<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT01701284</url>
  </required_header>
  <id_info>
    <org_study_id>NU 12CC12</org_study_id>
    <secondary_id>NCI-2012-01691</secondary_id>
    <nct_id>NCT01701284</nct_id>
  </id_info>
  <brief_title>Repetitive Transcranial Magnetic Stimulation in Cancer Patients With Depression and Anxiety</brief_title>
  <acronym>rTMSinCP</acronym>
  <official_title>A Randomized Open-Label Pilot Trial To Evaluate The Safety And Efficacy Of Repetitive Transcranial Magnetic Stimulation In Cancer Patients With Depression And Anxiety</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>Northwestern University</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
    <collaborator>
      <agency>Neuronetics</agency>
      <agency_class>Other</agency_class>
    </collaborator>
  </sponsors>
  <source>Northwestern University</source>
  <oversight_info>
    <has_dmc>Yes</has_dmc>
  </oversight_info>
  <brief_summary>
    <textblock>
      Cancer is a leading cause of mortality and morbidity worldwide. In addition, cancer is&#xD;
      associated with high rates of depression and anxiety among its sufferers, and cancer patients&#xD;
      with depression usually have worse treatment outcomes and long-term survival. Surprisingly,&#xD;
      many cancer patients with depression do not receive treatment for their depression, perhaps&#xD;
      because treatments for cancer-related depression are usually adapted from those used in&#xD;
      non-cancer populations and may not be suitable for cancer patients. Moreover, cancer patients&#xD;
      with depression are more likely to have a long latency of anti-depressant drug action,&#xD;
      negative drug-drug interactions with cancer chemotherapies and an increased susceptibility&#xD;
      for systemic side effects. Repetitive transcranial magnetic stimulation (rTMS) is a new&#xD;
      treatment modality for depression that affects the brain directly with no systemic side&#xD;
      effects and poses no potential for drug-drug interactions. rTMS therapy was recently cleared&#xD;
      by the FDA as an antidepressant treatment for treatment-resistant Major Depressive Disorder,&#xD;
      and now is being evaluated for a wide array of additional psychiatric indications. This&#xD;
      randomized, open label, two-arm, pilot study will investigate the safety, tolerability,&#xD;
      feasibility and the efficacy of two forms of rTMS (i.e., left (fast) and right (slow) sided&#xD;
      rTMS) in cancer-related depression. The study hypotheses are that rTMS will significantly&#xD;
      reduce symptoms of depression and that right-sided slow rTMS will be more effective than&#xD;
      left-sided fast rTMS for the treatment of severe anxiety.&#xD;
    </textblock>
  </brief_summary>
  <overall_status>Active, not recruiting</overall_status>
  <start_date>December 2012</start_date>
  <completion_date type="Anticipated">February 2023</completion_date>
  <primary_completion_date type="Anticipated">February 2023</primary_completion_date>
  <phase>N/A</phase>
  <study_type>Interventional</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <allocation>Randomized</allocation>
    <intervention_model>Parallel Assignment</intervention_model>
    <primary_purpose>Treatment</primary_purpose>
    <masking>None (Open Label)</masking>
  </study_design_info>
  <primary_outcome>
    <measure>Overall change in depression severity</measure>
    <time_frame>0, 2, 4, and 6 weeks</time_frame>
    <description>Overall change in depression severity (as measured by the Hamilton Depression Rating Scale) will be measured for each treatment arm.</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Relative change in depression severity</measure>
    <time_frame>0, 2, 4, and 6 weeks</time_frame>
    <description>Change in depression severity (as measured by the Hamilton Depression Rating Scale) for a treatment arm will be compared relative to change in depression severity in the other treatment arm.</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Presence and changes in severity of side effects</measure>
    <time_frame>0, 2, 4, and 6 weeks</time_frame>
