Brain Stimulation + Cognitive Behavioral Therapy for Depression

Overseen By Eun Hyung Choi

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Manitoba

Disqualifiers: Metallic implants, Claustrophobia, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 3 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: Unknown

Duration: 5 months

30 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine if brain stimulation, specifically High Definition Transcranial Direct Current Stimulation (HD-tDCS), can improve the coordination of different brain regions, thereby enhancing the effects of cognitive behavioral therapy (CBT) for individuals with depression. Participants will receive either active or inactive brain stimulation to assess its effectiveness. Suitable candidates for this trial include those already engaged in virtual mental health programs in Manitoba, such as CBT or group therapy sessions. As an unphased trial, participants can contribute to innovative research that may advance mental health treatments.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that this method is safe for treating depression?

Research has shown that High Definition Transcranial Direct Current Stimulation (HD-tDCS) is generally safe for people. One study found HD-tDCS to be a safe and fast-acting treatment for depression. Another review confirmed the safety of this brain stimulation, with no serious negative effects reported.

Reports also suggest that HD-tDCS is well-tolerated, meaning most people don't experience severe side effects. When comparing real brain stimulation to a sham treatment, there were no major differences in dropout rates or adverse reactions. This indicates that people usually continue with the treatment without more issues than those receiving the sham treatment.

Overall, the evidence supports HD-tDCS as a safe option for treating depression. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the use of HD-tDCS for depression because of its innovative approach to brain stimulation. Unlike traditional treatments like antidepressants which alter brain chemistry, HD-tDCS uses targeted electrical currents to directly stimulate specific brain areas involved in mood regulation. This method is non-invasive and offers a promising alternative for those who may not respond well to medications or are seeking options with fewer side effects. Additionally, HD-tDCS can potentially provide quicker relief compared to medications that often take weeks to show effects.

What evidence suggests that HD-tDCS is effective for depression?

Research has shown that High-Definition Transcranial Direct Current Stimulation (HD-tDCS), which participants in this trial may receive as part of the Active Stimulation arm, can significantly improve mood in people with moderate to severe depression. One study with 71 participants demonstrated a clear improvement in depressive symptoms after receiving HD-tDCS treatment. Another study found that active HD-tDCS reduced depression severity more effectively than a sham (inactive) treatment, which is also being tested in this trial as the Inactive Stimulation arm. These findings suggest that HD-tDCS is a promising option for easing depression symptoms. ^{1 5 6 7 8}

Are You a Good Fit for This Trial?

This trial is for individuals in Manitoba enrolled in virtual mental health programs, such as CBT or DBT, or those who provide these services. It's not suitable for people with MRI contraindications like metallic implants or claustrophobia.

Inclusion Criteria

I am enrolled in mental health programs like CBT or group therapy.

Patients who have agreed to participate in virtual mental health treatment at health care sites throughout Manitoba

Must be located within Manitoba

Exclusion Criteria

Contraindication for MRI (e.g., metallic implants and claustrophobia)

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive repeated treatment of High Definition Transcranial Direct Current Stimulation (HD-tDCS) combined with cognitive behavioral therapy and mindfulness classes

5 months

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• HD-tDCS

Trial Overview

The study tests if brain stimulation using the MxN-9 HD-tES device can boost the effects of cognitive behavioral therapy and mindfulness classes by improving brain connectivity.

How Is the Trial Designed?

Group I: Active Stimulation Active Control 1 Intervention

MxN-9 HD-tES Stimulator (Soterix Inc.) will be used to deliver direct current (High-Definition Transcranial Direct Current Stimulation) to the target brain areas via electrodes and conducive gels. A constant current will be applied for 20 minutes with peak current of 2 mA. The 9 electrodes (8 channels + 1 ground) positions and current intensity have been determined based on computer simulation using HDTargets software (Soterix Inc.) that results in maximum focal current on the left VLPFC (x=-50, y=+26, z=+8) and the PCC (x=1, y=-61, z=38) with inward field orientation.

Group II: Inactive Stimulation Placebo Group 1 Intervention

The current will be applied for 30 seconds ramp-up followed by 30 seconds ramp-down, and thus no active stimulation will be administered except for the initial and last 1 minutes of 20 minute stimulation duration.

Who Is Running the Clinical Trial?

University of Manitoba

Lead Sponsor

Trials

628

Recruited

209,000+

Winnipeg Foundation

Collaborator

Trials

2

Recruited

90+

Published Research Related to This Trial

In a case series of 16 treatment-resistant depression patients, home-administered transcranial direct current stimulation (HA-tDCS) showed clinical benefits, with 5 out of 12 patients responding within 6 weeks and 9 maintaining improvements after 12 weeks of treatment.

HA-tDCS was found to be safe and well-tolerated, with no significant cognitive impairments reported over up to 2 years of treatment, although two patients experienced mild side effects.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Clinical Case Series of Acute and Maintenance Home Administered Transcranial Direct Current Stimulation in Treatment-Resistant Depression. Le, B., Alonzo, A., Bull, M., et al.[2023]

In a study involving 22 patients with treatment-resistant major depression, anodal transcranial direct current stimulation (tDCS) did not show a significant improvement in depression scores compared to placebo after 2 weeks of treatment.

Despite the lack of overall efficacy in reducing depression scores, tDCS was associated with increased positive emotions, suggesting potential benefits that warrant further investigation with improved protocols.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Transcranial direct current stimulation in treatment resistant depression: a randomized double-blind, placebo-controlled study. Palm, U., Schiller, C., Fintescu, Z., et al.[2022]

Transcranial direct current stimulation (tDCS) is shown to be as safe and acceptable as sham treatment in patients with major depressive disorder (MDD), with dropout rates of 8.8% for active tDCS and 12% for sham, indicating no significant difference.

