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The Study About Mechanism of Transcranial Magnetic Stimulation Treatment of Depression Using Medical Imaging

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ClinicalTrials.gov Identifier: NCT03500029
Recruitment Status : Recruiting
First Posted : April 17, 2018
Last Update Posted : April 17, 2018
Sponsor:
Information provided by (Responsible Party):
Chenwang Jin, First Affiliated Hospital Xi'an Jiaotong University

Brief Summary:
Depression is the most common psychiatric condition and a important public health concern in society. But medications for depression don't work as well as people expected and cause serious side-effects. Transcranial magnetic stimulation (TMS) is a noninvasive electrical stimulation treatment for depression, which has been approved by the FDA and added to the Guidelines for the Treatment of Depression in China. Despite the effect of the treatment is clear ,the TMS target,the neural circuit which plays a role in TMS and its mechanism remain unknown now. TBS target and effective site may be not in the same position. A large number of previous studies demonstrate the advantages and application prospects of different techniques of magnetic resonance (MR)in the study of pathogenesis of depression. Based on the results of previous research supported by the National Natural Science Foundation of China,the National Key Technology Research and Development Program of China during the "10th Five-Year Plan" and New Health Care and New technology. project team puts forward the idea of joint use of brain structure imaging of MR ,Diffusion Tensor Imaging (DTI) and resting-state functional MRI (fMRI) with different analysis methods to conduct a comprehensive study. The study is focused on the effects of TBS treatment on brain structure network, fiber connectivity network and functional connectivity network ,and nodes affected by it. Then we make further investigation about the mechanism of TMS treatment. The research will provide not only help for studying the pathogenesis of depression but also more reliable targets of next TMS treatment.

Condition or disease Intervention/treatment Phase
Depression Radiation: Transcranial magnetic stimulation (TMS) Drug: antidepressants Phase 1

Detailed Description:

The advantages of 3D T1 WI are thin slice scan,no interval, scanning fast and three-dimension reconstruction in any orientation compared with 2D SE. It is not easy to miss small lesions, and shows normal anatomy and lesions more objectively and more accurately.

Doppler tissue imaging (DTI) can reflect white matter fiber so that can be used to determine whether the various diseases affect nerve cell connections.

Arterial spin labeling (ASL) is non-drug perfusion imaging and completely noninvasive technology which can reflect brain perfusion better.

Resting-state functional MRI (fMRI) is used to located the abnormal brain regions whose activity is consistent with dorsolateral prefrontal cortex (DLPFC) by the abnormal resting spontaneous brain activity in patients with depression and the abnormal functional connectivity network.


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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 240 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary Purpose: Treatment
Official Title: The Study About Mechanism of Transcranial Magnetic Stimulation Treatment of Patients With Depression Using Multimodal Magnetic Resonance Imaging
Actual Study Start Date : March 1, 2018
Estimated Primary Completion Date : December 30, 2021
Estimated Study Completion Date : February 2022

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: TMS treatment group
In the Transcranial magnetic stimulation (TMS) treatment group patients with severe depression receive rTMS treatment without drug treatment.
Radiation: Transcranial magnetic stimulation (TMS)
TMS treatment group is treated with TMS for 20-40 minutes a time, 5 times a week. The stimulation parameters were 20 Hz and 80% MT. Each stimulation continues for 2 seconds, and the interval time of stimulation is 58 seconds.

Active Comparator: medication group
In the medication group patients with severe depression are treated with anti-depressants.
Drug: antidepressants
Medication group is treated with anti-depression for 6 weeks. The drugs and their doses belong to the first-line treatment for depression in the current guideline .

No Intervention: healthy control group
The control group don't accept intervention and treatment.



Primary Outcome Measures :
  1. Hamilton Depression Scale-17(HAMD-17) [ Time Frame: Difference at HAMD-17 between day 1,week 2 and week 4. ]
    HAMD-17 are to evaluate the severity degree of depression and the clinical effectiveness for treatment of depression.HAMD-17 scores range in 0-52 points.Total score which is between 7 and 16 means that volunteer may be with depression.Total score which is between 17 and 23 means that volunteer certainly is with depression.Total score which is more than 23 means that volunteer is with severe depression.

