- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00125554
Metyrapone as Additive Treatment in Major Depression
Double-Blind, Placebo Controlled Trial of Metyrapone as Augmenting Agent in the Treatment of Major Depression
Study Overview
Detailed Description
The investigators' understanding of the neuroendocrine pathophysiology of depression has made significant progress in recent years, which should help to develop new remedies. Alterations of the hypothalamic-pituitary-adrenocortical (HPA) axis are the most consistent pathological endocrine findings in depression. Hence, attempts have been made to treat depression by directly targeting HPA-axis activity. Currently, three major pathways are investigated:
- Administration of CRH-antagonists;
- Administration of glucocorticoid-receptor-antagonists; and
- Treatment with steroid-synthesis inhibitors like ketoconazole, aminogluthethimide or metyrapone.
The investigators' aim was to conduct the first prospective, randomized, placebo-controlled, double-blind clinical trial of metyrapone as additive treatment in depression. Metyrapone was preferred, since this compound inhibits selectively the 11β-hydroxylase and the 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD-1), thereby exerting direct effects within the central nervous system (CNS). The additive approach was applied because the intended inclusion of severely depressed patients made a pure placebo group ethically challenging. Furthermore, the continuous use of an antidepressant allowed a standardized follow up after the double-blind period.
The hypotheses to be tested were, whether metyrapone exerts potentiating effects during a standard antidepressant therapy and whether an earlier onset-of-action and an improved overall and sustained treatment response can be achieved. Since GR/MR distribution as well as 11β-HSD-1 activities are subject to sexual dimorphism in humans, the sample was prospectively stratified for gender and balanced for treatment with two selected serotonergic antidepressants, allowing further analysis of gender effects and neuroendocrine treatment effects.
Study Type
Enrollment
Phase
- Phase 2
Contacts and Locations
Study Locations
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Hamburg, Germany, 20246
- Dept. of Psychiatry and Psychotherapy, UKE
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Diagnosis of major depressive disorder; single or recurrent according to DSM-IV criteria (296.2 or 296.3)
- A minimum baseline Hamilton score of 18 points on the Hamilton Rating Scale for Depression (HamD; 21-item version)
- Age from 18 to 75 years
- A drug free period of at least 5 days from antidepressants, antipsychotics, mood stabilizers and all other medications except for mild antihypertensive agents
- A negative urinary drug screening diagnosis
Exclusion Criteria:
- A current DSM-IV diagnosis for other axis I psychiatric disorders
- Serious medical conditions, especially those associated with adrenal insufficiency
- Pregnancy, nursing or refusal to use a reliable method of birth control in women.
Participants were randomly assigned to a study group if they met these criteria.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: TREATMENT
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: DOUBLE
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
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Two psychometric criteria defined by the number of responders and time to onset-of-action. The number of responders was considered twice after 3 and 5 weeks by defining the treatment response as a 30% and 50% reduction
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the course of concentrations of ACTH, cortisol, 11-deoxycortisol and DHEA.
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Secondary Outcome Measures
Outcome Measure |
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Other psychometric scores, demographic parameters and side effects were considered as secondary variables.
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Collaborators and Investigators
Investigators
- Study Director: Holger Jahn, MD, University Hospital Hamburg-Eppendorf, Germany
Publications and helpful links
Study record dates
Study Major Dates
Study Start
Study Completion
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ESTIMATE)
Study Record Updates
Last Update Posted (ESTIMATE)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- HH-PSY-ja-007
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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