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This study aims to assess the feasibility, safety, acceptability, and preliminary efficacy trends of a Accelerated Intermittent Theta-burst Stimulation (a-iTBS) intervention for adolescent depression through a pilot clinical trial. The findings will inform the design and optimization of subsequent formal randomized controlled trials, providing essential evidence for their execution.
This study is a randomized, double-blind, controlled pilot trial aimed at evaluating the feasibility, safety, acceptability, and preliminary efficacy trends of Accelerated Intermittent Theta-burst Stimulation (a-iTBS) for the treatment of adolescent depression.
Adolescents diagnosed with Major Depressive Disorder (MDD) will be randomly assigned in a 1:1:1 ratio to one of three groups: the experimental target a-iTBS treatment group, the conventional target a-iTBS treatment group, and the sham stimulation group. All three groups will receive 10 consecutive days of a-iTBS stimulation (5 Hz, 90% RMT) or sham stimulation intervention, using the Blackdolphin TMS Robot (SLD-YXRJ) by Xi'an Solide Brain Modulation Ltd. Co., with 50 sessions in total. The intervention frequency and procedure will remain consistent across all groups.
In the experimental target a-iTBS treatment group, participants will undergo MRI-guided identification of the left dorsolateral prefrontal cortex (DLPFC) region, where the voxel most negatively correlated with the functional connectivity of the subgenual anterior cingulate cortex (sgACC) will serve as the stimulation target. In the conventional target a-iTBS treatment group, participants will have the standard F3 target in the DLPFC identified via MRI guidance as the stimulation site. Participants in the sham stimulation group will receive a placebo treatment, simulating the a-iTBS procedure without generating an effective magnetic field output.
The primary outcome of the treatment phase is the efficacy rate or the remission rate of depressive symptoms. Secondary outcomes include symptom scales, anxiety symptoms, suicide risk, quality of life, sleep, rumination, and cognition. Safety will be monitored through adverse events, vital signs, laboratory tests, and tolerability assessments.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Experimental target a-iTBS treatment group | Experimental | Participants will undergo MRI-guided identification of the voxel in the left dorsolateral prefrontal cortex (DLPFC) that is most negatively correlated with the functional connectivity of the subgenual anterior cingulate cortex (sgACC) as the stimulation site. Accelerated Intermittent Theta-burst Stimulation (a-iTBS) (5 Hz, 90% RMT) will be administered using the Blackdolphin TMS Robot device (model SLD-YXRJ) by Xi'an Solide Brain Modulation Ltd. Co., with 50 sessions over 10 consecutive days. |
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| Conventional target a-iTBS treatment group | Experimental | Participants will undergo MRI-guided identification of the standard F3 target in the dorsolateral prefrontal cortex (DLPFC) as the stimulation site. Accelerated Intermittent Theta-burst Stimulation (a-iTBS) (5 Hz, 90% RMT) will be administered using the Blackdolphin TMS Robot device (model SLD-YXRJ) by Xi'an Solide Brain Modulation Ltd. Co., with 50 sessions over 10 consecutive days. |
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| Sham stimulation treatment group | Sham Comparator | Participants will receive a sham stimulation treatment designed to simulate the a-iTBS procedure without generating an effective magnetic field output. The intervention will use a dedicated sham stimulation coil, which is identical in appearance, operation, and stimulation protocol to the experimental group. This coil is designed to maintain the same auditory and tactile sensations as the active stimulation but is equipped with an electromagnetic shielding structure or an internal reverse coil arrangement to effectively prevent magnetic flux from penetrating the skull, ensuring no actual neuromodulatory effects. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Experimental target a-iTBS treatment | Device | Participants will undergo MRI-guided identification of the voxel in the left dorsolateral prefrontal cortex (DLPFC) that is most negatively correlated with the functional connectivity of the subgenual anterior cingulate cortex (sgACC) as the stimulation site. |
| Measure | Description | Time Frame |
|---|---|---|
| Change in CDRS-R (Children's Depression Rating Scale) scores from baseline | Response rate of depressive symptoms (defined as ≥50% reduction in CDRS-R score) or remission rate of depressive symptoms (defined as CDRS-R score ≤28). The CDRS-R scale ranges from 0 to 54, with higher scores indicating worse depressive symptoms. | Baseline of treatment period, 10 days; The follow-up period was 1 month, 3 months |
| Measure | Description | Time Frame |
|---|---|---|
| Change in BDI-II (Baker Depression Scale) scores from baseline | Change in Beck Depression Inventory - Second Edition (BDI-II) scores from baseline. The BDI-II scale ranges from 0 to 63, with higher scores indicating worse depressive symptoms. | Baseline of treatment period, 10 days; The follow-up period was 1 month, 3 months |
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Inclusion Criteria:
(1) Age 12 - 18 (2) Diagnosis of major depressive disorder (MDD) according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), confirmed through the Kiddie Schedule for Affective Disorders and Schizophrenia - Present and Lifetime version (K-SADS-PL), currently in a depressive episode (3) Score≥40 on the CDRS-R (4) Stable pharmacological treatment: At least 4 weeks of stable psychiatric medication use prior to enrollment, with continuation of the same psychiatric medication regimen throughout the study.
