NCT04099056 · Emory University
Brain Stimulation and Decision-making
What this study is about
Decision-making is an important process that is frequently shown to be impaired in patients with depression. While a number of preclinical and clinical studies have identified key regions involved in this process, it remains unclear exactly how these regions are influencing choice behavior especially when choices become more challenging.
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Decision-making is an important process that is frequently shown to be impaired in patients with depression. While a number of preclinical and clinical studies have identified key regions involved in this process, it remains unclear exactly how these regions are influencing choice behavior especially when choices become more challenging. The goal of this project is to understand how these regions, such as the cingulate cortex, impact difficult choice behavior. Specifically, the researchers are interested in learning how disruptions in cognitive control might impact choice preferences during difficult decisions in depressed patients. To do this, this study will recruit participants with depression (as well as healthy controls) to perform game-like tasks in the laboratory while undergoing TMS or TI.
Interventions
DEVICE
Neurostimulation
Participants will be seated comfortably in a chair and asked to complete simple computer tasks. Participants will receive neurostimulation in the form of Transcranial Magnetic Stimulation (TMS) or Temporal Interference (TI). TMS: Either during, or just before any of the tasks, participants will receive either repetitive transcranial magnetic stimulation (rTMS) or single pulse TMS. During this, the researchers place a small plastic coil next to the participant's head. The coil will then generate a magnetic pulse, and stimulation will occur during presentation of the visual stimuli on which subjects will conduct behavioral or cognitive tasks. TI: Either during, or just before, any of the above tasks, participants will receive stimulation with TI. To do so, commercially available gel-based electrodes will be placed on the scalp to target the relevant brain region. The position targeted by the electrodes will be guided by previously defined coordinates.
Primary outcome measures
Staggered Effort-Based Decision-Making Task
Time frame: Day 1, during TMS/ TI stimulation
Assessment of reward motivation will be accomplished using an effort-based decision-making task modified for fMRI use. During each trial, subjects are presented with a choice between two levels of task difficulty, a High Effort option and a Low Effort option, which require different amounts of speeded manual button pressing for differing levels of monetary reward. The reward magnitude for a No Effort option remains constant ($1.00), while the reward magnitude for the High Effort option varies from $1.00 to $11.00. Additionally, the amount of effort required for the High Effort option will vary between 20%, 50%, 80% and 100% of the subject's max effort (set for each individual prior to scan). Multiple metrics of task performance will be compared between study arms.
Who can participate
This study lists these criteria on ClinicalTrials.gov. A study coordinator reviews eligibility during screening — this page does not determine whether you qualify.
Inclusion criteria
- Provides written informed consent
- Fluent English speaker
- Absence of current drug use as assessed by subject history and/or urine drug screen
Exclusion criteria
- Pregnant or currently breastfeeding women or any woman of childbearing potential who is seeking to become pregnant or suspects that she may be pregnant, as assessed by subject report and/or urine pregnancy screen
- Contraindications to fMRI scanning (including presence of a cardiac pacemaker or pacemaker wires, metallic particles in the body, vascular clips in the head or previous neurosurgery, prosthetic heart valves, claustrophobia) as assessed with the standard MRI screening form from the Facility for Research and Education in Neuroscience (FERN)
- Unable to fit comfortably in the scanner
- Contraindication to TMS, including history or family history of epilepsy, metallic implants in the head and/or neck, brain stimulators, vagus nerve stimulators, ventriculoperitoneal (VP) shunt, pacemakers
- Current use of medications that may increase the risk of seizures (e.g., bupropion, varenicline, chlorpromazine, theophylline) or reduce the effects of rTMS, such as benzodiazepines
- History or current serious or unstable medical illness, including cardiovascular, hepatic, renal, respiratory, endocrine, neurologic, or hematologic disease, as assessed by subject history
- Not right-handed as assessed by the Chapman handedness inventory or self-report
- History of head injury resulting in more than a brief loss of consciousness, as assessed by subject history
- History of cocaine or stimulant use (e.g., amphetamine, cocaine, methamphetamine), as assessed by subject history
- History of use of dopaminergic drugs (including methylphenidate or other stimulant medication), as assessed by subject history
- Current use or more than occasional use in the past year of tobacco products, including cigarettes, e-cigarettes, cigars, snuff, and chewing tobacco, or nicotine replacement products such as gum or patches, as assessed by subject history
- Evidence of significant inconsistencies in self-report measures Additional Exclusion Criteria for Optional Ecological Momentary Assessment (EMA)Component for Subject Safety
- Anything above minimal risk for suicide, as assessed during the clinical interview (SCID) at screening and the Columbia Suicide Severity Rating Scale (C-SSR). C-SSRS risk will be assessed as any score \> 3.