    <description>At weeks 2, 4 and 6, UKU Side Effects Rating Scale scores will be compared to baseline UKU scores to determine changes in presence and severity of side effects. Additionally, UKU scores at weeks 2, 4, and 6 will be used to determine probability that side effects are related to intervention.</description>
  </primary_outcome>
  <secondary_outcome>
    <measure>Overall change in anxiety severity</measure>
    <time_frame>Weekly (starting with week 0 through week 6)</time_frame>
    <description>Overall change in anxiety severity (as measured by the Hamilton Anxiety Rating Scale) will be measured for each treatment arm.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Relative change in anxiety severity</measure>
    <time_frame>Weekly (starting with week 0 through week 6)</time_frame>
    <description>Change in anxiety severity (as measured by the Hamilton Anxiety Rating Scale) for a treatment arm will be compared relative to change in anxiety severity in the other treatment arm.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Correlation of anxiety with change in depression severity</measure>
    <time_frame>0 and 6 weeks</time_frame>
    <description>Baseline anxiety severity (as measured by the Hamilton Anxiety Rating Scale) will be correlated with change (from baseline to end of week 6) in depression severity (as measured by the Hamilton Depression Rating Scale) for each treatment arm and compared.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Correlation of anxiety with harm avoidance personality trait</measure>
    <time_frame>Baseline</time_frame>
    <description>Baseline anxiety severity (as measured by the Hamilton Anxiety Rating Scale) will be correlated with Harm Avoidance scores from the TCI personality inventory</description>
  </secondary_outcome>
  <number_of_arms>2</number_of_arms>
  <enrollment type="Actual">20</enrollment>
  <condition>Cancer in Remission (Any Type or Stage)</condition>
  <condition>Depression</condition>
  <condition>Anxiety</condition>
  <arm_group>
    <arm_group_label>Right-Sided Low-Frequency rTMS</arm_group_label>
    <arm_group_type>Experimental</arm_group_type>
    <description>Participants will have rTMS administered at 1Hz to the right dorsolateral Prefrontal Cortex (dlPFC) once a day for 40 minutes, 5 days a week, for a total of six weeks.</description>
  </arm_group>
  <arm_group>
    <arm_group_label>Left-Sided High-Frequency rTMS</arm_group_label>
    <arm_group_type>Experimental</arm_group_type>
    <description>Participants will have rTMS administered at 10Hz to the left dorsolateral Prefrontal Cortex (dlPFC) once a day for 40 minutes, 5 days a week, for a total of six weeks.</description>
  </arm_group>
  <intervention>
    <intervention_type>Device</intervention_type>
    <intervention_name>Repetitive Transcranial Magnetic Stimulation (rTMS)</intervention_name>
    <arm_group_label>Left-Sided High-Frequency rTMS</arm_group_label>
    <arm_group_label>Right-Sided Low-Frequency rTMS</arm_group_label>
    <other_name>Neurostar TMS Therapy(R) System</other_name>
  </intervention>
  <eligibility>
    <criteria>
      <textblock>
        Inclusion Criteria:&#xD;
&#xD;
          -  Female&#xD;
&#xD;
          -  Age 22-80&#xD;
&#xD;
          -  Had a previous diagnosis of cancer (any type or stage) confirmed by official medical&#xD;
             records&#xD;
&#xD;
          -  Has a DSM IV diagnosis of Major Depressive Disorder&#xD;
&#xD;
          -  Has a HAM-D 24-item score of more than 20&#xD;
&#xD;
          -  Failed to receive satisfactory improvement from one prior antidepressant medication at&#xD;
             or above the minimal effective dose and duration in the current depressive episode&#xD;
&#xD;
          -  All participants must have given signed, informed consent prior to registration in&#xD;
             study&#xD;
&#xD;
        Exclusion Criteria:&#xD;
&#xD;
          -  Participant had breast cancer with brain metastases&#xD;
&#xD;
          -  There is evidence of the disease at the time of entry into the trial&#xD;
&#xD;
          -  Presence or recent history of other concurrent cancers, with the following exceptions:&#xD;
&#xD;
               -  Participants with completely treated basal or squamous skin cancers can be&#xD;
                  included in the study if their physicians deem that they are medically stable&#xD;
&#xD;
