This study will evaluate the safety and effectiveness of magnetic brain stimulation for the treatment of major depression in depressed adults with moderate treatment resistance.

Condition	Intervention	Phase
Depression	Procedure: Prefrontal repetitive transcranial magnetic stimulation (rTMS)  Drug: Antidepressant regimen	Phase II Phase III

Further Study Details: 

Primary Outcomes: Depression remission, as measured by the Hamilton Rating Scale for Depression, at the end of Phases 1, 2, and 3
Secondary Outcomes: Change in depression symptoms; safety and side effect data; neuropsychological changes; quality of life
Expected Total Enrollment:  240

Major depression is a type of depression that can interfere with the ability to work, study, sleep, eat, and enjoy once pleasurable activities. Because people often develop resistances to medications used to treat depression, new treatments are needed. Decreased electrical activity in the prefrontal region of the brain has been linked to some symptoms of depression. Repetitive transcranial magnetic stimulation (rTMS) can be used to influence the brain’s electrical activity. This procedure entails attaching electrodes to the head and using a device to pass magnetic energy through coils and into the brain. rTMS has been shown to have antidepressant effects in depressed individuals. However, optimal levels of intensity and treatment duration have yet to be determined. This study will assess the safety and effectiveness of rTMS on the prefrontal region of the brain in depressed adults with moderate treatment resistance.

The treatment phase of this double-blind study will last a minimum of 32 weeks and will consist of 3 phases. In Phase I, participants will be randomly assigned to receive either rTMS or sham stimulation. The sham stimulation will mimic the sensation of rTMS but will not induce an intracerebral current. Treatments will be administered daily for 3 weeks. Participants who show signs of improvement may continue Phase I for up to 3 additional weeks. In Phase II, participants who were unresponsive to Phase I treatment will receive daily rTMS at a lower dose for 3 weeks. Participants who show signs of improvement, but have not achieved remission, may continue Phase II for 4 additional weeks. Baseline magnetic resonance images will be used to determine the optimal stimulus intensity by adjusting for individual differences in cortical to skull distances. Phase III participants will be only those who achieved remission in the first 2 phases. These participants will receive antidepressant medication treatment daily for six months. Participants’ functional status and symptoms of depression will be measured using self-report scales and video-recorded interviews at study start date and at the end of each treatment phase.

Ages Eligible for Study:  21 Years   -   70 Years,  Genders Eligible for Study:  Both

Criteria

Inclusion Criteria:

• Diagnosis of major depression with a current episode
• Hamilton Rating Scale for Depression score higher than 20
• No response or intolerance to antidepressant medication in the current depressive episode

Exclusion Criteria:

• Current use of antidepressants
• Diagnosis of psychosis or anxiety disorder
• Current substance abuse
• Seizures or history of head trauma

Please refer to this study by ClinicalTrials.gov identifier  NCT00149838

Mark S. George, MD      843-876-5142    georgem@musc.edu

Georgia
      Emory University, Atlanta,  Georgia,  30329-5102,  United States; Recruiting
New York
      Columbia University, New York,  New York,  10032,  United States; Recruiting
South Carolina
      Brain Stimulation Laboratory, Medical University of South Carolina, Charleston,  South Carolina,  29425,  United States; Recruiting
Washington
      University of Washington, Seattle,  Washington,  98104-2499,  United States; Recruiting

Study chairs or principal investigators

Mark S. George, MD,  Principal Investigator,  Medical University of South Carolina   

Study ID Numbers:  MH69887-01
Last Updated:  September 7, 2005
Record first received:  September 6, 2005
ClinicalTrials.gov Identifier:  NCT00149838
Health Authority: United States: Federal Government
ClinicalTrials.gov processed this record on 2005-09-13