Efficacy of Clinical Application of Transcranial Low Intensity Focused Ultrasonic Stimulation for Patients With Major Deperessive Disorder - Exploratory Clinical Trial

Yonsei University Health System (YUHS)

Status and phase: Completed; Phase 3

Conditions: Major Depressive Disorder(MDD)

Treatments: Procedure: Active stimulation group Sham stimluation group

Study type: Interventional

Funder types: Other

Identifiers

NCT04405791

3-2018-0352

Details and patient eligibility

About

The non-invasive type ultrasonography system is applied to patients with major depressive disorder to evaluate their effectiveness and safety. Brain Computer Tomography(CT) and Magnetic Resonance Image(MRI) are taken to induce images before transcranial low intensity focused ultrasonic stimulation.

Through random extraction, the group is divided into treatment group and placebo group. The treatment is started by targeting left Dorsolateral prefrontal cortex(DLPFC) region according to assigned groups. As for women, considering mood change during menstrual cycle, the treatment is taken place 1 week after the menstruation has initiated. The treatment group and the placebo group will be treated three times a week for two weeks.

To evaluate clinical symptoms, Quick Inventory of Depressive Symptomatology-Self Report, Scale for Suicidal Ideation, state-trait anxiety scale, frontal lobe management function test, memory test, and continuous performance test are performed before, during, and after treatment. For the assessment of side effects, Systematic Asseseement for Treatment Emergent Events-General Inquiry(SAFTEE) are conducted for treatment presentation events every week during the treatment implementation period and every two weeks after the treatment is completed.

Enrollment: 30 patients

Sex: All

Ages: 19 to 60 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

1)19 to 60 years of age 2)Having major depressive disorder without psychotic feature according to the DSM-5 diagnosis criteria SCID-5-CV: (ICD-10 code : F32.0, F32.1, F32.2, F33.0, F33.1, F33.2) 3)Montgomery-Asberg Depression Rating Scale (MADRS) score ≥12 4)No history of suicidal attempt with suicidal ideation tendency score assessed by the Scale for Suicide Ideation (SSI) ≤ 9 5)No antidepressants regimen for 4 weeks prior to enrollment. 6)n the case of active antidepressants regimen, patients with MADRS score ≥12 and who will not change their medication doses during the study period

Exclusion criteria

• Incompatibility with brain CT and MRI
• Disorders that may cause depression (e.g., thyroid dysfunction, uncontrolled diabetes) or who taking medications that can influence on mood (e.g., thyroid hormones, steroids.)
• History of epileptic seizures
• History of major psychiatric disorder including schizophrenia and bipolar disorder
• Mental retardation
• Severe physical illness including cancer and tuberculosis
• Significant skin problems including contact dermatitis
• Pregnant women or women planning to become pregnant
• (After CT scan) skull thickness ≥ 8, or significant calcification
• (After MRI scan) structural abnormalities such as brain tumors, hemorrhage, traumatic brain disease, or structural changes due to degenerative brain disorders

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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30 participants in 2 patient groups

Active stimulation group

Experimental group

Description:

"low intensity transcranial focused ultrasound (tFUS) stimulation"The acoustic intensity output of the FUS transducer was validated at the maximum intensity area using a calibrated needle hydrophone (HNR-500, Onda). The incident acoustic intensity and pressure at the FUS focus were 3W/cm2 spatial-peak pulse-average acoustic intensity (Isppa) and a peak negative pressure (Pr) of 300 kPa. The incident acoustic intensity and pressure at the FUS focus were 3W/cm2, and tone burst duration was 1 ms at 50 % duty cycle (thus, pulse repletion frequency was 500 Hz) for the duration of 300 ms, according to the studies in humans. Each sonication was delivered every 6 s for the duration of 20 min (a total FUS stimulation per each session was therefore 200 times). With a derating factor of 55% reduction in pressure transmission by the human skull, estimated in situ Pr was \~135 kPa with an in situ acoustic intensity of 600 mW/cm2 Isppa .

Treatment:

Procedure: Active stimulation group Sham stimluation group

Sham stimluation group

Sham Comparator group

Description:

"sham stimulation" In case of sham stimulation, the same procedure was repeated without providing actual sonication. No subjects in FUS condition hear/feel any tangible somatosensory phenomena; therefore, the sham condition was indistinguishable.

Treatment:

Procedure: Active stimulation group Sham stimluation group