               -  Participants with completely treated in situ carcinoma of the breast or cervix&#xD;
                  may be included in the study if they have not had chemotherapy within the past&#xD;
                  month and their physicians deem that they are medically stable&#xD;
&#xD;
               -  Participants with pre-cancerous lesions in the colon can be included in the study&#xD;
                  if they have not had chemotherapy within the past month and their physicians deem&#xD;
                  that they are medically stable&#xD;
&#xD;
          -  Participant had recent surgery (within two weeks)&#xD;
&#xD;
          -  Participant is undergoing chemotherapy&#xD;
&#xD;
          -  Participant is pregnant or nursing&#xD;
&#xD;
          -  Participant has any metallic object in or around their head&#xD;
&#xD;
          -  Participant has a pacemaker&#xD;
&#xD;
          -  Has unstable suicidal ideation as determined by the patient's treating psychiatrist&#xD;
&#xD;
          -  Substance use disorder within the prior six months&#xD;
&#xD;
          -  Significant history of head injury/trauma as defined by loss of consciousness for more&#xD;
             than 1 hour&#xD;
&#xD;
          -  Recurring seizures resulting from the head injury&#xD;
&#xD;
          -  Clear cognitive sequelae from the head injury and cognitive rehabilitation following&#xD;
             the injury&#xD;
&#xD;
          -  Any disorder that would predispose the participant to seizures&#xD;
&#xD;
          -  Use of concomitant medications that substantially increase seizure risk. Such drugs&#xD;
             could include neuroleptics (ex. haloperidol, droperidol), clozapine, tricyclic&#xD;
             antidepressants (ex. amoxapine, clomipramine), bupropion (particularly the immediate&#xD;
             release - IR - formulation) donepezil, psychostimulants (ex. methylphenidate),&#xD;
             theophylline and/or other drugs that reduce the seizure threshold. For individuals on&#xD;
             any of these medicines, a study clinician will evaluate the drugs and doses to&#xD;
             determine the risks and benefits. These will then be discussed with the individual's&#xD;
             Primary Care Physician to determine if the individual should be excluded from the&#xD;
             study.&#xD;
      </textblock>
    </criteria>
    <gender>Female</gender>
    <minimum_age>22 Years</minimum_age>
    <maximum_age>80 Years</maximum_age>
    <healthy_volunteers>No</healthy_volunteers>
  </eligibility>
  <overall_official>
    <last_name>Mehmet Dokucu, MD, PhD</last_name>
    <role>Principal Investigator</role>
    <affiliation>Northwestern University</affiliation>
  </overall_official>
  <location>
    <facility>
      <name>Northwestern University</name>
      <address>
        <city>Chicago</city>
        <state>Illinois</state>
        <zip>60611</zip>
        <country>United States</country>
      </address>
    </facility>
  </location>
  <location_countries>
    <country>United States</country>
  </location_countries>
  <reference>
    <citation>Burgess C, Cornelius V, Love S, Graham J, Richards M, Ramirez A. Depression and anxiety in women with early breast cancer: five year observational cohort study. BMJ. 2005 Mar 26;330(7493):702. doi: 10.1136/bmj.38343.670868.D3. Epub 2005 Feb 4.</citation>
    <PMID>15695497</PMID>
  </reference>
  <reference>
    <citation>George MS, Lisanby SH, Avery D, McDonald WM, Durkalski V, Pavlicova M, Anderson B, Nahas Z, Bulow P, Zarkowski P, Holtzheimer PE 3rd, Schwartz T, Sackeim HA. Daily left prefrontal transcranial magnetic stimulation therapy for major depressive disorder: a sham-controlled randomized trial. Arch Gen Psychiatry. 2010 May;67(5):507-16. doi: 10.1001/archgenpsychiatry.2010.46.</citation>
    <PMID>20439832</PMID>
  </reference>
  <reference>
    <citation>Janicak PG, O'Reardon JP, Sampson SM, Husain MM, Lisanby SH, Rado JT, Heart KL, Demitrack MA. Transcranial magnetic stimulation in the treatment of major depressive disorder: a comprehensive summary of safety experience from acute exposure, extended exposure, and during reintroduction treatment. J Clin Psychiatry. 2008 Feb;69(2):222-32. doi: 10.4088/jcp.v69n0208.</citation>
    <PMID>18232722</PMID>
  </reference>
  <reference>
