Depression Clinical Trial
Official title:
Magnetic Stimulation of the Brain in Schizophrenia or Depression: A Randomized, Double Blind, Sham Controlled Trial of Repetitive Transcranial Magnetic Stimulation in Schizophrenia or Depression
The primary objective is to evaluate if repetitive transcranial magnetic stimulation (rTMS) with theta burst frequency over dorsomedial prefrontal cortex (DMPFC) is an effective treatment for negative symptoms (anhedonia and avolition) in schizophrenia or depression. Other objectives are to increase the understanding of the underlying neurobiology of negative symptoms and the mechanisms for the treatment effect of rTMS.
This is a double blind parallel randomized sham controlled trial. The intervention is
intermittent theta-burst stimulation (iTBS), which is rTMS with theta burst frequency with
2400 pulses/day in two sessions at 90% of resting motor threshold intensity over the DMPFC,
given in ten days on week days (10 treatment days must be completed within a maximum of 21
days). Stratified (depression and schizophrenia diagnosis) block randomization will be used
for treatment allocation to active or sham side of the stimulation coil.
Patients will be referred from their regular psychiatric care facilities. At the screening
visit the patient will be assessed if fulfilling all inclusion and none of the exclusion
criteria. At the baseline visit thorough psychiatric, cognitive and neurophysiological
examination will be performed. The latter include investigation of cortical excitability with
paired-pulse TMS, mismatch negativity (MMN, a measure of aberrant stimulus detection),
startle-response, habituation, electrodermal activity (EDA), near-infrared spectroscopy
(NIRS), 24 hour actigraphy and heart rate registration.
During 10 week days the participants will receive a daily rTMS (or sham) treatment. On the
day after last rTMS treatment the examinations performed at the baseline visit will be
repeated. Four weeks after baseline there is a shorter visit to follow-up symptoms and
functioning. At the end of this visit the blinding is unmasked and patients who have received
sham rTMS will be offered active treatment in an open-phase. After the four weeks follow-up
there are two additional and identical visits at 10 and 26 weeks after start of treatment.
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