The study analyzed data from 6 randomized clinical trials, revealing that while adverse event rates were slightly higher in the active tDCS group (73.5%) compared to sham (68.3%), the difference was not statistically significant, suggesting that tDCS is well-tolerated in this patient population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Safety and acceptability of transcranial direct current stimulation for the acute treatment of major depressive episodes: Analysis of individual patient data. Moffa, AH., Brunoni, AR., Fregni, F., et al.[2019]

High-Definition transcranial Direct Current Stimulation (HD-tDCS) at amplitudes up to 4 mA was well tolerated by 292 older adults, with no safety-related adverse events reported and mostly mild sensations experienced during sessions.

The study demonstrated effective blinding for both participants and researchers, indicating that the sham stimulation was convincing, which supports the use of higher amplitudes for potentially greater therapeutic effects in older adults.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Tolerability and blinding of high-definition transcranial direct current stimulation among older adults at intensities of up to 4 mA per electrode. El Jamal, C., Harrie, A., Rahman-Filipiak, A., et al.[2023]

Transcranial direct current stimulation (tDCS) is being tested as a safe and noninvasive treatment for patients with ultraresistant major depressive disorder (MDD) in a trial involving 60 participants, aiming to improve depressive symptoms compared to a sham treatment.

The study will assess various outcomes, including changes in depression ratings and cognitive function, over 30 sessions of stimulation, with the goal of determining the efficacy of tDCS in patients who have not responded to standard treatments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Neurostimulation of the Brain in Depression Trial: Protocol for a Randomized Controlled Trial of Transcranial Direct Current Stimulation in Treatment-Resistant Depression. Suleman, R., Tucker, BV., Dursun, SM., et al.[2021]

Transcranial direct current stimulation (tDCS) combined with positive psychotherapy significantly improved mood, hope, and optimism in patients with clinical depression, showing greater benefits than either treatment alone after 4 weeks and at a 3-month follow-up.

The study utilized standardized scales to measure outcomes in participants, indicating that the combination of tDCS and positive psychology may have a synergistic effect in enhancing treatment efficacy for depression.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Transcranial direct current stimulation based on quantitative electroencephalogram combining positive psychotherapy for major depression. Khayyer, Z., Ngaosuvan, L., Sikström, S., et al.[2018]

Transcranial direct current stimulation (tDCS) is a promising noninvasive treatment for major depression, showing potential for significant clinical gains in recent studies, although past trials had mixed results due to varied methodologies.

Current evidence is not yet sufficient to fully endorse tDCS as a standard treatment for depression, but optimizing stimulation parameters, such as individualization and longer sessions, could enhance its effectiveness and warrant further research.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Transcranial direct current stimulation as a therapeutic tool for the treatment of major depression: insights from past and recent clinical studies. Murphy, DN., Boggio, P., Fregni, F.[2009]

Transcranial direct current stimulation (tDCS) significantly reduced depression scores compared to sham treatment, with the most effective results seen when tDCS was combined with medication, particularly selective serotonin re-uptake inhibitors (SSRIs).

The study included 12 randomized, sham-controlled trials with 251 participants receiving active tDCS and 204 receiving sham, showing that while tDCS alone or combined with psychotherapy did not significantly improve outcomes, the combination with medication led to a higher response rate and a greater reduction in depression scores.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Is transcranial direct current stimulation, alone or in combination with antidepressant medications or psychotherapies, effective in treating major depressive disorder? A systematic review and meta-analysis. Wang, J., Luo, H., Schülke, R., et al.[2022]

Transcranial Direct Current Stimulation (tDCS) is generally considered safe, but there are concerns that it could lead to significant negative effects in healthy individuals.

The scientific community needs to be alerted about the potential risks of tDCS, emphasizing the importance of protecting healthy volunteers from possible harm.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Safety of transcranial direct current stimulation in healthy participants. Boccard-Binet, S., Sen, A.[2021]

A systematic review of 64 studies involving 2262 participants found that transcranial direct current stimulation (tDCS) has a low dropout rate (6% for active and 7.2% for sham), indicating good acceptability among participants.

Despite the low dropout rates, many studies inadequately reported adverse events (AEs), highlighting a need for improved guidelines to standardize AE reporting in tDCS research.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Systematic Review on the Acceptability and Tolerability of Transcranial Direct Current Stimulation Treatment in Neuropsychiatry Trials. Aparício, LVM., Guarienti, F., Razza, LB., et al.[2018]

Transcranial direct current stimulation (tDCS) is generally considered a safe treatment for major depressive disorder, with very low side effects reported, making it a viable option for patients.

While meta-analyses indicate some efficacy of tDCS for acute depression with a moderate effect size, its effectiveness is reduced in treatment-resistant cases, suggesting that more research is needed to establish its overall therapeutic value.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

tDCS for the treatment of depression: a comprehensive review. Palm, U., Hasan, A., Strube, W., et al.[2018]

In a randomized study of 57 participants, both transcranial direct-current stimulation (tDCS) and venlafaxine ER (VNF) showed similar efficacy in reducing depression symptoms, with no significant differences in the Montgomery-Åsberg Depression Rating Scale scores after 4 weeks.

The response and remission rates were also comparable between tDCS (24% response, 17% remission) and VNF (43% response, 32% remission), suggesting that tDCS may be a viable alternative treatment for depression, although further research is needed to confirm its clinical effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Transcranial Direct-Current Stimulation (tDCS) Versus Venlafaxine ER In The Treatment Of Depression: A Randomized, Double-Blind, Single-Center Study With Open-Label, Follow-Up. Bares, M., Brunovsky, M., Stopkova, P., et al.[2022]

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