    <citation>Machado S, Paes F, Velasques B, Teixeira S, Piedade R, Ribeiro P, Nardi AE, Arias-Carrion O. Is rTMS an effective therapeutic strategy that can be used to treat anxiety disorders? Neuropharmacology. 2012 Jan;62(1):125-34. doi: 10.1016/j.neuropharm.2011.07.024. Epub 2011 Jul 27.</citation>
    <PMID>21807002</PMID>
  </reference>
  <reference>
    <citation>O'Reardon JP, Solvason HB, Janicak PG, Sampson S, Isenberg KE, Nahas Z, McDonald WM, Avery D, Fitzgerald PB, Loo C, Demitrack MA, George MS, Sackeim HA. Efficacy and safety of transcranial magnetic stimulation in the acute treatment of major depression: a multisite randomized controlled trial. Biol Psychiatry. 2007 Dec 1;62(11):1208-16. doi: 10.1016/j.biopsych.2007.01.018. Epub 2007 Jun 14.</citation>
    <PMID>17573044</PMID>
  </reference>
  <reference>
    <citation>Paes F, Machado S, Arias-Carrion O, Velasques B, Teixeira S, Budde H, Cagy M, Piedade R, Ribeiro P, Huston JP, Sack AT, Nardi AE. The value of repetitive transcranial magnetic stimulation (rTMS) for the treatment of anxiety disorders: an integrative review. CNS Neurol Disord Drug Targets. 2011 Aug;10(5):610-20. doi: 10.2174/187152711796234943.</citation>
    <PMID>21631403</PMID>
  </reference>
  <reference>
    <citation>Schutter DJ. Antidepressant efficacy of high-frequency transcranial magnetic stimulation over the left dorsolateral prefrontal cortex in double-blind sham-controlled designs: a meta-analysis. Psychol Med. 2009 Jan;39(1):65-75. doi: 10.1017/S0033291708003462. Epub 2008 Apr 30.</citation>
    <PMID>18447962</PMID>
  </reference>
  <reference>
    <citation>Slotema CW, Blom JD, Hoek HW, Sommer IE. Should we expand the toolbox of psychiatric treatment methods to include Repetitive Transcranial Magnetic Stimulation (rTMS)? A meta-analysis of the efficacy of rTMS in psychiatric disorders. J Clin Psychiatry. 2010 Jul;71(7):873-84. doi: 10.4088/JCP.08m04872gre. Epub 2010 Mar 9.</citation>
    <PMID>20361902</PMID>
  </reference>
  <verification_date>January 2023</verification_date>
  <study_first_submitted>October 3, 2012</study_first_submitted>
  <study_first_submitted_qc>October 3, 2012</study_first_submitted_qc>
  <study_first_posted type="Estimate">October 5, 2012</study_first_posted>
  <last_update_submitted>January 11, 2023</last_update_submitted>
  <last_update_submitted_qc>January 11, 2023</last_update_submitted_qc>
  <last_update_posted type="Actual">January 12, 2023</last_update_posted>
  <responsible_party>
    <responsible_party_type>Principal Investigator</responsible_party_type>
    <investigator_affiliation>Northwestern University</investigator_affiliation>
    <investigator_full_name>Mehmet Dokucu</investigator_full_name>
    <investigator_title>Assistant Professor of Psychiatry</investigator_title>
  </responsible_party>
  <keyword>repetitive Transcranial Magnetic Stimulation</keyword>
  <keyword>Cancer Survivors</keyword>
  <keyword>Depression</keyword>
  <keyword>Anxiety</keyword>
  <condition_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Depression</mesh_term>
    <mesh_term>Depressive Disorder</mesh_term>
    <mesh_term>Anxiety Disorders</mesh_term>
  </condition_browse>
  <patient_data>
    <sharing_ipd>No</sharing_ipd>
  </patient_data>
  <!-- Results have not yet been posted for this study                                          -->
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT01701284
org study id: NU 12CC12
secondary id: NCI-2012-01691
nct id: NCT01701284
lead sponsor: 
collaborator: 
has dmc: Yes
Cancer is a leading cause of mortality and morbidity worldwide. In addition, cancer is
      associated with high rates of depression and anxiety among its sufferers, and cancer patients
      with depression usually have worse treatment outcomes and long-term survival. Surprisingly,
      many cancer patients with depression do not receive treatment for their depression, perhaps
      because treatments for cancer-related depression are usually adapted from those used in
      non-cancer populations and may not be suitable for cancer patients. Moreover, cancer patients
      with depression are more likely to have a long latency of anti-depressant drug action,
      negative drug-drug interactions with cancer chemotherapies and an increased susceptibility
