A Clinical Evaluation of Subcallosal Cingulate Gyrus Deep Brain Stimulation for Treatment-Resistant Depression

Study Overview
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Brief Summary
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This is a randomized, placebo-controlled double-blind cross-over trial evaluating the safety, efficacy, daily functioning, and health-related quality of life of Subcallosal Cingulate Gyrus Deep Brain Stimulation (SCG DBS) for participants with Treatment-Resistant Depression (TRD). A total of 40 eligible participants will be randomized to four treatment sequences (10 participants per sequence). Each participant will be treated over a 6-month period with active or sham stimulation in which both the participants and the attending psychiatrists will be blinded to treatment allocation.

Official Title
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A Clinical Evaluation of Subcallosal Cingulate Gyrus Deep Brain Stimulation for Treatment-Resistant Depression

Conditions
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Treatment Resistant Depression, Depressive Disorder

Intervention / Treatment
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* Device: Libra Deep Brain Stimulation System


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Men and women (non-pregnant) ages 21-70 years; Diagnosed with non-psychotic major depressive disorder, single or recurrent episode by DSM-IV-TR criteria; First episode onset before age 45; Current episode > 12 months duration; In the current episode: Documented resistance (i.e. persistence of the major depressive episode) to a minimum of 4 adequate depression treatments from at least 3 different treatment categories (e.g. SSRI's, SNRI's, TCA's, MAO-inhibitors, Mirtazipine, Nefazodone, Trazodone, Bupropion, lithium augmentation, thyroid augmentation, ECT); Adequacy of treatments as defined by a score of at least 3 according to the amended Antidepressant Treatment History Form (ATHF) criteria; Hamilton Depression Rating Scale (HDRS) of > 20 at 3 separate baseline visits, rated by 2 separate psychiatrists, Baseline 2 and Baseline 3 HDRS scores cannot improve ≥ 25%; Exclusion Criteria: A diagnosis of a bipolar I or bipolar II disorder by DSM-IV-TR criteria; Meets criteria for borderline or antisocial personality disorder in the last 12 months by DSM-IV-TR criteria, derived from the Cluster B Personality. In the current depressive episode, has been diagnosed with General Anxiety Disorder (GAD) - as defined by the DSM-IV-TR, and GAD is the primary diagnosis; Has an intracranial Central Nervous System (CNS) disease that impairs motor, sensory or cognitive function or that requires intermittent or chronic medication (e.g., Parkinson's Disease, migraine, stroke, Huntington's, head trauma, etc.) with exception to non-migraine headaches; Has been diagnosed with fibromyalgia or has a current condition which requires chronic pain narcotic usage (e.g. morphine, methadone); Has been currently diagnosed with chronic fatigue syndrome; Substantial suicidal risk as defined by (1) a current plan and intent, (2) clinician judgment that there is a clear immediate intent for self-harm, (3) more than 3 suicide attempts within the last 12 months; Co-morbid obsessive compulsive disorder, post-traumatic stress disorder, panic disorder, bulimia or anorexia nervosa if previously present, must be in remission for 6 months as defined by DSM-IV-TR criteria, derived from the MINI; Alcohol, medication, or illegal substance dependence within last 12 months; Advanced cardiovascular disease which renders anesthesia and surgery as unsafe as determined by neurosurgeon; Plans to use diathermy; Have any metallic implants in the brain such as aneurysm clips or cochlear implants; Currently participating in another investigational device, drug or surgical trial.

Ages Eligible for Study
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Minimum Age: 21 Years
Maximum Age: 70 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: Non-Randomized
Intervention Model: Crossover Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Stimulation<br>Libra Deep Brain Stimulation System is implanted and activated post implantation | Device: Libra Deep Brain Stimulation System<br> <br> |
| Sham Comparator: No Stimulation<br>The Libra DBS System is implanted and not activated | Device: Libra Deep Brain Stimulation System<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Primary Efficacy: Changes in the Hamilton Depression Rating Scale-17 | evaluate change in HAMD-17 3 months and 6 months after implantation | 3 and 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The incidence of all adverse events | The incidence of all adverse events (i.e. hospitalization due to worsening depression, suicidal ideation, or behavior, medical treatment, and device related events) that occur over study duration. | 6 months | 
| Showing SCG-DBS significantly increases health related quality of life compared to sham stimulation in patients with TRD | The following health related quality of life measures will be evaluated: Sheehan Disability Scale-Visual Analog Scale (SDS-VAS), Short Form-12 (SF-12), Sexual Functioning questionnaire (SEX FX) and Endicott Work Productivity Scale (EWPS). Each measure will be evaluated at baseline and the after each treatment period. | 6 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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major depressive disorder (MDD), deep brain stimulation (DBS), subcallosal cingulate gyrus, Therapy-Resistant Depression, Electrical Stimulation of the Brain, Brain Stimulation, Deep