aiTBS for pharmacological treatment-resistant bipolar depression

JRCT ID: jRCTs042240019

Registered date:22/04/2024

Basic Information

• Recruitment status: Recruiting
• Health condition(s) or Problem(s) studied: Pharmacological treatment-resistant bipolar depression (DSM-5-TR based on SCID-5-RV)
• Date of first enrollment: 22/04/2024
• Target sample size: 22
• Study type: Interventional
• Intervention(s): Accelerated intermittent theta burst stimulation (aiTBS)

Outcome(s)

Primary Outcome

Response rate at week 4 (defined as a >= 50% reduction in MADRS total score from baseline to week 4 (endpoint))

MADRS: Montgomery-Asberg Depression Rating Scale

Secondary Outcome

1. Response rate at day 5-7, week 2, and 6
2. Remission rate at day 5-7, week 2, 4, and 6 (defined as a MADRS total score =< 7)
3. Change in depression symptoms (mean change from baseline to day 5-7, week 2, 4, and 6 in MADRS total score)
4. Change in bipolar depression severity (mean change from baseline to day 5-7, week 2, 4, and 6 in CGI-S score)
5. Change in treatment efficacy for bipolar depression (mean change from baseline to day 5-7, week 2, 4, and 6 in CGI-I score)
6. Change in bipolar mania severity (mean change from baseline to day 5-7, week 2, 4, and 6 in CGI-S score)
7. Change in suicide-related symptoms (mean change from baseline to day 5-7, week 2, 4, and 6 in C-SSRS score)
8. All-cause discontinuation
9. Discontinuation due to adverse events
10. Incidence of total adverse events
11. Incidence of serious adverse events
12. Mortality rate
13 Incidences of individual adverse events

CGI (-S, -I): Clinical Global Impression (-Severity, -Improvement), C-SSRS: Columbia Suicide Severity Rating Scale, MADRS: Montgomery-Asberg Depression Rating Scale

Key inclusion & exclusion criteria

• Age minimum: >= 18age old
• Age maximum: < 65age old
• Gender: Both

Include criteria

1. The clinical trial will be described in detail to the individuals, and would be written informed consent will be obtained from all participants and their guardians
2. Individuals age: 18 >= years old and < 65 years old
3. Individuals who will meet the DSM-5-TR criteria for bipolar depression (type I)
4. Individuals who will be diagnosed with pharmacological treatment-resistant* bipolar depression

* The definition
A individual who will not respond to at least two mood stabilizers or second-generation antipsychotics (valproate, lamotrigine, quetiapine extended-release, lurasidone, or olanzapine that are reported to have an efficacy for bipolar depression by a network meta-analysis (Yildiz 2023)) with a sufficient dose (within the doses approved in Japan) for 2 weeks or more (CGI-S >= 4, we will confirm the result from their medical records). If the individuals are receiving the combination therapy with two or more these drugs, we will select a candidate drug that had the highest dose of among the drugs (the Defined Daily Dose (https://www.who.int/tools/atc-ddd-toolkit/about-ddd). If there are two or more drugs that used the same equivalent dose during the same period, we will select one of these drugs for the evaluation of the definition.

5. Individuals who will have a HAM-D17 total score of 20 or higher at baseline

*Drugs demonstrated to be effective in treating individuals with bipolar depression in a recent network meta-analysis (Yildiz 2023) (valproate, lamotrigine, quetiapine extended-release, lurasidone, and olanzapine).

CGI-S: Clinical Global Impression-Severity Scale, DSM-5-TR: Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition-Text Revision, HAM-D17: 17-item Hamilton Rating Scale for Depression

Exclude criteria

1. Individuals with metal implants or devices close to the stimulation site (e.g., cochlear implants, surgical clips with magnetic properties, or neurostimulators such as deep brain stimulation or vagus nerve stimulation), individuals with a cardiac pacemaker
2. Individuals with metal implants or devices not close to the stimulation site (e.g., implanted medication pumps), titanium products in their heads, magnetic dentures/implants
3. Individuals with a history of seizures, a history of intracranial lesions at risk for seizures, individuals taking drugs that reduce seizure threshold (methylphenidate or ketamine), individuals with alcohol/caffeine/stimulants abuse or withdrawal symptoms, pregnant individuals, individuals with severe physical disease
4. Individuals with a history of receiving rTMS in the current depressive episode
5. Individuals diagnosed with dementia, organic or symptomatic mood disorder
6. Individuals with unimproved depressive symptoms due to poor adherence to pharmacological treatment
7. Individuals diagnosed with substance or medication-induced mood disorder
8. Individuals who will answer "yes" to question 4 (active suicidal ideation with some intent to act, without specific plan) or question 5 (active suicidal ideation with specific plan and intent) regarding suicidal ideation on the C-SSRS at baseline
9. Individuals judged to be inappropriate by researchers

C-SSRS: Columbia Suicide Severity Rating Scale, rTMS: repetitive transcranial magnetic stimulation

Related Information

• Primary Sponsor: Kishi Taro
• Source(s) of Monetary Support: Japan Agency for Medical Research and Development