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Post Stroke DepressionNCT07423273

Hyperbaric Oxygen Therapy for Persistent Post Stroke Depression

A study testing hyperbaric oxygen therapy in people with Post Stroke Depression, run by Assaf-Harofeh Medical Center at 1 site in Israel.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

The study evaluates the effect of HBOT on depression in patients suffering from persistent symptoms of post stroke depression (PSD) in an double blind sham control study. Read more about this study

Who is it for?
Ages 50 to 85 years
Conditions the study is for
Post Stroke Depression
What is being tested?
hyperbaric oxygen therapy
Type of treatment
Medical device
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
142 participants
Where
1 siteIsrael
Study dates
8 Nov 2023to 1 Dec 2030
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 50 to 85 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age between 50 -85
  • Suffered an ischemic stroke 6 months to 7 years prior to their inclusion
  • Treated or being treated by antidepressants for at least 3 months
  • Diagnosis of PSD based on HDRS-17 score of 17 and above.
  • Stable psychological and pharmacological treatment for more than three months prior to inclusion.
  • Subject willing and able to read, understand and sign an informed consent.

Who cannot join

  • Inability to attend scheduled clinic visits and/or comply with the study protocol
  • Diagnosis of a psychiatric disorder prior to the recent stroke including: major depression, schizophrenia or bipolar disease.
  • Diagnosis of aphasia or major cognitive decline
  • History of Deep brain stimulation (DBS)
  • History of traumatic brain injury, brain tumors, brain surgery, chronic subdural haemorrhages, Epilepsy
  • Active malignancy
Show all 18Show fewer
  • Substance use at baseline.
  • History of other neurodegenerative diseases including Alzheimer's disease (AD), Parkinson's disease (PD), Lewy body dementia (LBD), Frontotemporal dementia (FTD), Multiple sclerosis (MS), Amyotrophic lateral sclerosis (ALS), Creutzfeld Jacob disease (CJD), Multisystem atrophy (MSA), Pseudobulbar palsy (PSP), Corticobasal degeneration (CBD), Wernicke Korsakoff syndrome
  • Serious suicidal ideation
  • Renal or liver insufficiency, electrolyte imbalances
  • Chronic heart failure with ejection fraction of 30 or less
  • HBOT for any reason prior to study enrolment
  • Chest pathology incompatible with pressure changes (including active asthma or COPD)
  • Ear or Sinus pathology incompatible with pressure changes (above 3 otolaryngologist visits a year)
  • An inability to perform an awake brain MRI
  • No evidence of vascular related lesions in the brain MRI
  • Active smoking
  • Participation in another study

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Shai a Efrati, MD contact

972549212866

efratishai@outlook.com

Israel1 site, 1 recruiting
  • The Sagol Center for Hyperbaric Medicine and Research Shamir Medical Center (Assaf Harofeh)

    Zrifin, 70300

    Shai Efrati, Prof, 972-8-9779393, efratishai@outlook.com

    Recruiting

Other trials in Israel

About this study

Official title: Hyperbaric Oxygen Therapy for Persistent Post Stroke Depression: A Prospective, Randomized, Double Blind Study

The study evaluates the effect of HBOT on depression in patients suffering from persistent symptoms of post stroke depression (PSD) in an double blind sham control study.

Read the detailed description

Post-stroke depression (PSD) is a prevalent mental health complication, affecting approximately 33% of stroke survivors. Its occurrence not only hinders rehabilitation and recovery from motor and cognitive deficits post-stroke but also escalates the risk of subsequent neurovascular events. Both biological and psychological factors are instrumental in the onset of PSD.

Ischemia plays a pivotal role in the development of long-term PSD due to its impact on specific brain regions, neurotransmitter systems, neural connectivity, inflammatory responses, and mitochondrial dysfunction.

brain ischemia can instigate a protracted cycle of inflammation, levels and functions of neurotransmitters, impaired mitochondrial function, that directly impinges on the brain's ability to undergo neuroplastic changes. This relationship underscores the importance of targeting the cure of brain ischemia in therapeutic strategies for PSD. Managing the brain ischemia could potentially salvage neuroplasticity and mitigate the mental and cognitive decline associated with PSD.

The new protocols of hyperbaric oxygen therapy (HBOT), using the hyperoxic-hypoxic paradox (HHP), is one of the first therapeutic intervention already in clinical use today for the specific goal of inducing regeneration of damaged brain tissue.

Cumulative data from recent years provide convincing evidence that HBOT can induce neuroplasticity leading to repair of chronically impaired brain functions and improved quality of life in post-stroke patients.

Both neurological and cognitive functions were improved even years after the stroke.

The observed restoration of neuronal activity in the metabolically dysfunctional stunned areas indicates that HBOT is a potent means of delivering sufficient oxygen needed for activation of neuroplasticty and restoration of impaired functions.

