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. 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).
Inclusion Criteria:
- Adolescents from the ages of 10 to 18, 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 parents must be fluent in English.
Exclusion Criteria:
- 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 with a history of suicidal behavior to the extent that "yes" is entered on the Suicidal Behavioral section of the Columbia-Suicide Severity Rating Scale (C-SSRS) for either "actual attempt", "interrupted attempt", or "aborted attempt" or "preparatory acts or behaviors" will be excluded from enrollment.
- Pregnancy or suspected pregnancy in females.
- Metal in the head (except the mouth), implanted medication pumps, cardiac pacemaker.
- Prior brain surgery.
- Risk for increased intracranial pressure such as a brain tumor.
- Any unstable medical condition.
Last updated: 10/29/2012
NCT ID: NCT01718730
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