  2. Multimodal Magnetic Resonance Imaging [ Time Frame: Difference at Multimodal Magnetic Resonance Imaging between day 1,week 2 and week 4. ]
    Multimodal Magnetic Resonance Imaging include 3D-T1, ASL, DTI, resting-state functional MRI, etc.these show the Brain changes.


Secondary Outcome Measures :
  1. Clinical Global Impression.(CGI) [ Time Frame: Difference at CGI between day 1,week 2 and week 4. ]
    CGI is to evaluate the severity degree of depression to estimate whether patients are in accordance with inclusion criteria which concludes severty of illness (si),global improvement (gi) and efficacy index (ei).Si scores range in 0-7 points.Gi scores range in 0-7 points.Ei scores range in 0-4.00 points.

  2. Wisconsin Card Sorting Test (WCST) [ Time Frame: Difference at WCST between day 1,week 2 and week 4. ]
    WCST is to to evaluate the cognitive function of volunteers.Total score which is less 69 means that volunteer suffers from mental deficiency.



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Ages Eligible for Study:   18 Years to 60 Years   (Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

TMS treatment group and medication group:

  1. Hospitalized patients or outpatients which meet Clinical diagnosis of depression such as international Classification of diseases-10( ICD-10) which is the diagnostic criteria of unipolar depression;Scores of Hamilton Depression Scale (HAMD) ≥ 18 points, scores of clinical total impression scale (CGI)≥ 3 points, and without severe suicidal tendency;
  2. 18-60 years old, male or female;
  3. Physical and laboratory examination, electrocardiogram(ECG),and electroencephalogram (EEG) with no abnormal changes;
  4. No serious or unstable cerebrovascular, liver, kidney, endocrine, blood and other somatic diseases;
  5. The patient or the legal guardian should sign a written informed consent after fully understanding the research content of this study.

Healthy control group:

  1. 18-60 years old, male or female;
  2. Physical and laboratory examination, electrocardiogram(ECG),and electroencephalogram (EEG) with no abnormal changes;
  3. No serious or unstable heart, liver, kidney, endocrine, blood and other somatic diseases;
  4. Subjects or their legal guardians sign written informed consents after fully understanding the research contents of this study.

Exclusion Criteria:

  1. Mental disorders caused by organic diseases such as brain tumors;
  2. Serious somatic diseases, severe suicidal tendency and pacemakers;
  3. Secondary depressive disorder, psychotic depression or bipolar disorder caused by drugs;
  4. Antidepressants or psychoactive drugs were taken one month before enrollment.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03500029


Contacts
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Contact: Chenwang Jin, doctorate 18991232597 ext 14436421831 Jin1115@mail.xjtu.edu.cn

Locations
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China, Shaanxi
First Affiliated Hospital of Xi'an Jiaotong University Recruiting
Xi'an, Shaanxi, China, 710061
Contact: Xiancang Ma, doctorate         
Sponsors and Collaborators
Health Science Center of Xi’an Jiaotong University
Investigators
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Study Chair: Chenwang Jin, doctorate First Affiliated Hospital Xi'an Jiaotong University

Additional Information:
Publications of Results:
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Responsible Party: Chenwang Jin, chief physician, First Affiliated Hospital Xi'an Jiaotong University
ClinicalTrials.gov Identifier: NCT03500029     History of Changes
Other Study ID Numbers: JIN1115
First Posted: April 17, 2018    Key Record Dates
Last Update Posted: April 17, 2018
Last Verified: April 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Chenwang Jin, First Affiliated Hospital Xi'an Jiaotong University:
Depression
Transcranial magnetic stimulation(TMS)
Resting-state functional MRI(fMRI)
Additional relevant MeSH terms:
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Depression
Depressive Disorder
Behavioral Symptoms
Mood Disorders
Mental Disorders
Antidepressive Agents
Psychotropic Drugs