Single Session of tACS in a Depressive Episode

Participants will report for a study visit and will review and sign a consent form.

Participants will complete several clinical assessments and also take a urine drug test and urine pregnancy test (if applicable). Eligibility will be re-assessed by the investigators before the participant moves on to the next phase.

If the participant still qualifies, the participant will first be fitted with two 5x5cm electrodes placed over F3/F4 (10-20 measurement system) and one 5x7cm electrode placed over Cz. In addition, the participant will have a 128-channel EEG net placed on their head. Participants will provide a saliva sample to assess for brain-derived neurotrophic factor (BDNF), which may affect how the participant's brain responds to stimulation. Once the participant is fitted with this equipment, the participant will complete two interactive EEG tasks, then 2-minute resting state EEG with the participant's eyes closed, then a 5-minute resting state EEG with the participant's eyes open.

Following these recordings, participants will respond to additional questionnaires. Immediately following this, the participant will receive 40 minutes of stimulation (tACS or sham tACS). During this stimulation, participants will sit comfortably upright and awake.

After stimulation has completed, participants will respond to additional questionnaires. Once completed, participants will then complete an additional 5-minute resting state EEG with the participant's eyes open, as well as complete one of the additional interactive EEG tasks.

Finally, participants will respond to a blinding questionnaire to assess if the participant thought that the participant received stimulation. Once complete, the participant will leave. This session is estimated to last about 4 hours.

• XCSITE100 Stimulator Sham (Device), also known as Sham tACS: The participant will receive up to one minute of tACS stimulation until the stimulation fades. Sham stimulation mimics the skin sensations a participant would experience during a tACS session.
• XCSITE100 Stimulator tACS (Device), also known as tACS: Transcranial alternating current stimulation (tACS) is a method of noninvasive brain stimulation in which weak electrical current are applied to the scalp in a sine wave pattern to induce cortical oscillations at the frequency at which they are applied.

Primary outcomes

• Change in Alpha Frequency Electrical Activity in Left Frontal Cortex From Stimulation [5 minute recording before and after intervention]: Fast Fourier transform is applied to 5 minutes of EEG data before and after intervention. Primary outcome is the difference in alpha frequency amplitude (8-12 Hz) in the left frontal cortex from baseline as a result of intervention.

Sex: All, ages: 18 Years to 65 Years, accepts healthy volunteers

Inclusion Criteria for individuals with depressed mood:

* Ages 18-65 years
* Hamilton Depression Rating Scale score >8
* Capacity to understand all relevant risks and potential benefits of the study (informed consent)
* Low suicide risk which will be determined through the use of both the Structured Clinical Interview for the DSM-5 and by scoring less than 3 (0,1, or 2) in the Hamilton rating depression scale.
* Negative pregnancy test for female participants

Exclusion Criteria for individuals with depressed mood:

* DSM-5 diagnosis of alcohol of substance abuse (other than nicotine) within the 12 months
* DSM-5 diagnosis of alcohol or substance dependence (other than nicotine) within the last 12 months
* DSM-5 diagnosis of personality disorder
* Eating disorder (current or within the past 3 months)
* Anything that, in the opinion of the investigator, would place the participant at increased risk or preclude the participant's full compliance with or completion of the study
* Neurological disorders, including but not limited to history of seizures (except childhood febrile seizures and electro-convulsive therapy (ECT) induced seizures), dementia, history of stroke, Parkinson's disease, multiple sclerosis, cerebral aneurysm.
* Medical or neurological illness (unstable cardiac disease, AIDS, malignancy, liver or renal impairment) or treatment for a medical disorder that could interfere with study participation
* History of traumatic brain injury, reoccurring seizures or later cognitive rehabilitation or causing cognitive sequelae
* History of childhood trauma (determined by the Childhood Trauma Questionnaire)
* Prior brain surgery
* Any brain devices/implants, including cochlear implants and aneurysm clips
* Co-morbid neurological condition (i.e. seizure disorder, brain tumor)
* Use of illicit drugs, confirmed by a drug test
* Non English speakers
* Pregnant or nursing females
* Current use of benzodiazepines or anti-epileptic drugs

Inclusion Criteria for healthy controls:

* Ages 18-65 years
* Hamilton Depression Rating Scale score ≤8
* Capacity to understand all relevant risks and potential benefits of the study (informed consent)
* Negative pregnancy test for female participants

Exclusion Criteria for healthy controls:

* History of major neurological or psychiatric illness, including epilepsy
* Medication use associated with neurological or psychiatric illnesses
* Currently undergoing counseling or psychotherapy treatment for depression, anxiety, eating disorders, PTSD or other behavioral conditions
* DSM-5 diagnosis of personality disorder
* First degree relative (parent, sibling, child) with major neurological or psychiatric illness
* Prior brain surgery
* Major head injury
* Any brain devices/implants (including cochlear implants and aneurysm clips)
* History of childhood trauma (determined by the Childhood Trauma Questionnaire)
* Use of illicit drugs, confirmed by a drug test
* Braids or other hair styling that prevents direct access to the scalp (if removal not possible)
* Skin allergies or very sensitive skin
* Non English speakers
* Pregnant or nursing females

Participant flow

Outcome results

• Change in Alpha Frequency Electrical Activity in Left Frontal Cortex From Stimulation (Primary), Mean, microvolts: Alpha Stimulation in Participants in a Depressive Episode -0.005 +/- 0.022; Sham Stimulation in Participants in a Depressive Episode 0.008 +/- 0.023; Alpha Stimulation in Healthy Participants 0.004 +/- 0.017; Sham Stimulation in Healthy Participants 0.007 +/- 0.022 (p 0.0852)

Adverse events

Time frame: Adverse events were collected over the 5 hours of the single session experiment

Other adverse events by term

• Study Protocol and Statistical Analysis Plan (PDF, 2019-04-29)

• Flavio Frohlich, PhD, Principal investigator, UNC Chapel Hill

NIH grants: R01MH101547