Altering Default Mode Network Activity With Transcranial Focused Ultrasound to Reduce Depressive Symptoms

NCT06320028 | Active Not Recruiting Phase 1

• 1 other identifier: 019782-00001
• Study Type: interventional
• Target: 20
• Locations: 1 country
• Sites: 1

Brief Summary

Depression is a leading cause of disability worldwide, affecting roughly 21 million adults. Repetitive Negative Thought (RNT) has been identified as a potential maintaining factor in depression, such that those who exhibit higher degrees of RNT endorse greater symptoms. Research also suggests that the Default Mode Network (DMN), responsible for self-referential processing, plays an important role in depression wherein it has been linked to RNT. In depressed individuals, this network appears to be hyper-connected, or "too connected", within itself which, in turn, is thought to promote RNT. Half of depressed individuals are treatment-resistant, creating a critical need to identify more effective interventions derived from a better mechanistic understanding of the development and maintenance of depression. Non-invasive Transcranial-Focused Ultrasound Stimulation (tFUS) is promising for the treatment of depression. tFUS directs a low-intensity (nonthermal) focused ultrasound beam that passes safely through the skull. Compared to other noninvasive neuromodulation approaches, tFUS can target deeper brain regions with high spatial precision. The present study is an exploratory non-blinded single treatment study to investigate whether tFUS targeting a major hub of the DMN, the anterior-medial prefrontal cortex, can improve depression symptoms and reduce RNT. Twenty depressed individuals with high RNT (75th percentile) will complete up to eleven ultrasound sessions targeting the anterior medial prefrontal cortex, a hub of the brain's default mode network that has been found to be hyper-connected in depression. MRI scans will be obtained before the first and after the last ultrasound sessions. Based on previous literature, it is predicted that depression interview ratings and self-report symptoms will decrease after the intervention, and also that DMN connectivity will decrease following intervention.

Conditions

Depressive Disorder, Major; Depression

Keywords

Non-invasive Transcranial Focused Ultrasound Stimulation; Depression; Mood disorders

Outcome Measures

Primary Outcomes (4)

• Beck Depression Inventory - II (BDI-II)

  The BDI-II is one of the most widely used self-report measures for assessing depression. It includes 21 self-report items. Scores range from 0 to 63, and higher scores indicate higher levels of depressive symptoms. In this study, the BDI-II was used to monitor depressive symptoms over the course of treatment. In our research, we will employ the BDI-II to track changes in self-reported depressive symptoms throughout the intervention, comparing the total BDI-II scores at different assessment points to analyze the efficacy of the treatment.

  Before ultrasound treatment, daily after each ultrasound session, after completion of week 1 of treatment, after completion of week 3 of treatment (if applicable)

• Perseverative Thinking Questionnaire (PTQ)

  The PTQ is a commonly used self-report measure for assessing a characteristic of depression, repetitive negative thought (RNT). It includes 15 self-report items. Scores range from 0 to 60, and higher scores indicate higher levels of RNT. In this study, the PTQ was used to monitor RNT over the course of treatment. In our research, we will employ the PTQ to track changes in RNT throughout the intervention, comparing the total PTQ scores at different assessment points to analyze the efficacy of the treatment.

  Before ultrasound treatment, daily after each ultrasound session, after completion of week 1 of treatment, after completion of week 3 of treatment (if applicable)

• Hamilton Depression Rating Scale (HDRS)

  The Hamilton Depression Rating Scale (HDRS) is a widely utilized clinician-administered assessment tool designed to measure the severity of depressive symptoms in individuals. Comprising 17 items, the HDRS evaluates various aspects of depression. Scores range from 0 to 52, and higher total scores indicate greater depressive symptoms. In our research, we will employ the HDRS to track changes in depressive symptoms throughout the intervention, comparing the total HDRS scores at each main time point to analyze the efficacy of the treatment.

