Efficacy of Deep Transcranial Magnetic Stimulation (TMS) for Treatment-resistant Depression and Neuroanatomical Correlates: a Clinical Study Coupled With Positon Emission Tomography (PET)

Study Overview
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Brief Summary
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Repetitive transcranial magnetic stimulation (TMS) is an emergent non-invasive treatment for treatment resistant depression (TRD). The exact neuro-functional mechanisms related to TMS efficiency remains however unknown; besides local effect on the target, TMS may induce interaction changes between remote cerebral regions. On the other hand, few studies have been performed in comparison to sham placebo stimulation. The investigators recently showed that non-responder depressive patients to TMS exhibited deeper and wider brain functional abnormalities hardly reachable by standard coils. The H1-Coil is a novel TMS (H-TMS) device capable of inducing a magnetic field with a deeper and wider distribution than standard coils. The investigators design here a randomized controlled study in which the investigators will compare the clinical effects of H-coil TMS and standard TMS in patients with TRD, and their functional neuroanatomical correlates and changes in connectivity by Positron Emission Tomography (PET). The general objective is to better understand the mechanisms related to TMS efficiency in pharmacoresistant depression, in order to propose the best therapeutic approach for the patient.

Official Title
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Efficacy of Deep Transcranial Magnetic Stimulation (TMS) for Treatment-resistant Depression and Neuroanatomical Correlates: a Randomized Clinical Study Coupled With Positon Emission Tomography (PET)

Conditions
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Pharmacoresistant Depression

Intervention / Treatment
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* Device: Transcranial Magnetic Stimulation (TMS - ) - MagPro®
* Device: Positon Emission Tomography (PET) - Discovery 710®


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients who met the diagnosis of major depressive episode (MDE) Patient right-handed Men and women aged over 18 years with major depressive episode IV (DSM-IV criteria), isolated or recurrent. Scores on the scale MADRS> 20 Resistance Criterion defined as the failure of two antidepressants effective dose for a minimum of six weeks. Drug Therapy stable for at least 2 weeks Exclusion Criteria: Bipolar disorder type I or type II Depression With Psychotic Features Diagnosis according comorbid Axis I (DSM IV) with schizophrenia, alcohol abuse and / or toxic substances. Inpatient under stress or under legal protection measure (guardianship, curatorship) Counter to the practice of Transcranial Magnetic Stimulation : a personal history of seizure, history of neurological or neurosurgical pathologies, metallic prosthetic material or foreign objects (pacemakers, prosthetic eye equipment, etc.). Pregnant or breastfeeding ongoing. Somatic disorder may affect cognitive abilities and brain structures Known allergy to any component of Fludeoxyglucose

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Patients stimulated with a H-TMS (deep)<br>20 sessions navigated with Deep Transcranial Magnetic Stimulation | Device: Transcranial Magnetic Stimulation (TMS - ) - MagPro®<br>* Class IIa<br>Device: Positon Emission Tomography (PET) - Discovery 710®<br>* Class IB<br>|
| Other: Patients stimulated with a conventional TMS<br>20 sessions navigated with Conventional Transcranial Magnetic Stimulation | Device: Transcranial Magnetic Stimulation (TMS - ) - MagPro®<br>* Class IIa<br>Device: Positon Emission Tomography (PET) - Discovery 710®<br>* Class IB<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The depression score in Montgomery-Åsberg Depression Rating Scale (MADRS). | performed before and after TMS | 24 month | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Short self-completion questionnaire on symptoms of depression |  | 24 month | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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pharmaco-resistant depressed patients