Major Depressive Disorder
Conditions
Keywords
neurofeedback, major depressive disorder, amygdala
Brief summary
The purpose of this study is to determine the clinical efficacy of augmenting cognitive-behavioral therapy with real-time functional magnetic resonance imaging neurofeedback (rtfMRI-nf) training to increase the amygdala's response to positive autobiographical memories.
Detailed description
Previous research has shown that real-time fMRI neurofeedback (rtfMRI-nf) training aimed at increasing the amygdala's response to positive autobiographical memory recall holds therapeutic potential for treating patients with major depressive disorder (MDD), as clinically significant decreases in clinician administered and self-report measures of depression severity were observed following two rtfMRI amygdala neurofeedback sessions. Furthermore, rtfMRI amygdala neurofeedback changed emotional processing towards a positive bias. As this rtfMRI-nf procedure utilizes principles of cognitive-behavioral therapy (CBT), including restructuring thoughts and emotional processing towards the positive, the current study seeks to examine the effects of augmenting CBT with amygdala rtfMRI-nf. Specifically, the investigators plan to test the hypothesis that pretreatment with two amygdala rtfMRI-nf sessions prior to the the start of CBT will result in a higher percentage of patients who exhibit 'sudden gains' (a between session drop of at least 25% on the Beck Depression Inventory associated with better treatment response) compared to those who receive rtfMRI-nf from a parietal control region putatively not involved in emotional processing. Over the course of three years, 60 participants diagnosed with MDD and planning to start CBT will be recruited through the clinical services of the Western Psychiatric Institute and Clinic (WPIC) and through licensed CBT therapists in the Pittsburgh metropolitan area. Participants will undergo two rtfMRI-nf sessions within the two weeks prior to starting therapy. Half of the participants will receive amygdala neurofeedback and half will receive control neurofeedback. At weeks 1-3 and 9 & 10 following the start of therapy, the participant will complete the BDI-II and the NIH Patient Reported Outcomes Measurement Information System (PROMIS) Depression measure. The number of patients who meet criteria for sudden gains and the average session at which this occurred will be compared between CBT + amygdala rtfMRI-nf and CBT + control rtfMRI-nf groups. Success will suggest a new method for improving outcomes to CBT in depressed patients.
Interventions
Participants are shown activity from their left amygdala in real time and are instructed to increase the level of activity in that region by thinking of positive autobiographical memories
Participants are shown activity from their left horizontal segment of the intraparietal sulcus in real time and are instructed to increase the level of activity in that region by thinking of positive autobiographical memories
Sponsors
National Institute of Mental Health (NIMH)
Kymberly Young
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 55 Years
Healthy volunteers
No
Inclusion criteria
* right-handed adults * ages 18 - 55 * primary diagnosis of MDD for recurrent MDD who are currently depressed * able to give written informed consent prior to participation * unmedicated OR are stable on an unsuccessful antidepressant regime (at least 4 weeks to ensure symptoms are stable). Effective medications will not be discontinued for the purposes of the study.
Exclusion criteria
* clinically significant or unstable cardiovascular, pulmonary, endocrine, neurological, gastrointestinal illness or unstable medical disorder * alcohol and/or substance dependence (other than nicotine) within 12 months prior to screening * history of traumatic brain injury * unable to complete MRI scan due to claustrophobia or general MRI exclusions (e.g., shrapnel inside body) * currently pregnant or breast feeding * unable to complete questionnaires written in English * current (within 3 weeks of testing) use of any antipsychotics, anticonvulsants, stimulants, benzodiazepines, beta-blockers, or other medications (except antidepressants) likely to influence cerebral blood flow. Effective medications will not be discontinued for the purposes of the study. I * diagnosis of psychotic or organic mental disorder, bipolar I or II disorder. * eye problems or difficulties in corrected vision.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Beck Depression Inventory (BDI-II) | 10 weeks | The Beck Depression Inventory is a self-report questionnaire consisting of 21 questions assessing depressive symptoms. Scores can range from 0-63 with higher scores indicating more severe depression. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| PROMIS Item Bank v1.0 - Depression | 10 weeks | The PROMIS depression measure is a self-report measure of depressive symptoms consisting of 8 questions. Scores can range from 0-40 with higher scores indicating greater severity of depression. The raw scores are converted to T scores with scores with a mean of 50 and a standard deviation of 10. Scores under 55 indicate no depression and scores above 70 indicate severe depression. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Real-time fMRI Neurofeedback: Amygdala Amygdala neurofeedback - attempt to upregulate the left amygdala during positive autobiographical memory recall via real time fMRI neurofeedback from the amygdala. Two sessions will be performed one week apart.