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Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Xinyu Zhou | Contact | 15823996993 | zhouxinyu@cqmu.edu.cn |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| The First Affiliated Hospital of Chongqing Medical University | Chongqing | 400016 | China |
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This study employs a parallel assignment design. Participants will be randomly assigned in a 1:1:1 ratio to the experimental target a-iTBS treatment group, the conventional target a-iTBS treatment group, or the sham stimulation group. All three groups will utilize the Blackdolphin TMS Robot device (SLD-YXRJ) by Xi'an Solide Brain Modulation Ltd. Co., receiving 50 sessions of a-iTBS stimulation (5 Hz, 90% RMT) or sham stimulation over 10 consecutive days, with consistent intervention frequency and procedures. Participants will remain in their assigned group for the entire study duration without any crossover.
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| Conventional target a-iTBS treatment | Device | Participants will undergo MRI-guided identification of the standard F3 target in the dorsolateral prefrontal cortex (DLPFC) as the stimulation site. |
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| Sham stimulation treatment | Device | Participants will receive a sham stimulation treatment designed to simulate the a-iTBS procedure without generating an effective magnetic field output. |
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| Change in SCARED (The Screen for Child Anxiety-Related Emotional Disorders) scores from baseline |
Improvement in anxiety (SCARED minus the scores). The SCARED scale ranges from 0 to 82, with higher scores indicating worse anxiety symptoms. |
| Baseline of treatment period, 10 days; The follow-up period was 1 month, 3 months |
| Change in suicide risk from baseline on the C-SSRS (Columbia Suicide Severity Rating Scale) | The severity of the suicide risk. The C-SSRS scale ranges from 0 to 5, with higher scores indicating worse suicide risk severity. | Baseline of treatment period, 10 days; The follow-up period was 1 month, 3 months |
| Change in PSQI (Pittsburgh Sleep Quality Index) scores from baseline | Improvement in sleep status (PSQI minus the scores). The PSQI scale ranges from 0 to 21, with higher scores indicating worse sleep quality. | Baseline of treatment period, 10 days; The follow-up period was 1 month, 3 months |
| Change in PedsQL4.0 (The Pediatric Quality of Life Inventory) scores from baseline | Improvement of children's quality of life (PedsQL 4.0 minus the scores). The PedsQL 4.0 scale ranges from 0 to 100, with higher scores indicating better quality of life. | Baseline of treatment period, 10 days; The follow-up period was 1 month, 3 months |
| Change in CGI-S (Clinical Global Impressions-Severity Scales) scores from baseline | Improvement in overall clinical impression severity (7-point scale, with 1 being normal and 7 being among the most severely impaired). The CGI-S scale ranges from 1 to 7, with higher scores indicating worse clinical severity. | Baseline of treatment period, 10 days; The follow-up period was 1 month, 3 months |
| Change in CGI-I (Clinical Global Impressions-Improvement Scales) scores from baseline | Improvement of clinical general impression (7-point scale, with 1 denoting very much improved and 7 denoting very much worse, with higher scores indicating worse clinical improvement). | Baseline of treatment period, 10 days; The follow-up period was 1 month, 3 months |
| Change in RSS (Ruminative Responses Scale) | The level of improvement in negative thinking. The RSS scale ranges from 0 to 4 for each item, with a total possible score of 0 to 36, with higher scores indicating worse ruminative thinking. | Baseline of treatment period, 10 days; The follow-up period was 1 month, 3 months |