The Quietude Study: Quetiapine Use for Agitated Depression

A Multi-Centre, Double-Blind, Randomised, Parallel Group, Escitalopram Controlled Phase III-B Study of the Efficacy and Safety of Quetiapine Fumarate Extended Release (Seroquel XR TM) as Monotherapy in the Treatment of Adult Patients With Agitated Major Depressive Disorder

Most individuals with major depressive disorder manifest clinically significant agitation. Concurrent agitation in a depressed individual is associated with an intensification of mood symptoms, decreased probability of recovery, increased recurrence risk, suicidality, and increased medical-service utilization. The occurrence of anxiety/agitation phenomenology in the depressed patient often invites the need for augmentation strategies (e.g. atypical antipsychotics, benzodiazepines, etc.) and complicated polypharmacy regimens. Moreover, individuals with major depressive disorder often report worsening of symptom severity, irritability, hostility, dysphoria, and significant subjective distress (This response pattern is similar to individuals with bipolar disorder).

Results from large research studies provide evidence indicating that quetiapine is capable of offering clinically significant multidimensional symptom relief in bipolar depression. Moreover, results from several trials in major depressive disorder and generalized anxiety disorder have established the efficacy of quetiapine therapy for unipolar depression and anxiety syndromes. So far, no atypical antipsychotic agent has been evaluated specifically for the treatment of agitated depression.

In this study, it is hypothesized that persons with major depressive disorder and prominent agitation (i.e. agitated depression) will exhibit a more favourable response and tolerability profile to quetiapine XR when compared to escitalopram.

Study Overview

• Status: Terminated
• Conditions: Depression With Prominent Agitation
• Intervention / Treatment: Drug: Quetiapine XR; Drug: Escitalopram

• Study Type: Interventional
• Enrollment (Anticipated): 250
• Phase: Phase 3

Contacts and Locations

Study Locations

• Canada
  • Ontario
    • Brampton, Ontario, Canada, L6T 0G1
      • Aggarwal and associates Ltd
    • Brampton, Ontario, Canada, L6W 2A4
      • Aptekar Medicine Professional Corporation
    • Chatham, Ontario, Canada, N7L 1B7
      • Chatham-Kent Health Alliance
    • Fort Erie, Ontario, Canada, L2A 1Z3
      • Fort Erie Group Family Practice
    • Keswick, Ontario, Canada, L4P 2C7
      • Georgina Family Medical Centre
    • London, Ontario, Canada, N6A 5G6
      • Richmond Oxford Walk-In Clinic
    • Scarborough, Ontario, Canada, M1N 1W8
      • Gerald Rockman Medicine Professional Corporation
    • Sudbury, Ontario, Canada, P3E 1H5
      • Brady Clinic
    • Toronto, Ontario, Canada, M9W 4L6
      • Manna Research
    • Toronto, Ontario, Canada, M6G 1L4
      • Bloor-Park Medical Centre
    • Toronto, Ontario, Canada, M6H 3M2
      • Primary Care Lung

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 65 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Male or female
• Age 18 to 65
• Outpatient at enrolment
• A diagnosis of major depressive disorder
• Baseline HAMD-17 score > 20 and HAMD Item1 score > 2 both at enrolment and baseline
• Significant agitation
• CGI-S score > 4 at screening and baseline
• Negative serum pregnancy test at enrolment and use of a reliable method of birth control during the study
• Able to understand and comply with the requirements of the study
• Able and willing to give meaningful informed written consent

Exclusion Criteria:

• Another Axis I diagnosis of primary focus within 6 months of enrolment
• Axis II disorder causing impact on current diagnosis
• Current depressive episode <4 weeks, or >12 months
• Substance or alcohol abuse or dependency as defined by DSM IV within 6 months of enrolment
• Any pervasive developmental disorder or dementing disorder
• Treatment with other antipsychotics, mood stabilizer or other psychoactive drugs less than 7 days prior to randomization
• Treatment with fluoxetine less than 28 days prior to baseline
• Treatment with MAO inhibitors, anxiolytic drugs in excess of 2 mg lorazepam equivalents/day.
• Insufficient response to more than two antidepressants during the index episode prior to study involvement
• Known lack of antidepressant response to quetiapine at a dose of at least 50 mg/day x 4 weeks
• Known lack of antidepressant response to escitalopram at a dose of at least 10 mg/day
• Known intolerance or hypersensitivity to quetiapine or escitalopram
• Treatment with Electroconvulsive therapy within 90 days prior to baseline
• Use of Potent P450 3A4 inhibitors or inducers within 14 days of baseline
• AST & ALT ≥ 3X ULN
• TSH ≥ 10% ULN
• Unstable medical condition
• Medical condition the would affect absorption, distribution, metabolism or excretion of study treatment
• Significant ECG abnormalities
• Pregnancy or lactation
• Patients with increased suicidal risks, HAM-D item 3 ≥3 or have made a suicide attempt within the past 6 months.
• Patients who, in the investigators opinion, will require psychotherapy (other than supportive psychotherapy) during the study period, unless psychotherapy has been ongoing for a minimum of 3 months prior to randomisation
• A patient with Diabetes Mellitus (DM) fulfilling one of the following criteria:
• Unstable DM defined as enrolment glycosylated haemoglobin (HbA1c) >8.5%.
• Admitted to hospital for treatment of DM or DM related illness in past 12 weeks.
• Not under physician care for DM.
• Physician responsible for patient's DM care has not indicated that patient's DM is controlled.
• Physician responsible for patient's DM care has not approved patient's participation in the study
• Has not been on the same dose of oral hypoglycaemic drug(s) and/or diet for the 4 weeks prior to randomisation. For thiazolidinediones (glitazones) this period should not be less than 8 weeks.
• Taking insulin whose daily dose on one occasion in the past 4 weeks has been more than 10% above or below their mean dose in the preceding 4 weeks Note: If a diabetic patient meets one of these criteria, the patient is to be excluded even if the treating physician believes that the patient is stable and can participate in the study
• Clinically significant deviation from the reference range in clinical laboratory test results
• An absolute neutrophil count (ANC) of 1.5 x 109 per liter
• Those who are involved in the planning and/or conduct of the study cannot be enrolled as subjects
• Previous enrolment or randomization in the present study
• Participation in another medication trial within 4 weeks prior to enrolment into the study herein

