Bipolar Disorder, Transcranial Magnetic Stimulation
Conditions
Brief summary
The investigators are conducting this research study to better understand how individuals with bipolar disorder regulate their emotions, and if the study can use a technique called "transcranial magnetic stimulation" or TMS to help improve emotion regulation for individuals with bipolar disorder.
Detailed description
Emotion dysregulation contributes to the development and maintenance of a wide range of psychopathology, but is especially relevant for individuals with bipolar mood disorders (BD). These individuals experience severe and episodic emotion dysregulation associated with maladaptive functioning, interpersonal problems, decreased work productivity, and suicidal ideation and behavior. To date, both pharmacological and psychosocial treatments fail to normalize emotion dysregulation for many bipolar patients. As a consequence, all too many experience poor outcomes. Thus, there is a significant need for new innovative approaches to target and improve emotion dysregulation in bipolar patients. Non-invasive neuromodulation using transcranial magnetic stimulation (TMS) may provide a viable strategy to help improve emotion dysregulation in bipolar mood disorders. As a first step to test this hypothesis, the current proposal seeks to experimentally identify specific neural target sites for improving emotion regulation using TMS. If the investigators can demonstrate target engagement of emotion regulation at the behavioral level using TMS, this will provide an important first step towards examining the potential utility of TMS as a viable strategy to help improve emotion dysregulation in bipolar mood disorders. While this is not a definitive clinical trial, the sham-controlled double-crossover design of this study will provide valuable information for target site selection for the development of TMS as an intervention strategy to improve emotion dysregulation in BD.
Interventions
DEVICETranscranial Magnetic Stimulation (TMS)
Non-Invasive neuromodulation
Sponsors
Massachusetts General Hospital
National Institute of Neurological Disorders and Stroke (NINDS)
Study design
Allocation
NA
Intervention model
CROSSOVER
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Masking description
Participants are blinded to whether they received active versus sham (placebo) TMS.
Eligibility
Sex/Gender
ALL
Age
18 Years to 55 Years
Healthy volunteers
Yes
Inclusion criteria
* Patients * Men and women * Ages 18-50 years * Patients diagnosed with bipolar I disorder (BD-I), current mood state euthymic. * On a stable psychiatric medication regimen for at least a month prior to and during study participation Healthy Controls: * Men and women * Ages 18-50 years * Without major psychiatric illness
Exclusion criteria
* Patients * Any change in psychiatric medications within a month prior to and during study participation * Legal or mental incompetency * Intellectual disability * Current manic (YMRS \> 12) or severe depressive episode (HAM-D-17 \> 5) * Substance use disorder (abuse or dependence) with active use within the last 3 months * Significant medical or neurological illness * Prior neurosurgical procedure * History of seizures * History of ECT treatment or clinical TMS within the past three months * Implanted cardiac pacemakers * Patients who have conductive, ferromagnetic or other magnetic-sensitive metals implanted in their head or neck, or are non-removable and within 30 cm of the treatment coil. These include: * Aneurysm clips or coils * Carotid or cerebral stents * Metallic devices implanted in the head (e.g. Implanted pacemaker, medication pump, vagal stimulator, deep brain stimulator, TENS unit, or ventriculo-peritoneal shunt) * Magnetically active dental implants * Cochlear/otologic implants * CSF shunts * Ferromagnetic ocular implants * Pellets, bullets, fragments less than 30 cm from the coil * Facial tattoos with metallic ink, permanent makeup less than 30 cm from the coil * Pregnant women Healthy Controls: * History of major psychiatric illness, including psychosis * Has a first-degree relative with psychosis * Active use of neuropsychoactive medications * Legal or mental incompetency * Intellectual disability * Substance use disorder (abuse or dependence) with active use within the last 3 months * Significant medical or neurological illness * Prior neurosurgical procedure * History of seizures * History of ECT treatment or clinical TMS within the past three months * Implanted cardiac pacemakers * Individuals who have conductive, ferromagnetic or other magnetic-sensitive metals implanted in their head or neck, or are non-removable and within 30 cm of the treatment coil. These include: * Aneurysm clips or coils * Carotid or cerebral stents * Metallic devices implanted in the head (e.g. Implanted pacemaker, medication pump, vagal stimulator, deep brain stimulator, TENS unit, or ventriculo-peritoneal shunt) * Magnetically active dental implants * Cochlear/otologic implants * CSF shunts * Ferromagnetic ocular implants * Pellets, bullets, fragments less than 30 cm from the coil * Facial tattoos with metallic ink, permanent makeup less than 30 cm from the coil * Pregnant women
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Affective Multisource Interference Task - Reaction Time During Negative Interference Trials | Task administered 10 minutes pre TMS and 5 minutes post TMS | The Affective Multisource Interference Task is a behavioral task measuring the ability to identify an oddball number when overlayed on affective images as a proxy for emotion regulation. Outcome Measure 1: Slope of reaction time during trials with negative valenced stimuli where the oddball number is other than zero and in a location incongruent with the location on the button box |
| Affective Multisource Interference Task - Reaction Time During Positive Interference Trials | Task administered 10 minutes pre TMS and 5 minutes post TMS | The Affective Multisource Interference Task is a behavioral task measuring the ability to identify an oddball number when overlayed on affective images as a proxy for emotion regulation. Outcome Measure 2: Slope of reaction time during trials with positive valenced stimuli where the oddball number is other than zero and in a location incongruent with the location on the button box |
| Emotion Conflict Resolution Task - Incongruent Fear Trials Reaction Time | Task administered 10 minutes pre TMS and 5 minutes post TMS | The Emotion Conflict Resolution Task is a behavioral task requiring correct identification of an emotion word overlayed on photographs of facial expressions of emotion. Outcome measure 3: Slope of reaction time during trials when the image is of a fearful facial expression but the word is "Happy" (incongruent) |
| Emotion Conflict Resolution Task - Incongruent Happy Trials Reaction Time | Task administered 10 minutes pre TMS and 5 minutes post TMS | The Emotion Conflict Resolution Task is a behavioral task requiring correct identification of an emotion word overlayed on photographs of facial expressions of emotion. Outcome measure 4: Slope of reaction time during trials when the image is of a happy facial expression but the word is "Fear" (incongruent) |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORKristen K Ellard, PhD
Massachusetts General Hospital
Baseline characteristics
| Characteristic | — |
|---|---|
| Age, Categorical <=18 years | 0 Participants |
| Age, Categorical >=65 years | 0 Participants |
| Age, Categorical Between 18 and 65 years | 19 Participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 2 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 17 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants |
| Race (NIH/OMB) Black or African American | 1 Participants |
| Race (NIH/OMB) More than one race | 1 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Race (NIH/OMB) White | 17 Participants |
| Sex: Female, Male Female | 7 Participants |
| Sex: Female, Male Male | 12 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 0 / 19 |
| other Total, other adverse events | 0 / 19 |
| serious Total, serious adverse events | 0 / 19 |
Outcome results
None listed