HBOT was found to be effective in small clinical trials for patients suffering from post-stroke depression. In a meta-analysis done by Liang et al. the efficacy and safety of HBOT for PSD was evaluated. A total of 27 RCTs involving 2250 participants were identified. Patients in HBOT group had a higher response rate than patients in control group (response rate: 69.4% vs 51.2%, odds ratio [OR] = 2.51, 95% confidence interval [CI] [1.83-3.43], P = 0.000). HBOT significantly reduced Hamilton Depression (HAMD).

The aim of the current study is to evaluate the effect of HBOT on depression in patients suffering from persistent symptoms of post stroke depression (PSD) in an double blind sham control study.

Being tested
hyperbaric oxygen therapy
Keywords
hyperbaric oxygen therapy

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • hyperbaric oxygen therapyDevice

    The HBOT protocol consists of 60 daily sessions, five times per week, each session lasting 90 minutes.

    Investigational product:

    Multiplace hyperbaric oxygen chamber (Haux, Germany) located at the Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf-Harofeh) Medical Center, Israel.

Study groups in NCT07423273
Study groupRoleWhat they receive
hyperbaric oxygen therapy (HBOT) active treatmentActive comparatorThe HBOT protocol consists of 60 daily sessions, five times per week, within a three months' period. Then there will be a follow-up period for 3 months without any investigated intervention. each session lasting 90 minutes, of 100% oxygen at 2 ATA and 5-minute air breaks every 20 minutes.
Receives: Device: hyperbaric oxygen therapy
Sham hyperbaric oxygen therapy (HBOT) Sham treatmentSham comparatorAll the conditions provided in the HBOT intervention will be provided in the sham intervention. However, in contrast to the HBOT, each session includes breathing 21% oxygen by mask while in the same multiplace chamber. SHAM pressure will go up to 1.2 ATA during the first five minutes of the session (to simulate the pressure sensation in the ears), and then decrease during the next 5 minutes to 1.03 ATA for 90 minutes with 5-minute air breaks, every 20 minutes The initial 1.2 ATA level will provide a minimal pressure sensation in the ears, with the same nurse advice on pumping the ears. In the last five minutes of the session, the air will be circulated again with its related noises. Sham and HBOT sessions will never be adjacent, so subjects from the two groups cannot meet and discuss the session and its effects.
Receives: Device: hyperbaric oxygen therapy

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. PSD symptoms

    Depression severity will be evaluated by structured interview based on the HDRS-17 guided structural questioner (Hamilton Depression Rating Scale from 0-53 ,Levels of depression is categorized according to the following accepted criteria:

    • Not depressed: 0-7
    • Mild (subthreshold): 8-13
    • Moderate: 14-18
    • Severe: 19-22
    • Very severe: >23)

    Measured: Change from Baseline immediately after the intervention

Secondary outcomes (24)
  1. depression

    Beck depression inventory II. Each answer is scored on a scale value of 0 to 3 . The score ranges between 0 and 63, with higher scores indicating more severe depression symptoms.

    Measured: Change from Baseline immediately after the intervention

  2. Short form health survey (sf-36)

    Quality of life questionnaire, scale of 0-100, higher score means better outcome

    Measured: at baseline, 3 months, 6 months

  3. psychological distress

    The Brief Symptom Inventory-18 (BSI-18). self-report questionnaire which generates a summary scale, the global stress index (GSI), and three subscales: depression, anxiety, and somatization. Each item is rated on a 5-point scale, with distress ratings ranging from 0 (not at all) to 4 (extremely) .

    Measured: Change from Baseline immediately after the intervention

  4. health status

    Changes will be measured by The Stroke Impact Scale (SIS). The SIS version 3.0 includes 59 items, An extra question on stroke recovery asks that the client rate on a scale from 0 - 100 how much the client feels that he/she has recovered from his/her stroke.

    Measured: Change from Baseline immediately after the intervention

  5. independent living skills

    Changes will be measured by Instrumental Activities of Daily Living (IADL) Scale. There are eight domains of function measured with the Lawton IADL scale. Clients are scored according to their highest level of functioning in that category. A summary score ranges from 0 (low function, dependent) to 8 (high function, independent) for women, and 0 through 5 for men.

    Measured: Change from Baseline immediately after the intervention

  6. NeuroTrax

    computerized cognitive evaluation battery. each outcome parameter will be normalized and fit to an IQ-like scale (mean=100, STD=15), according to the participants' age and education.

    Measured: at baseline, 3 months

  7. MoCA

    Montreal Cognitive Assessment (MoCA). The maximum MoCA score is 30 points, with a 1-point scoring correction for individuals with 12 years of education or less. A score of 26 or above is considered normal and a score lower than 26 has been considered to be the optimal cutoff point for diagnosis of cognitive impairment.

    Measured: Change from Baseline immediately after the intervention

  8. CANTAB Cambridge Neuropsychological Test Automated Battery

    computerized cognitive evaluation battery test, divided into 2 tasks: 1- Multitasking test (MTT)- attention, reaction time and executive functions, Multitasking test Incongruency cost - A higher incongruency cost indicates that the subjects takes longer to process conflicting information. 2-Paired associated learning (PAL)- visual memory and new learning, PAL Number of Patterns Reached (0-8), PAL Total Errors (Adjusted) (0-64), PAL Total Attempts(0-64).

