- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03786614
Antidepressant Discontinuation in Treatment Resistant Depression
August 16, 2023 updated by: Rifaat S. El-Mallakh, University of Louisville
The purpose of this study is to compare the effects on depressive symptoms of subjects who discontinue serotonergic antidepressants (a certain type of antidepressant, such as Prozac, that works on serotonin receptors in the brain) with the effects on depressive symptoms of subjects who continue to take serotonergic antidepressants.
During this study, subjects will also be presented with the opportunity to undergo genetic testing for the serotonin gene transporter which has a short or long form.
This is being done because it has been demonstrated that genetic testing improves outcome while treating treatment-resistant depression.
Study Overview
Status
Recruiting
Conditions
Intervention / Treatment
Study Type
Interventional
Enrollment (Estimated)
30
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Contact
- Name: Lucas Miozza
- Phone Number: 502-588-0678
- Email: lgmioz01@louisville.edu
Study Locations
-
-
Kentucky
-
Louisville, Kentucky, United States, 40202
- Recruiting
- University of Louisville, Department of Psychiatry and Behavioral Sciences
-
Principal Investigator:
- Rif S. El-Mallakh, MD
-
Sub-Investigator:
- Ziad A. Ali, MD
-
Contact:
- Lucas Miozza
- Phone Number: 502-588-0678
- Email: lgmioz01@louisville.edu
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years to 70 years (Adult, Older Adult)
Accepts Healthy Volunteers
No
Description
Inclusion Criteria:
- Subjects must be a man or woman 18 to 70 years of age, inclusive.
- Subject must meet criteria for a major depressive disorder as confirmed by the Mini International Neuropsychiatric Interview [MINI].
- Subjects must have a current Treatment-Resistant Depression as defined below.
- Subjects must have been taking serotonergic antidepressants (serotonin reuptake inhibitor or monoamine oxidase inhibitor) for at least 2 years but not more than 4 years, and have failed 2 previous medication trial for the current episode. Current Montgomery-Åsberg Depression Rating Scale [MADRS] score must be equal to or more than 25.
- Subject must be medically stable.
- Female subjects must have a negative urine pregnancy test at screening, and agree to avoid pregnancy during the study.
- Each subject must sign an informed consent form indicating that he/she understands the purpose of the study and the procedures required and are willing to participate in the study.
- Subject must be able to participate in symptom measurement.
Exclusion Criteria:
- Subject has a current Diagnostic and Statistical Manual of Mental Disorders-5 [DSM-5] diagnosis of bipolar disorder or has a positive screening for bipolar disorder by Mini International Neuropsychiatric Interview [MINI] or Mood Disorder Questionnaire [MDQ].
- Subject has a current DSM-5 diagnosis of schizophrenia, schizoaffective disorder, autistic disorder, or intellectual disability.
- Subject has a substance use disorder (except for nicotine or cannabis) within 3 months prior to screening or has a positive drug screen test for any recreational drugs at the time of screening with the exception of Cannabis.
- Subject has evidence of any clinically significant, unstable medical problems that may create a safety risk for a subject, interfere with study participation, or make results difficult to interpret.
- Subject is at imminent risk of suicide according to the investigator's clinical judgment and/or a Columbia-Suicide Severity Rating Scale (C-SSRS) 3 or more at any time in the study.
- Subject is a woman who is pregnant, breast-feeding or planning to become pregnant while enrolled in the study.
- Subject has any condition (according to the investigator) for which participation will not be the best interest for the subject or it can prevent, limit or confound the protocol-specified assessments.
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Discontinuation arm
This group will be discontinued from serotonergic antidepressants and shifting them to other categories of antidepressants, i.e., medications that work through dopamine or nor-epinephrine, or by reducing the serotonin signal rather than increasing synaptic serotonin, as might be accomplished with low dose, sub-anti-psychotic doses of some second-generation anti-psychotics.
|
Discontinuation of serotonergic antidepressants and possibly shift to other antidepressant categories that were proven to be effective in treating depression such as pramipexole, bupropion, quetiapine, lurasidone, brexpipazole.
Additionally, subjects will have access to other treatment measures of treating treatment resistant depression.
|
Active Comparator: Continuation arm
This group will continue taking serotonergic antidepressants which is the standard care of treatment.
|
Continuation of serotonergic medications which is the standard care of treatment.
Additionally, subjects will have access to other treatment measures of treating treatment resistant depression.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Comparing the difference of response as measured by the Montgomery-Åsberg Depression Rating Scale [MADRS] between both arms.
Time Frame: From baseline and every visit [every 4 weeks] to the end of the study. [6 months]
|
The MADRS is a psychiatric scale to assess the depressive symptoms from the patient's prospective.
The final score ranges from 0 to 60 with 0 indicating no depression and higher scores indicating greater depression.
