Neuromodulatory treatments for psychiatric disease: A comprehensive survey of the clinical trial landscape

Highlights

• Clinical research involving psychiatric neuromodulation is a growing field.
• Most trials focus on depression, schizophrenia, or substance use disorders.
• ¾ of trials utilize non-convulsive non-invasive stimulation modalities like TMS.
• Trials span 37 countries; the largest contributors are the United States and China.
• Dorsolateral prefrontal cortex accounts for over ½ of focal neuromodulation trial targets.

Background

Numerous neuromodulatory therapies are currently under investigation or in clinical use for the treatment of psychiatric conditions.

Objective/hypothesis

We sought to catalogue past and present human research studies on psychiatric neuromodulation and identify relevant trends in this field.

Methods

ClinicalTrials.gov (https://www.clinicaltrials.gov/) and the International Clinical Trials Registry Platform (https://www.who.int/ictrp/en/) were queried in March 2020 for trials assessing the outcome of neuromodulation for psychiatric disorders. Relevant trials were categorized by variables such as neuromodulation modality, country, brain target, publication status, design, and funding source.

Results

From 72,086 initial search results, 1252 unique trials were identified. The number of trials registered annually has consistently increased. Half of all trials were active and a quarter have translated to publications. The largest proportion of trials involved depression (45%), schizophrenia (18%), and substance use disorders (14%). Trials spanned 37 countries; China, the second largest contributor (13%) after the United States (28%), has increased its output substantially in recent years. Over 75% of trials involved non-convulsive non-invasive modalities (e.g., transcranial magnetic stimulation), while convulsive (e.g., electroconvulsive therapy) and invasive modalities (e.g., deep brain stimulation) were less represented. 72% of trials featured approved or cleared interventions. Characteristic inter-modality differences were observed with respect to enrollment size, trial design/phase, and funding. Dorsolateral prefrontal cortex accounted for over half of focal neuromodulation trial targets. The proportion of trials examining biological correlates of neuromodulation has increased.

Conclusion(s)

These results provide a comprehensive overview of the state of psychiatric neuromodulation research, revealing the growing scope and internationalism of this field.