DBS for TRD With the Medtronic Percept PC
Trial statusRecruiting
Trial phaseNot applicable
Trial typeInterventional
Biological sexAll
Age25-70
SponsorHelen Mayberg, MD
About this trial
Of the estimated 30 million Americans who suffer from Major Depressive Disorder, approximately 10% are considered treatment resistant. Deep brain stimulation (DBS) to a region of the brain called the subcallosal cingulate (SCC) is an emerging strategy for treatment resistant depression (TRD), which involves placement of electrodes in a specific region of the brain and stimulating that area with electricity. This is believed to reset the brain network responsible for symptoms and results in a significant antidepressant response. A series of open-label studies have demonstrated sustained, long-term antidepressant effects in 40-60% of patients who received this treatment. A challenge to the effective dissemination of this fledgling treatment is the absence of biomarkers (objective, measureable indications of the state of the body and brain) to guide device placement and select stimulation parameters during follow-up care.
By using a DBS device called the Percept PC (Medtronic, Inc) which has the ability to both deliver stimulation to and record electrical signals directly from the brain, this study aims to identify changes in local field potentials (LFPs), specific electrical signals that are thought to represent how the brain communicates information from one region to another, to see how this relates to DBS parameter settings and patient depressive symptomatology. The goal of this study is to study LFPs before and during active DBS stimulation to identify changes that correlate with the antidepressant effects of SCC DBS.
The study team will recruit 20 patients with TRD and implant them with the Percept PC system. Participants will be asked to complete short questionnaires and collect LFP data twice daily for the first year of the study, as well as have weekly in person research procedures and assessments with the study team for up to one year. These include meetings with the study psychiatrist, psychologist, symptom ratings, and movement, voice, and video recordings. A brief discontinuation experiment will be conducted after 6 months of stimulation, in which the stimulation will be turned off and patterns of LFP changes will be recorded. The entire study is expected to last about 5 years, parcellated into several study phases. All participants are required to live in the New York metropolitan area for the first several months of the study.
Eligibility criteria
This trial does not accept healthy volunteersQualifiers
Age 25-70 years old.
Ability to provide written informed consent.
Primary psychiatric diagnosis of Major Depressive Disorder (MDD), either single episode or recurrent type, without psychotic features, currently experiencing a Major Depressive Episode (MDE), as diagnosed by Structured Clinical Interview for DSM IV-TR or DSM-5 (SCID-IV or SCID-5). Two independent psychiatrists will confirm the diagnosis, as well.
Current depressive episode of at least two years duration OR a history of more than 3 lifetime depressive episodes.
Disqualifiers
Other primary Axis I conditions
Active suicidal ideation with intent, suicide attempt within the last six months, more than three suicide attempts within the last two years, or serious suicide risk as determined by the study psychiatrists
Other primary neurological disorders or unstable medical illness
Conditions requiring anticoagulant therapy which cannot be discontinued for the perioperative period, as required
Trial design
Design model
Single group
Treatments tested in this trial
Medtronic Percept PC DBS system
DeviceOpen label active Deep Brain Stimulation (DBS)
Treatment groups
20 Participants
are divided into 1 treatment groupGroup A: Deep Brain Stimulation (DBS) for Treatment Resistant DepressionExperimental treatment 1 intervention
Trial outcomes
Primary outcomes
1
Change in Hamilton Depression Rating Scale (HDRS) score
Response to intervention defined as a decrease in the HDRS-17 score of 50% or greater from the 4-week average pre-surgical baseline. Clinical remission will be defined as an HDRS-17 score ≤ 7. Partial response will be defined as a decrease in HDRS-17 \>30% but less than 50%. Non-response will be defined as a \<30% decrease in HDRS-17. The score for Hamilton Depression Rating Scale, 17 item version, ranges from 0-50, with a higher score indicating more severe depression.
Time frame
baseline and up to 1 yearSecondary outcomes
1
Change in Montgomery-Asberg Depression Rating Scale (MADRS)
The MADRS consists of 10 items evaluating core symptoms of depression. Nine of the items are based upon patient report, and one is on the rater's observation during the rating interview. MADRS items are rated on a 0 to 6 continuum (0 = no abnormality, 6 = severe). Scores range from 0 to 60, with higher total scores indicating increased severity of depressive symptoms
Time frame
baseline and up to 1 yearSponsors and contacts
Click on the lead sponsor to view all of their trials.
Helen Mayberg, MD
Lead sponsor
Icahn School of Medicine at Mount Sinai
Sponsor institution
Georgia Institute of Technology
Collaborator
Source ClinicalTrials.gov