intracortical inhibition) of the motor cortex in chilren and adolescents in various disease states of MDD. Proton magnetic resonance spectroscopy and imaging scans (MRS/MRI) at 3 Tesla (3T) will examine glutamate concentrations in the motor cortex and anterior cingulate cortex.

This is a biomarker study (MRI/MRS and TMS neurophysiology measures); treatment is not provided in any form. This study will not utilize Repetitive Transcranial Magnetic Stimulation (rTMS).

Eligibility

Ages Eligible for Study:	10 Years to 18 Years
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No
Sampling Method:	Non-Probability Sample

Study Population

This protocol will plan to screen depressed children and adolescents who are seeking treatment at Mayo Clinic in Rochester, MN, using strict inclusion and exclusion criteria. These adolescents will represent gender and minority distribution consistent with the Rochester metro/rural area demographic distribution. This study will be inclusive of all races, genders, and socioeconomic classes.

Criteria

Inclusion Criteria:

Adolescents from the ages of 10 to 18, male or female.
Subjects with MDD (groups 2, 3, and 4):
Must have a Children's Depression Rating Scale, Revised (CDRS-R) score of 40 or higher
Must have a Clinical Global Impression-Severity scale (CGI-S) score of 4 or higher.
Group 1: (50 subjects): Subjects who have mild (CDRS-R score < 40) but clinically significant depression.
Group 2: (50 subjects): Subjects with moderate to severe MDD who have not yet initiated treatment with an SSRI.
Group 3: (50 subjects): Subjects with moderate to severe MDD that has responded to treatment with an SSRI.
Group 4: (50 subjects): Subjects with moderate to severe MDD which has not responded to treatment with an SSRI.
Capable of providing informed assent (consent if age 18) in addition to consent by parent or guardian.
Subjects and parents must be fluent in English.

Exclusion Criteria:

Primary Axis I or II disorder other than MDD.
Unprovoked seizure history, seizure disorder, history of febrile seizures, family history of epilepsy.
Any significant findings on the TMS Adult Safety Screen (TASS) or contraindications to MRI/MRS
Subjects with a history of suicidal behavior to the extent that "yes" is entered on the Suicidal Behavioral section of the Columbia-Suicide Severity Rating Scale (C-SSRS) for either "actual attempt", "interrupted attempt", or "aborted attempt" or "preparatory acts or behaviors" will be excluded from enrollment.
Pregnancy or suspected pregnancy in females.
Metal in the head (except the mouth), implanted medication pumps, cardiac pacemaker.
Prior brain surgery.
Risk for increased intracranial pressure such as a brain tumor.
Any unstable medical condition.

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT01718730

Locations

United States, Minnesota
Mayo Clinic	Recruiting
Rochester, Minnesota, United States, 55905
Contact: Katrina Schaefer 507-255-5452 schaefer.katrina@mayo.edu
Contact: Paul Croarkin, D.O. 507-255-7164
Principal Investigator: Paul E Croarkin, D.O.

Sponsors and Collaborators

Mayo Clinic

Investigators

Principal Investigator:

Paul E Croarkin, D.O.

Mayo Clinic

More Information

No publications provided

Responsible Party:	Paul E. Croarkin, PI, Mayo Clinic
ClinicalTrials.gov Identifier:	NCT01718730 History of Changes
Other Study ID Numbers:	12-000335
Study First Received:	October 29, 2012
Last Updated:	October 29, 2012
Health Authority:	United States: Institutional Review Board

Keywords provided by Mayo Clinic:

TMS
Adolescent
Child
MDD
Major depressive disorder
Mild MDD
Mild depression
SSRI
Motor cortex
Cortical excitability

Cortical inhibition
Cortical silent period
Motor threshold
Intracortical facilitation
Intracortical inhibition
gamma-aminobutyric acid (GABA)
Glutamate
N-methyl-D-aspartate (NMDA)
Magnetic resonance spectroscopy
MRS

Additional relevant MeSH terms:

Depressive Disorder
Depression
Depressive Disorder, Major
Recurrence
Mood Disorders
Mental Disorders
Behavioral Symptoms
Disease Attributes

Pathologic Processes
Gamma-Aminobutyric Acid
GABA Agents
Neurotransmitter Agents
Molecular Mechanisms of Pharmacological Action
Pharmacologic Actions
Physiological Effects of Drugs

ClinicalTrials.gov processed this record on May 23, 2013