- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05133804
Efficacy of Reboxetine and Methylphenidate Treatment on Attentional, Sensory and Emotional Dysregulation in Adults With PTSD
The Relation Between Attentional, Sensory and Emotional Dysregulation in Adults With Posttraumatic Stress Disorder: a Double-blind, Placebo-controlled Randomized Controlled Trial of the Combined Treatment With Reboxetine and Methylphenidate
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Posttraumatic stress disorder (PTSD) is a highly impairing psychiatric disorder, characterized by re-experiencing, avoidance behaviour, emotional numbing, and hyperarousal after traumatic exposure. Current treatments mainly focus on non-cognitive symptoms and are only partially effective: one third of PTSD patients will find symptoms to be chronic and progressive; highly impacting daily function and quality of life. Arising evidence suggests a correlation between impaired attention, sensory dysfunction, and PTSD symptoms. Thus, the importance of combined treatment, focused on concentration difficulties as often found PTSD, has been suggested. Two suggested leads are reboxetine and methylphenidate.
Hypothesising that impaired attentional and sensory processing induces re-experiencing with avoidance and hyperarousal as coping strategies, the investigators aim to elucidate the neuro-dysregulation characteristics of each of the PTSD symptoms, with focus on attention, executive function and sensory processing, and relate to their implications on daily life function, following a novel combined treatment strategy of reboxetine and methylphenidate (Ritalin).
A case-control study will be conducted, including 53adult patients with PTSD and 53 matched healthy controls. First, a baseline measure will be performed amongst all participants to create a population profile. Then, patients will be randomised into an active treatment group (n=27) and a placebo group (n=26) for a double-blind randomized controlled trial, investigating the effect of a 3-week treatment with reboxetine 4mg per day and a one-week addition of Ritalin 10mg twice a day.
This research will include established and innovative neurophysiological measures and questionnaires. A PTSD symptom profile will be created combining the Clinician-Administered Posttraumatic Stress Disorder Scale and Posttraumatic Stress Disorder Symptom Scale. Brain activity will be measured using functional near-infrared spectroscopy (fNIR) or electroencephalography, with the Auditory Sustained Attention Test (ASAT) and Electrodermal Activity (EDA). Together with the Conners' Adult Attention Deficit Hyperactivity Disorder (ADHD) Rating Scale - Short Version, the ASAT and EDA will create an attentional profile. Furthermore, a sensory profile consisting of the Adolescent/Adult Sensory Profile Questionnaire, and an executive function profile measured with the Behavior Rating Inventory of Executive Function will be created. Finally, in order to relate to individual experiences in real-life context, this research measures activities through the Daily Living Questionnaire and quality of life with the World Health Organization Quality of Life Instrument.
Using a translational research paradigm, this research is one of the first to investigate neuro-dysregulation in PTSD with a focus on sensory processing and executive function, with emphasis on attention and behaviour. It is also the first research to integrate the fNIR with the ASAT and EDA, thus contributing to the technological advancing of clinical research. This research will gather innovative data that may offer new explanations of PTSD symptoms and allow for further development of treatment interventions needed to reduce the burden of disease and optimise quality of life.
Study Type
Enrollment (Estimated)
Phase
- Phase 2
Contacts and Locations
Study Contact
- Name: Avi Avital, PhD
- Phone Number: +972-4-8420-364
- Email: avitalavi@hotmail.com
Study Locations
-
-
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Afula, Israel
- Recruiting
- Emek Medical Center
-
Contact:
- Tsipi Milman, MD
- Email: tsipimi@clalit.org.il
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Haifa, Israel
- Recruiting
- University of Haifa
-
Contact:
- Avi Avital, PhD
- Phone Number: +972-4-8420-364
- Email: avitalavi@hotmail.com
-
Contact:
- Batya Engel-Yeger, PhD
- Phone Number: +972-4-828-8387
- Email: bengel@univ.haifa.ac.il
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Sub-Investigator:
- Janne Hoogervorst, MD
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Netanya, Israel
- Recruiting
- Lev Hasharon Mental Health Center
-
Contact:
- Inbal Brenner, MD
- Phone Number: +972 9 8981111
- Email: inbalbrenner@gmail.com
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- diagnosed with PTSD according to DSM-IV or DSM-5 criteria
- current treatment at the outpatient facilities of Lev HaSharon Netanya Adult Clin
- age between 20 and 60 years
- PTSD diagnosis at least one month prior to study inclusion
- no present-day re-exposure to the traumatic event
- any psychotropic drug therapy that is being administered must be at a fixed dose for at least one month prior to the study conductance
Exclusion Criteria:
- comorbid major psychiatric disorder, e.g. psychotic disorder, unipolar or bipolar disorder, borderline personality disorder, or active suicidal ideation,
- ADHD diagnosis,
- significant or severe systematic disease that limits normal activity, e.g. autoimmune disease, AIDS or renal failure,
- cardiovascular disease, e.g. hypertension, atrioventricular (AV) block, bradycardia, or conduction disorder,
- severe disease that is a threat to life, e.g. acute myocardial infarction, respiratory failure, or cancer,
- nervous system impairment, e.g. multiple sclerosis, Alzheimer's disease, Parkinson's disease, epilepsy, or stroke,
- previous or current severe traumatic brain injury,
- glaucoma,
- impaired hearing,
- pregnancy or breastfeeding during study inclusion,
- active substance dependency including regular use of medical cannabis,
- use of steroid medication in the two months prior to study conductance,
- use of medication that may affect the function of the central nervous system,
- failure to complete all research steps
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Triple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Treatment with Reboxetine and Methylphenidate
During the first 3 weeks of the study, subjects in the active treatment group will take reboxetine at a dose of 4mgper day, with the instructions to start at 2mg per day for 3 days and then increase the dosage to 4mg per day for 26 days, i.e. until completion of the study. On day 22 of the study, the patients will take the first dosage of10mg Ritalin or a placebo, and remain in the clinic for 2 hours to guard safety and guidance during possible occurrence of side effects such as anxiety, palpitations, etc. During the observation time in the clinic, 6 Ritalin IR 10mg and 3 Reboxetine 4mg pills will be handed out to the participants. These pills will be taken at the responsibility of the subject at8:00 AM (Ritalin and Reboxetine) and at noon (Ritalin only) at the following three days. |
Ritalin 10mg
Other Names:
Reboxetine 4mg
|
Placebo Comparator: Treatment with Placebo
The patients will take placebos according to the medication schedule of the treatment group.
