Transcranial Direct Current Stimulation (tDCS) Therapy in Major Depression
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|ClinicalTrials.gov Identifier: NCT04507243|
Recruitment Status : Recruiting
First Posted : August 11, 2020
Last Update Posted : May 18, 2022
Noninvasive transcranial direct current stimulation (tDCS) is a low-intensity neuromodulation technique of minimal risk that has been used as an experimental procedure for reducing depressive symptoms and symptoms of other brain disorders. Though tDCS applied to prefrontal brain areas is shown to reduce symptoms in some people with major depressive disorder (MDD), the extent of antidepressant response often differs. Methods that map current flow directly in the brain while a person is receiving tDCS and that determine how functional neuroimaging signal changes after a series of tDCS sessions may help us understand how tDCS works, how it can be optimized, and if it can be used as an effective antidepressant. Investigators will address these questions in a two-part randomized double blind exploratory clinical trial. For this part of the study, investigators will determine relationships between target engagement and clinical outcomes (mood) and functional sub-constructs of cognitive control and emotion negativity bias, and whether imaging markers at baseline predict changes in antidepressant response.
One hundred people with depression (50 in each group) will be randomized to receive either HD-tDCS or sham-tDCS for a total of 12 sessions each lasting 20 minutes occurring on consecutive weekdays. At the first and last session, subjects will receive 20-30 minutes of active or sham HD-tDCS in the MRI scanner, which will allow investigators to map tDCS currents, and track changes in regional cerebral blood flow (rCBF) pre-to- post treatment using completely non-invasive methods. At the first and last session and mid-way through the trial, participants will also complete a series of clinical ratings and neurocognitive tests.
|Condition or disease||Intervention/treatment||Phase|
|Major Depressive Disorder||Device: Active - HD tDCS Device: Sham - HD tDCS||Not Applicable|
Transcranial direct current stimulation (tDCS), a noninvasive neuromodulation technique, applied to the left dorsolateral prefrontal cortex (DLPFC) can reduce depressive symptoms and improve cognitive control in major depressive disorder (MDD). Such findings suggest modulation of top down prefrontal-limbic circuits, which are functionally distinct from ventro-limbic networks and include reciprocally connected DLPFC and dorsomedial anterior cingulate cortex (dACC). However, substantial variation in tDCS response is observed in MDD. This may be due to imprecise stimulation protocols and suboptimal engagement of the neural circuits mediating antidepressant response. Methods that optimize electrode placement and account for individual variation in anatomy and that map current flow directly in the brain may inform the mechanisms and potential clinical utility of tDCS. A new tDCS technique, high definition (HD) tDCS, offers more focal stimulation than conventional tDCS (C-tDCS). The degree to which C-tDCS or HD-tDCS engage dorsal prefrontal-limbic neural circuits is unknown, yet is vital for understanding, confirming and subsequently improving possible therapeutic effects. Innovative MRI techniques that are able to map tDCS currents in vivo and that track changes in regional cerebral blood flow occurring with tDCS over time can provide direct evidence of neural effects. Based on a) theoretical modeling of tDCS current flow, b) studies showing hypo-metabolism, decreased CBF or activity in dorsal prefrontal-limbic networks, c) modulation of these regions with treatment, and, c) our prior results showing significant relationships in between change in dACC rCBF and clinical response to electroconvulsive therapy (ECT), an established brain stimulation treatment, we will test for the tDCS engagement and modulation of the DLPFC and dACC using tDCS current mapping performed in vivo and perfusion MRI. MRI-guided neuronavigation will be used to optimize and standardize electrode placement for DLPFC stimulation.
In this trial, using HD-tDCS that optimal target engagement of DLPFC and larger rCBF changes in the DLPFC and dACC compared to C-tDCS in the first part of the trial, we will define relationships between target engagement and change in mood and behavior. Patients with moderate to severe MDD (N=100, n=50 in each group) will be randomized to Active or Sham left anodal DLPFC HD-tDCS. Patients will complete MRI scans including tDCS current mapping and pCASL as well as two functional imaging tasks probing cognitive control and emotion negativity bias, recruiting prefrontal-limbic circuitry, before and after completing a 12-day trial of 20-minute tDCS sessions.
|Study Type :||Interventional (Clinical Trial)|
|Estimated Enrollment :||100 participants|
|Intervention Model:||Parallel Assignment|
|Intervention Model Description:||Active and Sham controlled|
|Masking:||Double (Participant, Outcomes Assessor)|
|Masking Description:||Double blind|
|Official Title:||Imaging-guided tDCS Therapy in Major Depression|
|Actual Study Start Date :||December 1, 2020|
|Estimated Primary Completion Date :||April 1, 2023|
|Estimated Study Completion Date :||April 1, 2023|
Experimental: Active - HD tDCS
Participants randomized to this arm will receive 12 sessions of high definition tDCS (HD-tDCS) stimulation (Soterix Medical) delivered to the left dorsolateral prefrontal cortex for 20-30 minutes.
Device: Active - HD tDCS
Non-invasive neuromodulation using HD electrodes placed on the scalp to deliver a constant, low current at 2 mA.
Sham Comparator: Sham - HD tDCS
Participants randomized to this arm will receive 12 sessions of sham HD tDCS stimulation (Soterix Medical) delivered to the left dorsolateral prefrontal cortex for 20-30 minutes.
Device: Sham - HD tDCS
Sham neuromodulation using HD electrodes placed on the scalp to deliver a low current ramped up/down for 20 sec.
- Measured joint longitudinal change in rCBF and mood scores over the tDCS trial [ Time Frame: 3 weeks ]Correlation between percent change in rCBF after the tDCS trial and percent change in depressive symptoms for active versus sham tDCS conditions
- Measured joint longitudinal change in regional brain activation and mood scores over the tDCS trial [ Time Frame: 3 weeks ]Correlation between percent change in regional brain activation for tasks probing cognitive control and emotion and percent change depressive symptoms for active versus sham tDCS conditions
- Measured magnetic fields and rCBF at baseline and change in mood scores over the tDCS trial [ Time Frame: 3 weeks ]Correlation between variations in magnetic fields and rCBF at baseline and clinical outcomes at the end of the tDCS treatment trial
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): NCT04507243
|Contact: Suzanne Kozikowski, MS||(424) 402-9051||DGCNeurostimStudy@mednet.ucla.edu|
|United States, California|
|University of California, Los Angeles (UCLA)||Recruiting|
|Los Angeles, California, United States, 90095|
|Contact: Suzanne Kozikowski, MS 424-402-9051 DGCNeurostimStudy@mednet.ucla.edu|
|Principal Investigator: Katherine L Narr, PhD|
|Principal Investigator:||Katherine L Narr, PhD||University of California, Los Angeles|