Cortical Excitability and Inhibition in Children and Adolescents With Major Depressive Disorder
Trial status: Open for Enrollment
Why is this study being done?
This study is focused on understanding the neurophysiology of major depressive disorder (MDD), and the impact of selective serotonin reuptake inhibitors (SSRIs) in children and adolescents. This is a cross-sectional study which will utilize single and paired-pulse transcranial magnetic stimulation (TMS) to collect measures of glutamatergic cortical excitability (the motor threshold and intracortical facilitation), and GABAergic cortical inhibition (the cortical silent period and intracortical inhibition) of the motor cortex in chilren and adolescents in various disease states of MDD. The optional proton magnetic resonance spectroscopy and imaging scans (MRS/MRI) at 3 Tesla (3T) will examine glutamate concentrations in the motor cortex and anterior cingulate cortex.
This is a biomarker study (MRI/MRS and TMS neurophysiology measures); treatment is not provided in any form. This study will not utilize Repetitive Transcranial Magnetic Stimulation (rTMS).
Who is eligible to participate?
- Adolescents from the ages of 13 to 21, male or female.
- Subjects with MDD (groups 2, 3, and 4):
- Must have a Children's Depression Rating Scale, Revised (CDRS-R) score of 40 or higher
- Must have a Clinical Global Impression-Severity scale (CGI-S) score of 4 or higher.
- Group 1: (50 subjects): Subjects who have mild (CDRS-R score < 40) but clinically significant depression.
- Group 2: (50 subjects): Subjects with moderate to severe MDD who have not yet initiated treatment with an SSRI.
- Group 3: (50 subjects): Subjects with moderate to severe MDD that has responded to treatment with an SSRI.
- Group 4: (50 subjects): Subjects with moderate to severe MDD which has not responded to treatment with an SSRI.
- Capable of providing informed assent (consent if age 18) in addition to consent by parent or guardian.
- Subjects and at least 1 parent must be fluent in English.
- Primary Axis I or II disorder other than MDD.
- Unprovoked seizure history, seizure disorder, history of febrile seizures, family history of epilepsy.
- Any significant findings on the TMS Adult Safety Screen (TASS) or contraindications to MRI/MRS
- Subjects who are judged by the Principal Investigator to be at imminent risk for self harm or suicide as indicated by interview or C-SSRS.
- Pregnancy or suspected pregnancy in females.
- Metal in the head (except the mouth*), implanted medication pumps, cardiac pacemaker.
* Subjects with braces will be excluded from MRI/MRS portion of study only
- Prior brain surgery.
- Risk for increased intracranial pressure such as a brain tumor.
- Any unstable medical condition.