      for systemic side effects. Repetitive transcranial magnetic stimulation (rTMS) is a new
      treatment modality for depression that affects the brain directly with no systemic side
      effects and poses no potential for drug-drug interactions. rTMS therapy was recently cleared
      by the FDA as an antidepressant treatment for treatment-resistant Major Depressive Disorder,
      and now is being evaluated for a wide array of additional psychiatric indications. This
      randomized, open label, two-arm, pilot study will investigate the safety, tolerability,
      feasibility and the efficacy of two forms of rTMS (i.e., left (fast) and right (slow) sided
      rTMS) in cancer-related depression. The study hypotheses are that rTMS will significantly
      reduce symptoms of depression and that right-sided slow rTMS will be more effective than
      left-sided fast rTMS for the treatment of severe anxiety.
allocation: Randomized
intervention model: Parallel Assignment
primary purpose: Treatment
masking: None (Open Label)
measure: Overall change in depression severity
time frame: 0, 2, 4, and 6 weeks
description: Overall change in depression severity (as measured by the Hamilton Depression Rating Scale) will be measured for each treatment arm.
measure: Relative change in depression severity
time frame: 0, 2, 4, and 6 weeks
description: Change in depression severity (as measured by the Hamilton Depression Rating Scale) for a treatment arm will be compared relative to change in depression severity in the other treatment arm.
measure: Presence and changes in severity of side effects
time frame: 0, 2, 4, and 6 weeks
description: At weeks 2, 4 and 6, UKU Side Effects Rating Scale scores will be compared to baseline UKU scores to determine changes in presence and severity of side effects. Additionally, UKU scores at weeks 2, 4, and 6 will be used to determine probability that side effects are related to intervention.
measure: Overall change in anxiety severity
time frame: Weekly (starting with week 0 through week 6)
description: Overall change in anxiety severity (as measured by the Hamilton Anxiety Rating Scale) will be measured for each treatment arm.
measure: Relative change in anxiety severity
time frame: Weekly (starting with week 0 through week 6)
description: Change in anxiety severity (as measured by the Hamilton Anxiety Rating Scale) for a treatment arm will be compared relative to change in anxiety severity in the other treatment arm.
measure: Correlation of anxiety with change in depression severity
time frame: 0 and 6 weeks
description: Baseline anxiety severity (as measured by the Hamilton Anxiety Rating Scale) will be correlated with change (from baseline to end of week 6) in depression severity (as measured by the Hamilton Depression Rating Scale) for each treatment arm and compared.
measure: Correlation of anxiety with harm avoidance personality trait
time frame: Baseline
description: Baseline anxiety severity (as measured by the Hamilton Anxiety Rating Scale) will be correlated with Harm Avoidance scores from the TCI personality inventory
arm group label: Right-Sided Low-Frequency rTMS
arm group type: Experimental
description: Participants will have rTMS administered at 1Hz to the right dorsolateral Prefrontal Cortex (dlPFC) once a day for 40 minutes, 5 days a week, for a total of six weeks.
arm group label: Left-Sided High-Frequency rTMS
arm group type: Experimental
description: Participants will have rTMS administered at 10Hz to the left dorsolateral Prefrontal Cortex (dlPFC) once a day for 40 minutes, 5 days a week, for a total of six weeks.
intervention type: Device
intervention name: Repetitive Transcranial Magnetic Stimulation (rTMS)
arm group label: Left-Sided High-Frequency rTMS
arm group label: Right-Sided Low-Frequency rTMS
other name: Neurostar TMS Therapy(R) System
criteria: 
gender: Female
minimum age: 22 Years
maximum age: 80 Years
healthy volunteers: No
last name: Mehmet Dokucu, MD, PhD
role: Principal Investigator
affiliation: Northwestern University
facility: 
country: United States
citation: Burgess C, Cornelius V, Love S, Graham J, Richards M, Ramirez A. Depression and anxiety in women with early breast cancer: five year observational cohort study. BMJ. 2005 Mar 26;330(7493):702. doi: 10.1136/bmj.38343.670868.D3. Epub 2005 Feb 4.
