rTMS for Depressed Teens: A Sham-Controlled Trial, Part 1

Status:Active, not recruiting
Conditions:Depression, Major Depression Disorder (MDD)
Therapuetic Areas:Psychiatry / Psychology, Pulmonary / Respiratory Diseases
Age Range:12 - 21
Start Date:April 2013
End Date:December 2019

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A Randomized, Double-Blinded, Sham-Controlled Trial of Repetitive Transcranial Magnetic Stimulation in Depressed Adolescents

This research proposal aims to better understand the neurobiology of depression in
adolescents and how repetitive transcranial magnetic stimulation (rTMS) may therapeutically
impact brain function and mood. This study will be the first to use a randomized,
double-blinded, sham-controlled approach to the investigation of rTMS therapy for depressed
adolescents. This approach will allow for the validation of rTMS treatment outcomes in the
depressed adolescent population in a scientifically rigorous manner. The magnetic resonance
(MR) spectroscopy pattern of rTMS response will be analyzed according to previously
established protocols.

Part 1 of the study aims to:

- Evaluate the antidepressant effects of daily, active rTMS (when compared with sham
treatment) in adolescents meeting criteria for Major Depressive Disorder, single or
recurrent episode.

- Evaluate, by proton magnetic resonance spectroscopy (1H-MRS) at 3 Tesla(3T),
neurometabolic biomarkers at the beginning and end of each study phase.

- Define regional specificity [anterior cingulate (AC) and left dorsolateral
prefrontal cortex (L-DLPFC)] of cerebral metabolites(i.e. glutamate and glutamine)
in adolescent depression.

- Study whether specific neurochemical resonances are associated with response,
remission, and/or maintenance of improvement of clinical depressive symptoms when
rTMS is used to treat adolescent depression.

Inclusion Criteria:

- Diagnosis of unipolar major depressive disorder, in a current major depressive
episode, without psychotic features

- Pretreatment CDRS-R Raw score ≥ 40

- Age is at least 12 and less than 22 years

- Ongoing, stable dose antidepressant therapy for at least 6 weeks to include the
following antidepressants (with dosing range):

- Celexa (citalopram hydrobromide) - 10 to 60mg

- Cymbalta (duloxetine) - 40mg to 120mg

- Desyrel (trazodone HCl) - 12.5mg to 150mg

- Effexor (venlafaxine HCl) - 37.5mg to 300mg

- Luvox (fluvoxamine maleate) - 25mg to 200mg

- Lexapro (escitalopram oxalate) - 10mg to 40mg

- Paxil (paroxetine HCl) - 10mg to 50mg

- Pristiq (desvenlafaxine) - 50mg to 100mg

- Prozac (fluoxetine HCl) - 10mg to 80mg

- Remeron (mirtazapine) - 7.5mg to 45mg

- Savella (milnacipran HCl) - 25mg to 200mg

- Zoloft (sertraline HCl) - 25mg to 200mg

- Subjects able to attend at least 31 study visits at study site.

- Willing to provide informed assent (adolescent) and informed consent (family)

Exclusion Criteria:

- Subjects currently on stimulant, antipsychotic, bupropion or tricyclic antidepressant

- Prior rTMS, vagus nerve stimulation (VNS) or electroconvulsive therapy (ECT)

- Contraindication to MRI

- Contraindication to rTMS (history of neurological disorder such as seizures, increased
intracranial pressure, brain surgery, or head trauma with loss of consciousness for
>15 minutes, history of stroke, family history of epilepsy, intracardiac lines,
Anticoagulant, immune suppressive and/or chemotherapy, or those who received any of
these therapies within 3 months before enrollment in the study Unstable medication
conditions such as hematological or infectious (e.g., human immunodeficiency
virus-HIV) disorders, implanted electronic device, metal in the head, or pregnancy)

- History of schizophrenia, schizoaffective disorder, other [non mood disorder]
psychosis, depression secondary to a medical condition, mental retardation, substance
dependence or abuse within the past year (except nicotine), bipolar disorder,
psychotic features in this or previous episodes, amnestic disorder, obsessive
compulsive disorder, post-traumatic stress disorder, panic disorder

- History of autoimmune, endocrine, viral, or vascular disorder.

- Unstable cardiac disease, uncontrolled hypertension, or sleep apnea

- Active suicidal intent or plan, or history of attempt within the past 6 months
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200 First Street SW
Rochester, Minnesota 55905
Mayo Clinic Rochester Mayo Clinic is a nonprofit worldwide leader in medical care, research and...
Rochester, MN
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171 Ashley Avenue
Charleston, South Carolina 29425
Medical University of South Carolina The Medical University of South Carolina (MUSC) has grown from...
Charleston, SC
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