The final scores will be evaluated with a non-paired, two-tailed t-test.
|
From baseline and every visit [every 4 weeks] to the end of the study. [6 months]
|
Comparing the difference of response as measured by the Montgomery-Åsberg Depression Rating Scale [MADRS] between subjects with low expressing alleles and high expressing alleles of the serotonin gene transporter.
Time Frame: End of study [6 months].
|
Genetic testing for the serotonin transporter gene will be done for every patient in the study.
All subjects with homozygous and heterozygous low expression alleles will be combined as one group, and all high expression subjects will be the other group.
One-way ANOVAs will be conducted for each genotype group, with genotype group as the independent variable (IV) and MADRS scores as the dependent variables (DV).
|
End of study [6 months].
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Evaluating changes in levels of anxiety as measured by the Hamilton Anxiety Rating Scale [HAM-A] between both arms.
Time Frame: From baseline and every visit [every 4 weeks] to the end of the study. [6 months]
|
The HAM-A will be collected to assess changes in anxiety levels from the patient's prospective.
It ranges from 0 to 56 with greater scores indicating more anxiety.
The final scores will be evaluated with a non-paired, two-tailed t-test.
|
From baseline and every visit [every 4 weeks] to the end of the study. [6 months]
|
Evaluating the difference of response as measured by the Columbia Suicide Severity Rating Scale [C-SSRS] between both arms.
Time Frame: From baseline and every visit [every 4 weeks] to the end of the study. [6 months]
|
The C-SSRS is a psychiatric scale to assess suicidality.
It ranges from 0 to 5 with 0 indicating no suicidal ideas and higher scores indicating greater suicidal ideas.
The final scores will be evaluated with a non-paired, two-tailed t-test.
|
From baseline and every visit [every 4 weeks] to the end of the study. [6 months]
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Investigators
- Principal Investigator: Rifaat S. El-Mallakh, MD, University of Louisville, Department of Psychiatry and Behavioral Sciences
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
June 20, 2019
Primary Completion (Estimated)
December 1, 2024
Study Completion (Estimated)
December 1, 2024
Study Registration Dates
First Submitted
December 18, 2018
First Submitted That Met QC Criteria
December 23, 2018
First Posted (Actual)
December 26, 2018
Study Record Updates
Last Update Posted (Actual)
August 18, 2023
Last Update Submitted That Met QC Criteria
August 16, 2023
Last Verified
August 1, 2023
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 18.1351
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
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.
Clinical Trials on Treatment Resistant Depression
-
Changping LaboratoryBeijing HuiLongGuan HospitalRecruitingTreatment-Resistant DepressionChina
-
Central Institute of Mental Health, MannheimCharite University, Berlin, Germany; German Federal Ministry of Education and... and other collaboratorsActive, not recruitingTreatment-resistant DepressionGermany
-
Janssen Research & Development, LLCCompletedTreatment-resistant DepressionUnited States, Australia, France, United Kingdom, Belgium, Germany, Taiwan, Spain, Argentina, Mexico, Poland, Bulgaria, Malaysia, South Africa, Turkey, Finland, Korea, Republic of, Brazil, Austria, Sweden, Lithuania
-
Janssen Research & Development, LLCCompletedTreatment-resistant DepressionUnited States, France, Belgium, Mexico, Canada, Brazil, Estonia, Hungary, Slovakia
-
University of OttawaCanadian Institutes of Health Research (CIHR)Completed
-
GH Research Ireland LimitedRecruitingTreatment-resistant DepressionIreland, Czechia
-
First Affiliated Hospital of Zhejiang UniversityRecruitingTreatment-resistant DepressionChina
-
University Hospital FreiburgBoston Scientific CorporationRecruitingTreatment-resistant DepressionGermany, France
-
Janssen Research & Development, LLCCompletedTreatment-resistant DepressionUnited States, Poland, Germany, Spain, Czechia
-
Millennium Pharmaceuticals, Inc.WithdrawnTreatment-Resistant Depression
Clinical Trials on Discontinuation of serotonergic antidepressants
-
University of ZurichCompletedSkin CancerSwitzerland
-
West Virginia UniversityRecruiting
-
Nicole HamblettUniversity of Washington; Dartmouth-Hitchcock Medical Center; Cystic Fibrosis...Completed
-
Leiden University Medical CenterZonMw: The Netherlands Organisation for Health Research and DevelopmentActive, not recruiting
-
Baxter Healthcare CorporationCompleted
-
Weill Medical College of Cornell UniversityNovartisTerminatedImmune ThrombocytopeniaUnited States
-
Utrecht Institute for Pharmaceutical SciencesUCB PharmaTerminated
-
Fondazione Policlinico Universitario Agostino Gemelli...Fundacion Clinic per a la Recerca Biomédica; Newcastle University; University...RecruitingRheumatoid ArthritisItaly, Spain, United Kingdom
-
Centre Hospitalier Régional Metz-ThionvilleRecruiting
-
University of Colorado, DenverPatient-Centered Outcomes Research Institute; University of Alabama at Birmingham and other collaboratorsCompletedMultiple SclerosisUnited States