Major Depressive Disorder
Conditions
Keywords
Major Depressive Disorder, Depression, tACS, 5-HT
Brief summary
This study will apply a comprehensive tools that integrates neuroimaging, psychological evaluation, and sleep monitoring through 18F-MPPF PET/MR, neuropsychological tests, and polysomnography (PSG) to explore the neurobiological mechanisms underlying transcranial alternating current stimulation (tACS) for depressive disorders, mainly focusing on the serotonergic system revealed by Serotonin-1A (5-HT1A) receptor.
Detailed description
5-HT1A receptor appears to be significantly involved in the effectiveness of electroconvulsive therapy (ECT). Like alternating current in ECT, tACS also applies alternating current to intervene in neuropsychiatric disorders. We previously found that tACS with large current, such as 15 mA, via the forehead and bilateral mastoids can improve depressive symptoms. However, the underlying mechanism of 15 mA tACS in depression remains unclear. We propose a scientific hypothesis that 15 mA tACS may increase hippocampal 5- HT1A receptors, then to reduce depression in depressive patients. Meanwhile, 15 mA tACS may increase the whole-brain functional connectivity with the hippocampus as the seed point. This study will utilize a multimodal data through 18F-MPPF PET/MR, including MPPF metabolism, resting-state fMRI, DTI, and 3D-T1 structural images. By observing the alterations of 5-HT1A receptor and the functional network between MDD patients and healthy controls, and between the pre- and post-tACS intervention in MDD patients, our aims to explore the effect of tACS on the serotonergic system in depression.
Interventions
DEVICEtACS
tACS in 4 weeks, once per weekday for 40 minutes each, 20 sessions. The treatment group will receive transcranial alternating current stimulation at a gamma frequency (77.5Hz) with a peak amplitude of 15mA.
OTHERControl
Without the tACS stimulation in this group.
Sponsors
Xuanwu Hospital, Beijing
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Parallel Assignment; Non-Randomized; Open-label
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
Yes
Inclusion criteria
Inclusive Criteria: 1. 18 to 65 years old, Chinese, male or female. 2. Non-psychotic major depressive disorder according to DSM-IV. 3. HAMD-17 total score ≥ 17 at the baseline. 4. Currently experiencing an acute episode. 5. No history of prior treatment with psychotropic medications. 6. Understanding of all aspects of the research protocol and the ability to provide informed consent.
Exclusion criteria
for patients: 1. Unable to do PET/MR examinations. 2. Have secondary insomnia disorders, anxiety disorders, or depressive disorders caused by physical illnesses. 3. Severe or unstable organic diseases. 4. Pregnant or lactating women or those planning a pregnancy in the near future. 5. Alcohol or substance dependence or abuse within the past year. 6. Received electroconvulsive therapy or transcranial magnetic stimulation in the month preceding enrollment. 7. Skin damage at the electrode placement site or those allergic to electrode gel or adhesives. 8. Participated in any other clinical trials within the month before baseline. 9. Any inappropriate conditions considered by the study group. Inclusion Criteria for healthy volunteers 1. To undergo PET/MR examinations. 2. Be matched with the patient group regarding age, sex, and educational level.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The changes in quantitative MPPF values before and after the tACS intervention. | baseline (before the tACS intervention), 4 weeks (after the tACS intervention) | Twenty patients with depressive disorders will receive 18F-MPPF PET/MR imaging before and after the tACS intervention. MPPF metabolism values in different brain regions will be calculated. A comparative analysis will be then performed between the baseline and post-treatment in patients with depressive disorders. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Cognitive changes will be assessed using the Mini-Mental State Examination (MMSE) before and after the tACS intervention in depression. | baseline, 4 weeks | MMSE total score is from 0 to 30. The criteria on cognitive impairment in Chinese as follows: the illiterate ≤ 17 points, the primary school ≤ 20 points, and the middle school or above ≤ 24 points |
| The changes in scores for 17-item Hamilton Depression Rating Scale (HAMD-17) before and after the tACS intervention. | baseline, 4 weeks | HAMD-17 will be assessed before and after the tACS intervention in twenty patients with depressive disorders. HAMD-17 scores range from 0 to 52, with higher scores indicating more depression, a score of 24 or more indicates severe depression. |
| The changes in scores for Hamilton Anxiety Rating Scale (HAMA) before and after the tACS intervention. | baseline, 4 weeks | HAMA evaluation will be conducted before and after the tACS intervention in twenty patients with depressive disorders. HAMA scores range from 0 to 56, with higher scores indicating more anxiety, a score of 29 or more indicates severe anxiety. |
| Cognitive changes will be assessed using the Montreal Cognitive Assessment (MoCA) before and after the tACS intervention in depression. | baseline, 4 weeks | MoCA total score ranges 0 to 30. If the length of education is less than 12 years, 1 point will be added, with a maximum score of 30 points. A score of 26 is considered normal. |
| The changes in scores for Pittsburgh Sleep Quality Index (PSQI) before and after the tACS intervention. | baseline, 4 weeks | PSQI score ranges 0 to 21, a score of 8 or more indicates insomnia. |
| The changes in scores for Insomnia Severity Index (ISI) before and after the tACS intervention. | baseline, 4 weeks | ISI total score is 0 to 28, a total score of 0-7 indicates 'no clinically signifi cant insomnia', 8-14 means 'subthreshold insomnia', 15-21 is 'clinical insomnia (moderate severity)', and 22-28 means 'clinical insomnia (severe)'. |
| The changes in scores for Generalized Anxiety Disorder-7 item (GAD-7) before and after the tACS intervention. | baseline, 4 weeks | GAD-7 total score range 0 to 21. A score of 10 or higher means significant anxiety is present. Score over 15 are severe. |
Countries
China
Contacts
Primary ContactWenfeng Zhao, MD
Backup ContactHongxing Wang, MD & PhD
Outcome results
None listed