Effects of tDCS-enhanced Cognitive Control Training on Depression

Depression Unipolar Clinical Trial

Official title:

Effects of tDCS-enhanced Cognitive Control Training on Depression

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT03518749
• Other study ID #: 01EE1403D-2
• Status: Recruiting
• Phase: N/A
• Start date: March 19, 2018
• Est. completion date: December 31, 2019

Study information

• Verified date: February 2019
• Source: University Hospital Tuebingen
• Contact: Christian Plewnia, MD
• Phone: +49 (0)7071-2986121
• Email: christian.plewnia[@]uni-tuebingen.de
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Deficient cognitive control (CC) is one of the central characteristics of major depression (MD). Hypoactivation of the dorsolateral prefrontal cortex (dlPFC) has been linked with this deficit. Antidepressants and cognitive-behavioral therapies modify CC most-likely as a common mechanism of treatment. Transcranial direct current stimulation (tDCS) is a safe, simple and effective non-invasive method to modulate the cortical excitability. It has been shown, that the activity of the dlPFC can be modulated by transcranial direct current stimulation (tDCS) with polarity-dependent learning-phase specific effects on performance that, when combined with training, can outlast the stimulation.

The goal of this randomized, sham-controlled, rater blind clinical trial is to investigate the effect of a tDCS-enhanced CC Training (CCT) on depressive symptom severity and compare the stimulation intensities 1mA, 2mA and sham tDCS. Overall, the study will include 57 participants (n = 19 per group). Each participant will complete 12 training sessions with online sham/ anodal tDCS.

As a training task we will use an adaptive version of the paced auditory serial addition task (PASAT). In the PASAT, digits are presented auditive and participants have to add the current digit to the digit they heard before. In the adaptive version the interstimulus-intervals decrease (increase) when four consecutive trials are correct (incorrect). The PASAT is known to elicit frustration. Participants have to exert cognitive control over these emotions to complete the task successfully.

Before, during and after the training symptom severity will be assessed. Baseline and post-training performance in the PASAT and in a transfer task (delayed working memory task, DWM) will be measured.

To further explore variables that influence the effect of tDCS on depressive symptom severity we will measure brain activity (EEG, NIRS), heart rate, global functioning (GAF), emotion regulation strategies, self-esteem, mood ratings and subjective performance ratings before and after the training and collect genetic factors.

Sustainability of the training effects will be measured at a follow-up visit (3 months later).

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 57
• Est. completion date: December 31, 2019
• Est. primary completion date: October 1, 2019
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 65 Years

Eligibility

Inclusion Criteria:

• current Major Depressive Episode

• right handedness

Exclusion Criteria:

• history of seizures

• Intracranial implants (e.g. aneurysm clips, shunts, stimulators, cochlear implants, or electrodes) or any other metal object within or near the head, excluding the mouth, that cannot be safely removed

• pregnancy

• use of mood stabilizers

• diagnosed bipolar disorder

• current substance abuse (nicotine excluded)

• current substance addiction (nicotine excluded)

• diagnosed psychotic diseases

• diagnosed anorexia nervosa

• diagnosed personality disorders: cluster A, antisocial personality disorder,

• borderline personality disorder

Related Conditions & MeSH terms

• Depression
• Depression Unipolar
• Depressive Disorder

Intervention

Other:
• 1mA tDCS
transcranial direct current stimulation with the intensity of 1mA
• 2mA tDCS
transcranial direct current stimulation with the intensity of 2mA

Behavioral:
• Cognitive control training
cognitive control training with the PASAT

Locations

Country	Name	City	State
Germany	University Hospital Tuebingen	Tubingen	Baden-Württemberg

Sponsors (3)

Lead Sponsor	Collaborator
University Hospital Tuebingen	German Federal Ministry of Education and Research, Universität Tübingen

Country where clinical trial is conducted

Germany, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Change of MADRS scores	Change in Depressive Symptom severity will be measured with the Montgomery-Åsberg Depression Rating Scale (MADRS) from Baseline session to the last stimulation session, scale range from 0 to 60 points, higher scores indicate a more severe depression	Assessment one week before training start (week -1, day -5 on average) and in the last training session (week 4, day 26)
Secondary	BDI scores	Beck Depression Inventory	Assessment one week before training start (week -1, day -5 on average), in the post training session (week 5, day 31 on average) and at follow-up (week 17, day 110 on average)
Secondary	Number of correct trials in the PASAT	Performance in the PASAT. Number of correct trials.	Assessment one week before training start (week -1, day -5 on average), in the post training session (week 5, day 31 on average) and at follow-up (week 17, day 110 on average)
Secondary	RT in the DWM	Reaction time in the transfer task, a delayed working memory task (DWM)	Assessment one week before training start (week -1, day -5 on average), in the post training session (week 5, day 31 on average) and at follow-up (week 17, day 110 on average)
Secondary	Number of correct trials in the DWM	Number of correct trials in the transfer task, a delayed working memory task (DWM)	Assessment one week before training start (week -1, day -5 on average), in the post training session (week 5, day 31 on average) and at follow-up (week 17, day 110 on average)
Secondary	GAF score	Global Assessment of Functioning	Assessment one week before training start (week -1, day -5 on average) and in the post training session (week 5, day 31 on average)
Secondary	Delta Mood ratings	Mood changes (PANAS delta) through the PASAT performance: the positive and negative affective schedule (PANAS) will be conducted immediately before and after the PASAT performance. The change in mood ratings (PANAS delta = PANAS pre PASAT - PANAS post PASAT) will be the outcome measure.	Assessment one week before training start (week -1, day -5 on average), in the post training session (week 5, day 31 on average) and at follow-up (week 17, day 110 on average)
Secondary	Subjective performance ratings	Participants will be asked to rate their performance and overall cognitive abilities on a likert scale.	Assessment one week before training start (week -1, day -5 on average), in the post training session (week 5, day 31 on average) and at follow-up (week 17, day 110 on average)
Secondary	Electroencephalography (EEG) measures	EEG will be conducted to measure resting state oscillations and event related potentials stimulus locked to the presented feedback in the PASAT	Assessment one week before training start (week -1, day -5 on average) and in the post training session (week 5, day 31 on average)
Secondary	Prefrontal Brain activity (NIRS)	Functional Near Infrared Spectroscopy will be used to measure frontal brain activity: resting state and during task performance.	Assessment one week before training start (week -1, day -5 on average) and in the post training session (week 5, day 31 on average)
Secondary	Course of MADRS scores	Depressive Symptom severity will be measured with the Montgomery-Åsberg Depression Rating Scale	Assessment once a week during training (week 1, 2 and 3 at day 5, 12 and 19 respectively on average) and at the follow up visits (week 5 and 17, day 31 and 110 on average)
Secondary	Prefrontal Brain activity (NIRS) as a predictor	The investigators will analyze if frontal brain activity measured with NIRS during resting state and task performance can contribute to the prediction of the effectiveness of the tDCS training.	Assessment one week before training start (week -1, day -5 on average)
Secondary	Electroencephalography (EEG) measures as a predictor	The investigators will analyze if resting state oscillations and event related potentials stimulus locked to the presented feedback in the PASAT can contribute to the prediction of the effectiveness of the tDCS training.	Assessment one week before training start (week -1, day -5 on average)
Secondary	Genetic factors as predictors	The investigators will analyze if genetic factors involved in neuroplasticity (5-HTTLPR, BDNF, COMT) can contribute to the prediction of the effectiveness of the tDCS training.	Assessment one week before training start (week -1, day -5 on average)