  Before ultrasound treatment, after completion of week 1 of treatment, after completion of week 3 of treatment (if applicable)

• Default Mode Network (DMN) Connectivity

  The DMN is a set of brain regions known to be "hyperconnected" in depressed individuals and may be a potential biomarker for this costly disorder. In our research, we will compare DMN connectivity at each major time point to observe whether there is a decrease in DMN connectivity to assess the efficacy of treatment.

  Before ultrasound treatment, after completion of week 1 of treatment, after completion of week 3 of treatment (if applicable)

Secondary Outcomes (1)

• The Montgomery-Åsberg Depression Rating Scale (MADRS)

  Before ultrasound treatment, after completion of week 1 of treatment, after completion of week 3 of treatment (if applicable)

Study Arms (1)

Non-invasive Transcranial Focused Ultrasound

EXPERIMENTAL

Device: Transcranial Ultrasound Power The ultrasound will be delivered using a custom Neuromodulation device consisting of 128 element ultrasound array (Openwater) with the ultrasound beam having the following parameters: acoustic frequency = 400 kHz, pulse duration = 5 ms, pulse repetition rate (PRR) = 10 Hz, spatial peak/temporal average acoustic intensity = 435 mW /cm2, peak negative pressure 650 kPa. The ultrasound probe will be secured by a custom-designed headset created by Openwater. The Localite Neuronavigation Software (TMS Navigator 3.3 adapted for ultrasound device), including a 3D camera, fiducial markers on the headset and pointer, and software will register the position of the probe with respect to the patient's structural MRI.

Device: Non-Invasive Transcranial Focused Ultrasound

Interventions

Non-Invasive Transcranial Focused Ultrasound DEVICE

The ultrasound will be delivered for 10 minutes per treatment session targeting to the participant's amPFC.

Non-invasive Transcranial Focused Ultrasound

Eligibility Criteria

• Age: 18 Years - 50 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Participants must be between the ages of 18-50
• Participants must have normal or corrected vision (glasses, contacts, etc)
• Must be proficient in English in order to read the consent form (Spanish speakers are included, as long as they are also proficient in English)
• Must be right-handed
• Upper 25% of distribution on perseverative thinking scores based on local norms (score ≥ 37)
• Participants meeting DSM-5 criteria for current major depressive episode
• Participants may be excluded from the MRI portion of the experiment if they are pregnant or are unsure if they may be pregnant or have any contraindications for MRI, including severe claustrophobia, non-MRI compatible cardiac pacemakers; implantable defibrillators; aneurysm clips; neural stimulators; artificial heart valves; ear implants; insulin pumps; drug infusion devices; IUDs; magnetic dental appliances; metal fragments or foreign objects in the eyes, skin or body; metal plates, screws, and prosthetics; non-removable metal piercings; tattoos on the head and neck, other certain older tattoos or permanent makeup (eyeliner) using metal-containing inks, some medicated patches, or any other condition, metal implant or other injury or device that is contraindicated for MRI. If a subject has any of these, the experimenter will evaluate whether it is safe for them to participate in the MRI portion of the experiment.

You may not qualify if:

• History of head injury with loss of consciousness for more than 5 min
• Uncorrected hearing or vision impairment severe enough to interfere with participation.
• Currently have or history of brain or mental illness judged likely to interfere with testing, including drug and/or alcohol dependence
• Sleep disorder (e.g., insomnia)
• Current drug, alcohol, or prescription drug intoxication
• History of epilepsy
• History of diagnosed migraines
• Metal implants in their head or face, including dental retainers that cannot be removed
• History of cardiac problems that could impact brain function (e.g., atrial fibrillation)
• Current active suicidal potential necessitating immediate treatment

Sponsors & Collaborators

• University of Arizona: lead
• Openwater: collaborator

Study Sites (1)

University of Arizona

Tucson, Arizona, 85721, United States

Location

Related Publications (8)

• Fini M, Tyler WJ. Transcranial focused ultrasound: a new tool for non-invasive neuromodulation. Int Rev Psychiatry. 2017 Apr;29(2):168-177. doi: 10.1080/09540261.2017.1302924. Epub 2017 Apr 21.

