- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05427981
Anti-suicidal Effects of Buprenorphine In Depressed Individuals
Functional Brain Mechanisms Underlying the Anti-Suicidal Effects of Low-dose Buprenorphine in Major Depression
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Buprenorphine is an approved treatment for pain and opioid relapse prevention. Buprenorphine has recently shown promise in the treatment of depression and suicidal ideation relatively faster than currently available antidepressants, but its mechanisms in treating these conditions are unknown. Buprenorphine activates the mu opioid receptor in the brain and blocks the kappa opioid receptor. Activation of the mu receptors produces pleasant emotions while the kappa receptors are linked to dysphoria and other negative emotional states. By blocking kappa receptors, buprenorphine may reduce negative emotions and improve suicidal thoughts.
In this project, we will compare buprenorphine to placebo as adjunctive to usual treatments for patients who still have depression and suicidal thoughts despite being treated with adequate antidepressant medications for at least 4 weeks. We hypothesize that suicidal ideation will decrease after two weeks of treatment in the buprenorphine group relative to the placebo group.
Using functional magnetic resonance imaging, we will also examine the effects of buprenorphine on the activity of brain regions involved in the brain's response to negative emotions and test whether these effects are associated with the reduction in suicidal thoughts. This would provide some evidence that the antidepressant and anti-suicidal effects of buprenorphine are related to its kappa opioid receptor blockade.
The mechanism of action of buprenorphine is different from the currently available antidepressants. This study will help understand this mechanism which may help refine the use of buprenorphine in this context. Research in this area may also facilitate the development of new anti-suicidal treatments (i.e., other opioid-active compounds).
Study Type
Phase
- Phase 3
Contacts and Locations
Study Contact
- Name: Mina M Rizk, MD
- Phone Number: 929-305-5055
- Email: mina.rizk@nyspi.columbia.edu
Study Contact Backup
- Name: Jeffrey M Miller, MD
- Phone Number: 646-774-7613
- Email: jeffrey.miller@nyspi.columbia.edu
Study Locations
-
-
New York
-
New York, New York, United States, 10032
- New York State Psychiatric Institute
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
In order to be eligible to participate in this study, an individual must meet all of the following criteria:
- Provision of signed and dated informed consent form.
- Stated willingness to comply with all study procedures and availability for the duration of the study.
- Male or female.
- Aged 18-65 years.
- Ability to take oral medication and be willing to adhere to the treatment regimen.
- Current major depressive episode.
- Hamilton Depression Rating Scale (HDRS) Score > 16.
- Active suicidal ideation (Columbia Suicide Severity Rating Scale (C-SSRS) of 3 or more).
- Participants must have been on a medication regimen for depression that includes an adequate dose of antidepressant for at least the past 4 weeks.
Exclusion Criteria:
An individual who meets any of the following criteria will be excluded from participation in this study:
- Current active psychosis or mania.
- Current or past alcohol use disorder or substance use disorder involving any prescribed or any illicit drug (opioid, benzodiazepine, or other drug use) including mild severity.
- Family history of alcohol or substance use disorder in a first-degree relative.
- Current or past history of prescription or non-prescription opioid use.
- History of other risk factors for the development of opioid misuse and opioid use disorder other than comorbid depression (e.g., homelessness, criminal record, aggressive or violent behavior that resulted in injury to another person).
- Current acute or chronic pain.
- Neurological disorders (e.g., epilepsy, brain tumors or patients with increased intracranial pressure due to other reasons).
- A history of prior head trauma with evidence of cognitive impairment. Participants who endorse a history of prior head trauma will be administered the Trail-making A and B test. Those who score 1.5 standard deviations below the mean on the Trail-making A or B will be excluded from study participation.
- Active significant medical illness that would make study participation hazardous to the participant or compromise study findings or would prevent the participant from completing the study (e.g., oral mucositis, orthostatic hypotension, history of hypotensive disorders, hypokalemia, hypomagnesemia, or clinically unstable cardiac disease, including unstable atrial fibrillation, symptomatic bradycardia, unstable congestive heart failure, or active myocardial ischemia, history of Long QT syndrome or immediate family member with this condition, moderate to severe hepatic impairment or hepatitis, liver cirrhosis , severe chronic pulmonary diseases, significant respiratory depression, acute or severe bronchial asthma, known or suspected gastrointestinal obstruction, including paralytic ileus).
- Participants taking medications that prolong the QT interval (e.g., Class IA antiarrhythmic medications (e.g., quinidine, procainamide, disopyramide) or Class III antiarrhythmic medications (e.g., sotalol, amiodarone, dofetilide)).
- Participants taking medications with potentially clinically-significant drug interactions with BELBUCA , including benzodiazepines, central nervous system (CNS) depressants (e.g., alcohol, anxiolytics, general anaesthetics, hypnotics, neuroleptics, phenothiazines, sedatives, tranquilizers), other opioid analgesics, muscle relaxants, diuretics, anticholinergic drugs, non-nucleoside reverse transcriptase inhibitors (e.g., efavirenz, nevirapine, etravirine, delavirdine), protease inhibitors (e.g., atazanavir, ritonavir). Additionally, patients must discontinue CYP3A4 strong inhibitors (e.g., clarithromycin, telithromycin, nefazodone, itraconazole, ketoconazole) 2 weeks before initiation of the study.