    Measured: at baseline, 3 months

  9. MRI Imaging

    At each of the evaluations, patients will undergo structural and functional MRI scanning. Images will be acquired on Vida 3 Tesla Scanner, configured with a 64-channel receiver head coils (Siemens Healthcare, Erlangen, Germany) at Shamir medical center radiology department.

    Measured: Change from Baseline immediately after the intervention

  10. fMRI Imaging

    Resting state fMRI(rsfMRI or R-fMRI)- a method of functional brain imaging that can be used to evaluate regional interactions that occur when a subject is not performing an explicit task. This resting brain activity is observed through changes in blood flow in the brain which creates what is referred to as a blood-oxygen-level dependent (BOLD) signal that can be measured using functional Magnetic Resonance Imaging (fMRI).

    Measured: Change from Baseline immediately after the intervention

  11. Physical, Neurological and functional evaluation

    A general physical and neurological evaluation will be done. NIHSS - The National Institutes of Health Stroke Scale, or NIH Stroke Scale (NIHSS), will be used as part of the neurological evaluation to objectively quantify the impairment caused by the stroke. The NIHSS is composed of 11 items, each of which scores a specific ability between a 0 and 4 .For each item, a score of 0 typically indicates normal function in that specific ability, while a higher score is indicative of some level of impairment.

    Measured: Change from Baseline immediately after the intervention

  12. electrical brain activity

    Quantitative EEG (qEEG) including task related EEG analysis. EEG analysis for each state within subject and between subjects will include frequency analysis (peak frequency and relative power), oscillations (proportions of the different bands alpha, beta, theta, delta activities) and power spectra distribution.

    Measured: Change from Baseline immediately after the intervention

  13. Inflammatory cytokines 1

    blood tests will include Inflammatory markers: IL-1 (IL-1β): pg/mL

    Measured: Change from Baseline immediately after the intervention

  14. Inflammatory cytokines 2

    blood tests will include Inflammatory markers: IL-6: pg/mL

    Measured: Change from Baseline immediately after the intervention

  15. Inflammatory cytokines 3

    blood tests will include Inflammatory markers: Tumor necrosis factor-alpha (TNF-α): pg/mL

    Measured: Change from Baseline immediately after the intervention

  16. Inflammatory cytokines 4

    blood tests will include Inflammatory markers: hsCRP (high-sensitivity C-reactive protein): mg/L

    Measured: Change from Baseline immediately after the intervention

  17. Inflammatory cytokines 5

    blood tests will include Inflammatory markers: Exosomes: particles/mL (by NTA) or µg protein/mL (by protein assay)

    Measured: Change from Baseline immediately after the intervention

  18. Inflammatory cytokines 6

    blood tests will include Inflammatory markers: Serum VEGF: pg/mL

    Measured: Change from Baseline immediately after the intervention

  19. Inflammatory cytokines 7

    blood tests will include Inflammatory markers: Testosterone (serum): ng/dL or nmol/L

    Measured: Change from Baseline immediately after the intervention

  20. Inflammatory cytokines 8

    blood tests will include Inflammatory markers: Estradiol (E2, serum): pg/mL or pmol/L

    Measured: Change from Baseline immediately after the intervention

  21. Inflammatory cytokines 9

    blood tests will include Inflammatory markers: DHEA-S (serum): µg/dL (commonly) or µmol/L

    Measured: Change from Baseline immediately after the intervention

  22. Inflammatory cytokines 10

    blood tests will include Inflammatory markers: Progesterone (serum): ng/mL or nmol/L

    Measured: Change from Baseline immediately after the intervention

  23. Inflammatory cytokines 11

    blood tests will include Inflammatory markers: Cortisol (serum): µg/dL or nmol/L

    Measured: Change from Baseline immediately after the intervention

  24. Inflammatory cytokines 12

    blood tests will include Inflammatory markers: Telomere length: kilobases (kb) or relative T/S ratio (qPCR, arbitrary units)

    Measured: Change from Baseline immediately after the intervention

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted20 Feb 2026
  2. Study start8 Nov 2023
  3. Primary completion1 Dec 2030 (estimated)
  4. Study completion1 Dec 2030 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
hyperbaric oxygen therapy (2ATA, 100% oxygen) vs. sham (1.2ATA, 21% oxygen)
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
142 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07423273
Sponsor's protocol ID
0202-23
Status last verified
Apr 2026
First submitted
15 Apr 2024
Last updated
17 Apr 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No

Questions about this trial

What is this clinical trial studying?

A study testing hyperbaric oxygen therapy in people with Post Stroke Depression, run by Assaf-Harofeh Medical Center at 1 site in Israel.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 18 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 17 Apr 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Israel. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Shai a Efrati, MD (972549212866, efratishai@outlook.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

PSD symptoms (time frame: Change from Baseline immediately after the intervention). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 17 Apr 2026.

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