  PMID: 28430535 BACKGROUND

• Kubanek J. Neuromodulation with transcranial focused ultrasound. Neurosurg Focus. 2018 Feb;44(2):E14. doi: 10.3171/2017.11.FOCUS17621.

  PMID: 29385924 BACKGROUND

• Samantha J. Reznik, Joseph L. Sanguinetti, William J. Tyler, Chris Daft, John J.B. Allen. (2020) A double-blind pilot study of transcranial ultrasound (TUS) as a five-day intervention: TUS mitigates worry among depressed participants, Neurology, Psychiatry and Brain Research, 37(60-66), ISSN 0941-9500, https://doi.org/10.1016/j.npbr.2020.06.004.

  BACKGROUND

• Sanguinetti JL, Hameroff S, Smith EE, Sato T, Daft CMW, Tyler WJ, Allen JJB. Transcranial Focused Ultrasound to the Right Prefrontal Cortex Improves Mood and Alters Functional Connectivity in Humans. Front Hum Neurosci. 2020 Feb 28;14:52. doi: 10.3389/fnhum.2020.00052. eCollection 2020.

  PMID: 32184714 BACKGROUND

• Sanguinetti, J. L., Smith, E., Allen, J. J. B., Hameroff, S. (2014). Human brain stimulation with transcranial ultrasound (TUS); Potential applications for mental health. In Bioelectromagnetic Medicine. New York, NY: Taylor & Francis.

  BACKGROUND

• Sheline YI, Barch DM, Price JL, Rundle MM, Vaishnavi SN, Snyder AZ, Mintun MA, Wang S, Coalson RS, Raichle ME. The default mode network and self-referential processes in depression. Proc Natl Acad Sci U S A. 2009 Feb 10;106(6):1942-7. doi: 10.1073/pnas.0812686106. Epub 2009 Jan 26.

  PMID: 19171889 BACKGROUND

• Schachtner JN, Dahill-Fuchel JF, Zhang D, Allen KE, Bawiec CR, Hollender PJ, Ornellas SB, Konecky SD, Achrol AS, Allen JJB. The effect of non-invasive transcranial focused ultrasound for depression on the default mode network: an open-label pilot trial. Front Psychiatry. 2026 Jan 20;16:1722575. doi: 10.3389/fpsyt.2025.1722575. eCollection 2025.

  PMID: 41641082 DERIVED

• Schachtner JN, Dahill-Fuchel JF, Allen KE, Bawiec CR, Hollender PJ, Ornellas SB, Konecky SD, Achrol AS, Allen JJB. Transcranial focused ultrasound targeting the default mode network for the treatment of depression. Front Psychiatry. 2025 Apr 4;16:1451828. doi: 10.3389/fpsyt.2025.1451828. eCollection 2025.

  PMID: 40256163 DERIVED

MeSH Terms

Conditions

Depressive Disorder, Major; Depression; Mood Disorders

Condition Hierarchy (Ancestors)

Depressive Disorder; Mental Disorders; Behavioral Symptoms; Behavior

Study Officials

• John JB Allen, PhD

  University of Arizona Psychology Department

  PRINCIPAL INVESTIGATOR

• Jessica N Schachtner, BA

  University of Arizona Psychology Department

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: phase 1
• Allocation: NA
• Masking: NONE
• Masking Details: There is no masking.
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Distinguished Professor of Psychology

Model Details: All participants will receive the same treatment protocol.

Study Record Dates

• First Submitted: March 13, 2024
• First Posted: March 20, 2024
• Study Start: April 27, 2023
• Primary Completion: January 3, 2024
• Study Completion: June 3, 2024
• Last Updated: March 20, 2024

Record last verified: 2024-03

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)