PMID: 15695497
citation: George MS, Lisanby SH, Avery D, McDonald WM, Durkalski V, Pavlicova M, Anderson B, Nahas Z, Bulow P, Zarkowski P, Holtzheimer PE 3rd, Schwartz T, Sackeim HA. Daily left prefrontal transcranial magnetic stimulation therapy for major depressive disorder: a sham-controlled randomized trial. Arch Gen Psychiatry. 2010 May;67(5):507-16. doi: 10.1001/archgenpsychiatry.2010.46.
PMID: 20439832
citation: Janicak PG, O'Reardon JP, Sampson SM, Husain MM, Lisanby SH, Rado JT, Heart KL, Demitrack MA. Transcranial magnetic stimulation in the treatment of major depressive disorder: a comprehensive summary of safety experience from acute exposure, extended exposure, and during reintroduction treatment. J Clin Psychiatry. 2008 Feb;69(2):222-32. doi: 10.4088/jcp.v69n0208.
PMID: 18232722
citation: Machado S, Paes F, Velasques B, Teixeira S, Piedade R, Ribeiro P, Nardi AE, Arias-Carrion O. Is rTMS an effective therapeutic strategy that can be used to treat anxiety disorders? Neuropharmacology. 2012 Jan;62(1):125-34. doi: 10.1016/j.neuropharm.2011.07.024. Epub 2011 Jul 27.
PMID: 21807002
citation: O'Reardon JP, Solvason HB, Janicak PG, Sampson S, Isenberg KE, Nahas Z, McDonald WM, Avery D, Fitzgerald PB, Loo C, Demitrack MA, George MS, Sackeim HA. Efficacy and safety of transcranial magnetic stimulation in the acute treatment of major depression: a multisite randomized controlled trial. Biol Psychiatry. 2007 Dec 1;62(11):1208-16. doi: 10.1016/j.biopsych.2007.01.018. Epub 2007 Jun 14.
PMID: 17573044
citation: Paes F, Machado S, Arias-Carrion O, Velasques B, Teixeira S, Budde H, Cagy M, Piedade R, Ribeiro P, Huston JP, Sack AT, Nardi AE. The value of repetitive transcranial magnetic stimulation (rTMS) for the treatment of anxiety disorders: an integrative review. CNS Neurol Disord Drug Targets. 2011 Aug;10(5):610-20. doi: 10.2174/187152711796234943.
PMID: 21631403
citation: Schutter DJ. Antidepressant efficacy of high-frequency transcranial magnetic stimulation over the left dorsolateral prefrontal cortex in double-blind sham-controlled designs: a meta-analysis. Psychol Med. 2009 Jan;39(1):65-75. doi: 10.1017/S0033291708003462. Epub 2008 Apr 30.
PMID: 18447962
citation: Slotema CW, Blom JD, Hoek HW, Sommer IE. Should we expand the toolbox of psychiatric treatment methods to include Repetitive Transcranial Magnetic Stimulation (rTMS)? A meta-analysis of the efficacy of rTMS in psychiatric disorders. J Clin Psychiatry. 2010 Jul;71(7):873-84. doi: 10.4088/JCP.08m04872gre. Epub 2010 Mar 9.
PMID: 20361902
responsible party type: Principal Investigator
investigator affiliation: Northwestern University
investigator full name: Mehmet Dokucu
investigator title: Assistant Professor of Psychiatry
mesh term: Depression
mesh term: Depressive Disorder
mesh term: Anxiety Disorders
sharing ipd: No