- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02480400
The Effect of Patient and Investigator Expectation on the Efficacy of Escitalopram in the Treatment Depression
The Effect of Patient and Investigator Expectation on the Efficacy of Escitalopram in the Treatment of Patients With Major Depressive Disorder.
Study Overview
Detailed Description
This study is designed to determined if trial design, in the form of the frequency of patient contact (assessment visit numbers) has an effect on the efficacy outcome after 8-week treatment with escitalopram.
The placebo response is a major issue in clinical trials for psychiatric disorders-and especially in the management of depression. Possible contributing factors to this problem include diagnostic misclassification, issues concerning inclusion/exclusion criteria, outcome measures' lack of sensitivity to change, measurement errors, poor quality of data entry and verification, waxing and waning of the natural course of depression, regression toward the mean phenomenon, patient and clinician expectations about the trial, study design issues, non-specific therapeutic effects, and high attrition.
Over the past few decades, researchers have attempted to reduce the placebo effect in a variety of ways. Unfortunately, approaches with very little or no benefit have included restricting enrollment to selected populations, rater training, requirement of same rater, and placebo lead-in phases. Some benefits, although often marginal, have been derived from standardizing diagnostic procedures, managing clinicians' overestimation of change, simplification of study visits and assessments, minimizing nonspecific, therapeutic effects, extending trial duration, reducing number of sites, increasing the sensitivity of outcome measures, and reducing the number of treatment arms.
Thus far, there has been no attempt to develop new study designs aimed at reducing the placebo effect.
We are proposing a novel study design, suitable for doubleblind, trials in mood disorders. This design is aimed at characterizing and identifying both the overall placebo response rate and the sample size required for such
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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Bat-Yam, Israel, 59100
- Abarbanel MHC
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Outpatients, men and women between 18 and 65 years of age (both extremes included)
- DSM IV-TR criteria for a current MDE lasting between 3 and 12 months
- Baseline MADRS total score > 22
Exclusion Criteria:
- WHO-5 total score > 13 or a score > 3 on any single item of the WHO-5 (not revealed to the investigator)
- Other primary or co-primary psychiatric disorder which is more distressful for the patient than MDDD, as evaluated by investigator
- Patients with any history of mania/bipolar I disorder
- Patients using medications which are contraindicated with the use of escitalopram
- Known contraindication for the use of citalopram or escitalopram
- Patients that have not responded to 2 or more treatments with an adequate dose of an antidepressant for an adequate time
- Patients receiving formal behaviour therapy, or systematic psychotherapy
- Unable to understand or read Hebrew and give written informed consent
- Prominent suicidal ideation > 5 on item 10 (suicidal thoughts) of the MADRS]
- Alcohol or substance dependence in the past 6 months
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Health Services Research
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
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Experimental: Supported Escitalopram
Escitalopram, with assessment visits at baseline, and weeks 2, 4, 6 and 8
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Patients diagnosed with MDD and will fulfill the inclusion and exclusion criteria will start with escitalopram 10mg, according to the Summary of Product Characteristics.
At week 2, patients with a baseline MADRS between 22 and 29 continue on 10mg, and patients with a baseline MADRS > 30 receive a fixed dose 20mg until the end of treatment.
Other Names:
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Active Comparator: Escitalopram
Escitalopram, with assessment visits at baseline, week 4 and week 8, and a safety visit at week 2
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Patients diagnosed with MDD and will fulfill the inclusion and exclusion criteria will start with escitalopram 10mg, according to the Summary of Product Characteristics.
At week 2, patients with a baseline MADRS between 22 and 29 continue on 10mg, and patients with a baseline MADRS > 30 receive a fixed dose 20mg until the end of treatment.
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Sheehan Disability Scale
Time Frame: Change from baseline to study completion by week 8.
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The Sheehan Disability Scale (Sheehan 1983) is a composite of three self-rated items designed to measure the extent to which three major sectors in the patient's life are impaired by panic, anxiety, phobic, or depressive symptoms.
This scale has been used widely in psychopharmacology randomized controlled trials, particularly for panic disorder.
This anchored visual analog scale uses spatiovisual, numeric, and verbal descriptive anchors simultaneously to assess disability across three domains: work, social life, and family life.
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Change from baseline to study completion by week 8.
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Montgomery Åsberg Depression Rating Scale
Time Frame: Change from baseline to study completion in week 8.
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This is a 10-item checklist.
Widely used in drug-treatment trials, mainly because of its particular sensitivity to treatment effects.
Since there is a comparative lack of emphasis on somatic symptoms, the scale is useful for the assessment of depression in people with physical illness.
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Change from baseline to study completion in week 8.
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Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Study Chair: Yehuda Baruch, MD, MHA, Abarbanel MHC, Israel.
Publications and helpful links
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
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
- Behavioral Symptoms
- Mental Disorders
- Mood Disorders
- Depression
- Depressive Disorder
- Depressive Disorder, Major
- Physiological Effects of Drugs
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Parasympatholytics
- Autonomic Agents
- Peripheral Nervous System Agents
- Muscarinic Antagonists
- Cholinergic Antagonists
- Cholinergic Agents
- Psychotropic Drugs
- Serotonin Uptake Inhibitors
- Neurotransmitter Uptake Inhibitors
- Membrane Transport Modulators
- Serotonin Agents
- Antidepressive Agents
- Antidepressive Agents, Second-Generation
- Antiparkinson Agents
- Anti-Dyskinesia Agents
- Citalopram
- Dexetimide
Other Study ID Numbers
- Lu-Pl-001
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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