- Known allergy or sensitivity to buprenorphine.
- If female, pregnancy, abortion or miscarriage in the previous two months, current breastfeeding or plans to conceive during the course of study participation. Patients who are not on contraceptives will be asked to at least use barrier methods during sexual intercourse. All patients must commit to not attempting to become pregnant during participation in the study.
- Inability to read and speak English fluently.
- Metal implants or paramagnetic objects contained within the body (including heart pacemaker, shrapnel, or surgical prostheses) which may present a risk to the subject or interfere with the MR scan, according to the guidelines set forth in the following reference book commonly used by neuroradiologists: "Guide to MR procedures and metallic objects", F. G. Shellock, Lippincott Williams and Wilkins NY 2001. Additionally, transdermal patches will be removed during the MRI.
- Claustrophobia significant enough to interfere with MRI scanning.
- Weight over 350 lbs or inability to fit into MRI scanner.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Buprenorphine
Buccal Films
|
Buprenorphine Buccal Films
|
Placebo Comparator: Placebo
Buccal Films
|
Placebo Buccal Films
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Changes in Beck Scale for Suicidal Ideation (SSI) scores from pre- to Week 2 post-treatment.
Time Frame: 2 Weeks
|
Clinician-based questionnaire measuring level of suicidal ideas over the last 7 days; 21 items scored 0 to 2; total score ranges from 0 to 38 (last 2 items not counted), higher scores mean more intense suicidal ideas.
|
2 Weeks
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Changes in functional magnetic resonance imaging (fMRI) blood oxygen- level dependent (BOLD) signal in the amygdala in response to negative vs. neutral pictures from pre- to Week 2 post-treatment
Time Frame: 2 Weeks
|
fMRI negative picture task administered at baseline and week 2 post-treatment
|
2 Weeks
|
Collaborators and Investigators
Investigators
- Principal Investigator: Mina M Rizk, MD, New York State Psychiatric Institute
- Principal Investigator: Jeffrey M Miller, MD, New York State Psychiatric Institute
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
Additional Relevant MeSH Terms
- Behavioral Symptoms
- Mental Disorders
- Mood Disorders
- Self-Injurious Behavior
- Suicide
- Depressive Disorder
- Suicidal Ideation
- Depressive Disorder, Major
- Physiological Effects of Drugs
- Central Nervous System Depressants
- Peripheral Nervous System Agents
- Analgesics
- Sensory System Agents
- Analgesics, Opioid
- Narcotics
- Narcotic Antagonists
- Buprenorphine
Other Study ID Numbers
- IRB #8086
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.
Clinical Trials on Suicidal Ideation
-
University of WashingtonUnited States Department of Defense; Military Suicide Research ConsortiumCompletedSuicidal and Self-injurious Behavior | Suicidal Ideation ActiveUnited States
-
The Catholic University of AmericaUniversity of Washington; VA Office of Research and DevelopmentCompletedSuicidal and Self-injurious Behavior | Suicidal Ideation Active
-
Emory UniversityGeorgia Institute of TechnologyCompletedSuicide, Suicidal IdeationUnited States
-
Henry M. Jackson Foundation for the Advancement...University of Pennsylvania; University of Michigan; Duke University; US Department... and other collaboratorsUnknownSuicide, Attempted | Suicidal Ideation ActiveUnited States
-
Technische Universität DresdenUnknownDepression | Suicidal Ideation/BehaviorGermany
-
International Islamic University, IslamabadRecruitingImpulsivity | Suicidal Ideation and BehaviorPakistan
-
VA Office of Research and DevelopmentCentral Texas Veterans Health Care SystemRecruitingHealth | Reintegration Difficulties | Suicidal Ideation and Behaviors | ConnectednessUnited States
-
Children's Hospital Medical Center, CincinnatiCompleted
-
Eisenhower Army Medical CenterAugusta University; The Geneva Foundation; Congressionally Directed Medical Research...CompletedSuicidal Ideation | Suicide | Suicidal Intention | Suicidal Impulses | Suicidal and Self-Injurious Behavior | Suicidal DepressionUnited States
-
Ohio State UniversityUniversity of Minnesota; Rutgers UniversityCompletedSuicidal Ideation | SuicidalUnited States
Clinical Trials on Belbuca Buccal Product
-
BioDelivery Sciences InternationalCompletedPain | Low Back PainUnited States
-
BioDelivery Sciences InternationalCompletedLow Back PainUnited States
-
BioDelivery Sciences InternationalCompleted
-
BioDelivery Sciences InternationalCompletedLow Back PainUnited States
-
Carolinas Pain InstituteBioDelivery Sciences InternationalRecruitingChronic Pain | Back Pain Lower Back ChronicUnited States
-
BioDelivery Sciences InternationalPRA Health SciencesCompletedRespiratory DepressionUnited States
-
BioDelivery Sciences InternationalCompleted
-
University of MinnesotaBaylor College of Medicine; University of California, San Diego; New York University and other collaboratorsTerminatedUrethral StrictureUnited States
-
Datar Cancer Genetics LimitedNational University of Singapore; Test At Home Pte. LtdNot yet recruiting
-
University of California, San FranciscoBaylor College of Medicine; University of California, San Diego; New York University and other collaboratorsTerminatedUrethral StrictureUnited States