- Any physical or neuropsychiatric conditions that may worsen/or prevent walking or running. Additional Exclusion Criteria for Optional Ecological Momentary Assessment (EMA)Component for Data Quality
- Meet criteria for current psychotic disorders, bipolar disorders, or severe substance use disorders as assessed by the Mini International Neuropsychiatric Interview.
- Used psychotropic medications within the last six weeks as assessed by subject history. Additional Exclusion Criteria for Participants with Major Depressive Disorder:
- Anything above minimal risk for suicide, as assessed during the clinical interview (SCID) at screening and the Columbia Suicide Severity Rating Scale (C-SSRS)
- A symptom severity score of at least 11, as assessed by the Beck Depression Inventory (BDI)-II
- History or current diagnosis of any of the following Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV psychiatric illnesses:
- Organic mental disorder
- Schizophrenia spectrum disorders
- Delusional disorder
- Psychotic disorders not otherwise specified
- Patients with mood-congruent or mood-incongruent psychotic features
- Patients with bipolar mood disorders
- Substance dependence
- Substance abuse within the last 12 months (except cocaine or stimulant abuse), which will lead to exclusion
- Absence of any psychotropic medications for at least 2 weeks. No patient will be asked to discontinue or otherwise interrupt any psychotropic medications to participate in this study. The listed "washout" periods are only applicable for patients who previously used psychotropic medications, but recently decided to discontinue their use for some other reason.
- 6 weeks for fluoxetine
- 6 months for neuroleptics
- 2 weeks for benzodiazepines
- 2 weeks for any other antidepressants Additional Exclusion Criteria for Healthy Controls:
- Any current or past history of any DSM-IV psychiatric illnesses, presence of a DSM-IV psychiatric disorder within a first-degree relative, or current or past use of psychotropic medications
- Score no greater than 10 on the BDI-II
- Score \> 1 on the SHAPS
Where
- Atlanta, Georgia
Collaborators
National Institute of Mental Health (NIMH)
Related conditions & keywords
Frequently asked questions
What is a clinical trial?
A clinical trial is a research study that tests new medical treatments, drugs, devices, or procedures to determine their safety and effectiveness. Trials are carefully designed and monitored to protect participants while advancing medical knowledge.
Is it safe to participate?
Clinical trials follow strict safety guidelines and ethical standards. Trials must be reviewed and approved, and participants are closely monitored by medical professionals throughout the study. You can withdraw at any time if you choose.
Will I be compensated?
Many clinical trials offer compensation for your time, travel expenses, and inconvenience. The specific compensation varies by study and will be discussed during the screening process. All study-related medical care is typically provided at no cost to participants.
Will I receive a placebo instead of treatment?
When effective treatment exists, participants typically receive either the standard treatment plus the study intervention, or the standard treatment plus placebo. You would not be denied effective care. Placebos are primarily used when no proven treatment is available, or in addition to standard care. Your trial consent form will clearly explain what treatments you may receive.
Can I leave a trial if I change my mind?
Absolutely. Participation in clinical trials is completely voluntary. You have the right to withdraw from the study at any time, for any reason, without penalty or loss of benefits to which you are otherwise entitled.
How long does a clinical trial last?
Trial duration varies widely depending on the study design and purpose. Some trials last just a few weeks, while others may continue for months or years. The study coordinator will provide specific timeline information during your screening call.
Data: ClinicalTrials.gov · synced Dec 10, 2025 · Source of record for eligibility and locations