Cognitive Dysfunction in the Addictions Study - Project 4 (P4)

Major Depressive Disorder Clinical Trial

— CDiA-P4  

Official title:

Assessing the Role of Repetitive Transcranial Magnetic Stimulation on Aberrant Executive Function in the Context of Major Depressive Disorder in Adult Outpatients Seeking Treatment for Alcohol Use Disorder

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT06299787
• Other study ID #: 058-2021
• Status: Recruiting
• Phase: N/A
• Start date: February 7, 2022
• Est. completion date: July 1, 2025

Study information

• Verified date: March 2024
• Source: Centre for Addiction and Mental Health
• Contact: Daphne Voineskos, MD
• Phone: 416-535-8501
• Email: daphne.voineskos[@]camh.ca
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The prefrontal cortex, although well established as an efficacious target for the treatment of major depressive disorder (MDD), has recently come into favour as a therapeutic target for alcohol use disorders (AUD). Depressive symptoms are also highly prevalent in individuals with AUD. A number of cognitive and psychological processes stemming from the prefrontal cortex, a common treatment target for repetitive transcranial magnetic stimulation (rTMS), are disrupted in both MDD and AUD. The proposed study will enhance the development of theta burst stimulation (TBS) as a new intervention for AUD in the context of depressive symptoms and uses integrated TMS-EEG to identify neurophysiological targets of executive dysfunction in this disorder.

Description:

The prefrontal cortex, although well established as an efficacious target for the treatment of major depressive disorder (MDD), has recently come into favour as a therapeutic target for alcohol use disorders (AUD). Depressive symptoms are also highly prevalent in individuals with AUD. A number of cognitive and psychological processes stemming from the prefrontal cortex, a common treatment target for repetitive transcranial magnetic stimulation (rTMS), are disrupted in both MDD and AUD. The proposed study will enhance the development of theta burst stimulation (TBS) as a new intervention for AUD in the context of depressive symptoms and uses integrated TMS-EEG to identify neurophysiological targets of executive dysfunction in this disorder.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 40
• Est. completion date: July 1, 2025
• Est. primary completion date: December 31, 2024
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 59 Years

Eligibility

Inclusion Criteria:

1. are outpatients;

2. are voluntary and competent to consent to treatment;

3. have a Diagnostic and Statistical Manual for Mental Disorders, 5th edition (DSM-5) diagnosis of AUD based on the MINI;

4. do not exhibit problematic use of any substances (excluding nicotine and caffeine), including alcohol, for >1 month;

5. are male or female between the ages of 18 - 59;

6. screened positive for an MDE based on the MINI without psychotic symptoms

7. are agreeable to keeping their current antidepressant medications and medications for alcohol use disorder constant during the study;

8. are reliably taking SUD agonist therapies if appropriate and managed by their clinical team;

9. are able to adhere to the study schedule;

10. meet the TMS safety criteria.

Exclusion Criteria:

1. have a concomitant major unstable medical illness;

2. are pregnant or intend to get pregnant during the study;

3. have possible or probable dementia (based on the Informant Questionnaire on Cognitive Decline in the Elderly that will be administered to any participant with a baseline total score of < 26 on the Montreal Cognitive Assessment (MoCA);

4. have failed a course of ECT, due to the lower likelihood of response to rTMS;

5. have any significant neurological disorder (e.g., a space occupying brain lesion, a history of stroke, a cerebral aneurysm, a seizure disorder, Parkinson's disease, Huntington's chorea, multiple sclerosis, significant history of head trauma with radiological evidence of intracranial trauma at the time of injury due to risk of possible seizure foci from prior intracranial lesions.

6. present with a medical condition, a medication, or a laboratory abnormality that could cause a major depressive episode or significant cognitive impairment in the opinion of the investigator (e.g., hypothyroidism with low TSH, Cushing's disease);

7. have an intracranial implant (e.g., aneurysm clips, shunts, cochlear implants) or any other metal object within or near the head, excluding the mouth, that cannot be safely removed;

8. require a benzodiazepine with a dose equivalent to lorazepam 2 mg/day or higher or any anticonvulsant due to the potential of these medications to limit the efficacy of rTMS [79];

9. have an inability to communicate in English fluently enough to complete the clinical assessments.

10. have a MINI diagnosis or active symptoms of Bipolar Disorder

Related Conditions & MeSH terms

• Alcohol Drinking
• Alcohol Use Disorder
• Alcoholism
• Depression
• Depressive Disorder
• Depressive Disorder, Major
• Major Depressive Disorder

Intervention

Device:
• intermittent theta burst stimulation
Theta-burst stimulation
• Sham stimulation
Stimulation with double-sided B70-type coil

Locations

Country	Name	City	State
Canada	Centre for Addiction and Mental Health	Toronto	Ontario

Sponsors (1)

Lead Sponsor	Collaborator
Centre for Addiction and Mental Health

Country where clinical trial is conducted

Canada, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Columbia-Suicide Severity Rating Scale	Decrease in Columbia-Suicide Severity Rating Scale score, 0 is lowest score, 25 is highest, higher value = more suicidal ideation	baseline and 4 weeks after baseline (after 20 treatments of active/sham rTMS)
Primary	Executive Function Index - inhibition	Flanker task	baseline and 4 weeks after baseline (after 20 treatments of active/sham rTMS)
Primary	Executive Function Index - working memory	N-back task	baseline and 4 weeks after baseline (after 20 treatments of active/sham rTMS)
Primary	Executive Function Index - set shifting	switch task	baseline and 4 weeks after baseline (after 20 treatments of active/sham rTMS)
Secondary	17-Item Hamilton Depression Rating Scale (HRSD-17)	Decrease in 17-Item Hamilton Depression Rating Scale score, 0 is lowest value, 52 is highest, higher value = more severe depression	baseline and 4 weeks after baseline (after 20 treatments of active/sham rTMS)