real-time fMRI neurofeedback: Amygdala: Participants are shown activity from their left amygdala in real time and are instructed to increase the level of activity in that region by thinking of positive autobiographical memories | 19 |
| Real-time fMRI Neurofeedback: HIPS HIPS neurofeedback - attempt to upregulate the left horizontal segment of the intraparietal sulcus (HIPS), a region not involved in emotional processing, during positive autobiographical memory recall via real time fMRI neurofeedback from the HIPS. Two sessions will be performed one week apart.
real-time fMRI neurofeedback: HIPS: Participants are shown activity from their left horizontal segment of the intraparietal sulcus in real time and are instructed to increase the level of activity in that region by thinking of positive autobiographical memories | 17 |
| Total | 36 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Withdrawal by Subject | 1 | 0 |
Baseline characteristics
| Characteristic | Real-time fMRI Neurofeedback: Amygdala | Real-time fMRI Neurofeedback: HIPS | Total |
|---|---|---|---|
| Age, Continuous | 32 years STANDARD_DEVIATION 12 | 31 years STANDARD_DEVIATION 9 | 32 years STANDARD_DEVIATION 10 |
| Beck Depression Inventory Baseline | 27.2 units on a scale STANDARD_DEVIATION 10.7 | 26.6 units on a scale STANDARD_DEVIATION 13.4 | 26.8 units on a scale STANDARD_DEVIATION 11.8 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 1 Participants | 0 Participants | 1 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 18 Participants | 17 Participants | 35 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| PROMIS Baseline | 68 t-score STANDARD_DEVIATION 8 | 66 t-score STANDARD_DEVIATION 9 | 67 t-score STANDARD_DEVIATION 9 |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 1 Participants | 1 Participants |
| Race (NIH/OMB) Black or African American | 1 Participants | 0 Participants | 1 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 1 Participants | 1 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 18 Participants | 15 Participants | 33 Participants |
| Region of Enrollment United States | 19 participants | 17 participants | 36 participants |
| Sex: Female, Male Female | 13 Participants | 13 Participants | 26 Participants |
| Sex: Female, Male Male | 6 Participants | 4 Participants | 10 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 19 | 0 / 17 |
| other Total, other adverse events | 0 / 19 | 0 / 17 |
| serious Total, serious adverse events | 0 / 19 | 0 / 17 |
Outcome results
Primary
Beck Depression Inventory (BDI-II)
The Beck Depression Inventory is a self-report questionnaire consisting of 21 questions assessing depressive symptoms. Scores can range from 0-63 with higher scores indicating more severe depression.
Time frame: 10 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Real-time fMRI Neurofeedback: Amygdala | Beck Depression Inventory (BDI-II) | 16.1 units on a scale | Standard Deviation 9.66 |
| Real-time fMRI Neurofeedback: HIPS | Beck Depression Inventory (BDI-II) | 24.3 units on a scale | Standard Deviation 12.3 |
p-value: <0.001ANOVA
Secondary
PROMIS Item Bank v1.0 - Depression
The PROMIS depression measure is a self-report measure of depressive symptoms consisting of 8 questions. Scores can range from 0-40 with higher scores indicating greater severity of depression. The raw scores are converted to T scores with scores with a mean of 50 and a standard deviation of 10. Scores under 55 indicate no depression and scores above 70 indicate severe depression.
Time frame: 10 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Real-time fMRI Neurofeedback: Amygdala | PROMIS Item Bank v1.0 - Depression | 53 t-score | Standard Deviation 11 |
| Real-time fMRI Neurofeedback: HIPS | PROMIS Item Bank v1.0 - Depression | 61 t-score | Standard Deviation 12 |
p-value: <0.001ANOVA