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Quadruple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Escitalopram	Drug: Escitalopram; Dosage form: capsules Day 1-7: 10 mg Day 8-57: 10 or 20 mg/day (flexible)
Active Comparator: Quetiapine XR	Drug: Quetiapine XR; Dosage form: tablets Day 1-2: 50 mg Day 3-7: 150 mg Day 8-57: either 150 or 300 mg/day (flexible); Other Names: Seroquel XR

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change from baseline to endpoint in the Hamilton Depression Rating Scale 17-Item (HAMD-17) total score	A tool to assess the range of symptoms of depression	Day 1, Day 57

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in anxiety factor score on the Hamilton Depression Rating Scale 17-item (HAMD-17) from baseline to endpoint	A tool to assess the range of symptoms of depression	Day 1, Day 57
Change from baseline to endpoint in Hamilton Anxiety Rating Scale (HAMA) total score	A tool to measure severity of symptoms of anxiety	Day 1, Day 57
Change in Clinical Global Impression score from baseline to endpoint	A tool to assess illness severity, improvement and response to treatment	Screening Visit, Day 1, Day 8, Day 15, Day 29, Day 43, Day 57
Change from baseline to endpoint in Sheehan Disability Scale (SDS) sub-scales and total score	A tool to assess functional impairment	Day 1, Day 57
Change in Hamilton Depression Rating Scale 17-item (HAMD-17) sleep disturbance factor score on the from baseline to endpoint	A tool to assess the range of symptoms of depression	Day 1, Day 57
Change in Hamilton Anxiety Rating Scale (HAMA) somatic and psychic anxiety factor scores from baseline to endpoint	A tool to measure severity of symptoms of anxiety	Day 1, Day 57
Change from baseline in the Sex Functioning Questionnaire (Sex FX)	A tool to assess sexual functioning	Day 1, Day 57
Change in blood pressure and heart rate from baseline to end of treatment		Day 1, Day 57
Change in weight, BMI, waist circumference from baseline to end of treatment		Day 1, Day 57
Change in findings from physical examination from baseline to end of treatment		Screening, Day 57
Tabulation of spontaneous adverse events		Day 1, Day 57
Tabulation of clinical haematology and chemistry results		Screening, Day 57
Incidence of premature study withdrawal due to inadequate control of depressive symptoms
Proportion of patients with HAM-D Item 3 score > 2 at any time after randomization or adverse events of suicidality/suicidal ideation/suicide attempts/suicide completion		Day 1, Day 57

Collaborators and Investigators

• Sponsor: Physicians Research And Education Network
• Investigators: Study Director: Roger McIntyre, MD, FRCPC, Physicians Research And Education Network

Study record dates

Study Major Dates

• Study Start: October 1, 2010
• Primary Completion (Actual): January 1, 2013
• Study Completion (Actual): February 1, 2013

Study Registration Dates

• First Submitted: May 20, 2011
• First Submitted That Met QC Criteria: May 27, 2011
• First Posted (Estimate): June 1, 2011

Study Record Updates

• Last Update Posted (Estimate): January 8, 2014
• Last Update Submitted That Met QC Criteria: January 7, 2014
• Last Verified: January 1, 2014

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Behavioral Symptoms; Mental Disorders; Mood Disorders; Depression; Depressive Disorder; Physiological Effects of Drugs; Neurotransmitter Agents; Molecular Mechanisms of Pharmacological Action; Central Nervous System Depressants; Antipsychotic Agents; Tranquilizing Agents; Psychotropic Drugs; Serotonin Uptake Inhibitors; Neurotransmitter Uptake Inhibitors; Membrane Transport Modulators; Serotonin Agents; Antidepressive Agents; Antidepressive Agents, Second-Generation; Citalopram; Quetiapine Fumarate
• Other Study ID Numbers: D1443C00037