|
Placebo matched to Reboxetine
Other Names:
Placebo matched to Ritalin
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Clinician-Administered Posttraumatic Stress Disorder Scale for the Diagnostic and Statistical Manual (DSM)-5 (CAPS-5) between baseline score (before treatment) and score on day 26 (after treatment)
Time Frame: Day 1 and day 26
|
PTSD symptom severity score.
Total of 56 questions.
Minimum score 0, maximum score 80.
A higher score reflects a worse outcome.
|
Day 1 and day 26
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Posttraumatic Stress Disorder Symptom Scale (PSS-SR5)
Time Frame: Day 1 and day 26
|
PTSD symptom severity score.
Total of 24 questions.
Minimum score 0, maximum score 80.
A higher score reflects a worse outcome.
|
Day 1 and day 26
|
Conner's Adult ADHD Rating Scales - Self Report: short version (CAARS-S:S)
Time Frame: Day 1 and day 26
|
ADHD index score.
Total of 26 questions.
Minimum score 26, maximum score 78.
A higher score reflects a worse outcome.
|
Day 1 and day 26
|
Electroencephalography (EEG)
Time Frame: Day 1, day 21 and day 26
|
Electrical brain activity, measured through event-related potentials (ERP)
|
Day 1, day 21 and day 26
|
Functional near-infrared spectroscopy (fNIRS)
Time Frame: Day 1, day 21 and day 26
|
Cortical hemodynamic activity, measured through concentrations of oxygenated and deoxygenated hemoglobin.
|
Day 1, day 21 and day 26
|
Electrodermal Activity (EDA)
Time Frame: Day 1, day 21 and day 26
|
Electrodermal activity, measured through sweat secretion on digit 2 and digit 4 of right hand.
|
Day 1, day 21 and day 26
|
Auditory Sustained Attention Test (ASAT)
Time Frame: Day 1, day 21 and day 26
|
Pre-pulse inhibition, measured through the eyeblink reflex at the level of the musculus orbicularis oculi 1cm below the pupil.
|
Day 1, day 21 and day 26
|
Adolescent/Adult Sensory Profile Questionnaire (AASP)
Time Frame: Day 1 and day 26
|
Sensory profile.
Total of 60 questions.
Minimum score 60, maximum score 300.
A higher score reflects a worse outcome.
|
Day 1 and day 26
|
Behavior Rating Inventory of Executive Function - Adult Version (BRIEF-A)
Time Frame: Day 1 and day 26
|
Global executive composite.
Total of 75 questions.
Minimum score 75, maximum score 225.
A higher score reflects a worse outcome.
|
Day 1 and day 26
|
Daily Life Questionnaire (DLQ)
Time Frame: Day 1 and day 26
|
Daily life limitations.
Total of 59 questions.
Minimum score 28, maximum score 112.
A higher score reflects a worse outcome.
|
Day 1 and day 26
|
World Health Organization Quality of Life Questionnaire - BREF (WHOQOL-BREF)
Time Frame: Day 1 and day 26
|
Quality of Life.
Total of 26 questions.
Minimum score 24, maximum score 120.
A higher score reflects a better outcome.
|
Day 1 and day 26
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Avi Avital, PhD, University of Haifa
- Principal Investigator: Batya Engel-Yeger, PhD, University of Haifa
- Principal Investigator: Inbal Brenner, MD, Lev Hasharon Mental Health Center
- Principal Investigator: Tsipi Milman, MD, Emek Medical Center
Publications and helpful links
General Publications
- McAllister TW, Zafonte R, Jain S, Flashman LA, George MS, Grant GA, He F, Lohr JB, Andaluz N, Summerall L, Paulus MP, Raman R, Stein MB. Randomized Placebo-Controlled Trial of Methylphenidate or Galantamine for Persistent Emotional and Cognitive Symptoms Associated with PTSD and/or Traumatic Brain Injury. Neuropsychopharmacology. 2016 Apr;41(5):1191-8. doi: 10.1038/npp.2015.282. Epub 2015 Sep 11.
- Aga-Mizrachi S, Cymerblit-Sabba A, Gurman O, Balan A, Shwam G, Deshe R, Miller L, Gorodetsky N, Heinrich N, Tzezana O, Zubedat S, Grinstein D, Avital A. Methylphenidate and desipramine combined treatment improves PTSD symptomatology in a rat model. Transl Psychiatry. 2014 Sep 23;4(9):e447. doi: 10.1038/tp.2014.82.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Mental Disorders
- Trauma and Stressor Related Disorders
- Stress Disorders, Traumatic
- Stress Disorders, Post-Traumatic
- Physiological Effects of Drugs
- Adrenergic Agents
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Psychotropic Drugs
- Neurotransmitter Uptake Inhibitors
- Membrane Transport Modulators
- Antidepressive Agents
- Dopamine Agents
- Dopamine Uptake Inhibitors
- Central Nervous System Stimulants
- Adrenergic Uptake Inhibitors
- Methylphenidate
- Reboxetine
Other Study ID Numbers
- LH9/2019
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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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