Mechanisms of Antidepressant Non-Response in Late-Life Depression
Tutkimuksen yleiskatsaus
Tila
Tila
Ehdot
Ehdot
Interventio / Hoito
Interventio / Hoito
Yksityiskohtainen kuvaus
Opintotyyppi
Opintotyyppi
Ilmoittautuminen (Todellinen)
Ilmoittautuminen
Vaihe
Vaihe
- Ei sovellettavissa
Yhteystiedot ja paikat
Opiskelupaikat
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New York
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New York, New York, Yhdysvallat, 10032
- New York State Psychiatric Institute
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Osallistumiskriteerit
Kelpoisuusvaatimukset
Kelpoisuusvaatimukset
Opintokelpoiset iät
Hyväksyy terveitä vapaaehtoisia
Sukupuolet, jotka voivat opiskella
Kuvaus
Inclusion Criteria:
- Men and women aged 60-90 years
- Diagnosis with nonpsychotic Diagnostic and Statistical Manual (DSM) IV MDD
- 24-item Hamilton Rating Scale for Depression (HRSD) score ≥ 16
- Willing to and capable of providing informed consent and complying with study procedures
Exclusion Criteria:
- Current comorbid Axis I DSM IV disorder other than Nicotine Dependence, Adjustment Disorder, or Anxiety Disorder
- diagnosis of substance abuse or dependence (excluding Nicotine Dependence) within the past 12 months
- History of psychosis, psychotic disorder, mania, or bipolar disorder
- Diagnosis of probable Alzheimer's Disease, Vascular Dementia, or Parkinson's Disease
- MMSE < 24
- HRSD suicide item > 2 or Clinical Global Impressions (CGI)-Severity score of 7 at baseline
- history of allergic or adverse reaction to escitalopram, or non-response to adequate trial of escitalopram (at least 4 weeks at dose of 20mg) during the current episode
- current treatment with psychotherapy, antidepressants, antipsychotics, or mood stabilizers
- having contraindication to MRI scanning (such as metal in body) or unable to tolerate the scanning procedures (i.e., severe obesity, claustrophobia)
- acute, severe, or unstable medical or neurological illness
Opintosuunnitelma
Miten tutkimus on suunniteltu?
Suunnittelun yksityiskohdat
- Ensisijainen käyttötarkoitus: Hoito
- Jako: Satunnaistettu
- Inventiomalli: Rinnakkaistehtävä
- Naamiointi: Nelinkertaistaa
Aseiden lukumäärä
Aseet ja interventiot
Osallistujaryhmä / ArmOsallistujaryhmä / Arm |
Interventio / HoitoInterventio / Hoito |
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Placebo Comparator: Double Blind-Placebo
Blinded treatment with placebo, one pill a day.
If after the 4 weeks, the patient has not remitted, they will be increased to 2 pills a day.
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Inert substance or treatment which is designed to have no therapeutic value but resemble the active medication in this study
Muut nimet:
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Active Comparator: Double Blind-Escitalopram
Blinded treatment with either escitalopram 10mg, increased to escitalopram 20mg at week 4 if depression has not remitted.
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Escitalopram is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class.
It is FDA approved for the treatment of major depressive disorder (MDD) and generalized anxiety disorder (GAD) in adults and children over 12 years of age.
Muut nimet:
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Active Comparator: Open Treatment with Escitalopram
Open treatment with 10mg of escitalopram, increased to 20mg if depression has not remitted at week 4.
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Escitalopram is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class.
It is FDA approved for the treatment of major depressive disorder (MDD) and generalized anxiety disorder (GAD) in adults and children over 12 years of age.
Muut nimet:
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Mitä tutkimuksessa mitataan?
Ensisijaiset tulostoimenpiteet
Ensisijaiset tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
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Hamiltonin masennuksen luokitusasteikko (HRSD)
Aikaikkuna: Perustaso
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Tavoitteenamme on masennusoireet mitattuna Hamilton Rating Scale for Depression (HRSD) -asteikolla.
HRSD on 24 kohdan kyselylomake, jota käytetään indikaattorina masennuksesta ja oppaasta toipumisen arvioinnissa.
Kokonaispisteet vaihtelevat 0-74, ei sisällä epätyypillisten oireiden ala-asteikkoa.
Pistemäärä 16 tai enemmän katsotaan yleensä osoittavan masennusoireita.
Korkeammat pisteet osoittavat suurempaa vakavuutta.
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Perustaso
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Toissijaiset tulostoimenpiteet
Toissijaiset tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
|---|---|---|
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Hamilton Rating Scale for Depression (HRSD)
Aikaikkuna: Week 8
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Our target is depressive symptomatology as measured by the Hamilton Rating Scale for Depression (HRSD).
The HRSD is a 24-item questionnaire used as an indication of depression and a guide to evaluate recovery.
Total scores range from 0-74, not including atypical symptoms sub-scale.
A score of 16 or above is typically considered to indicate the presence of depressive symptoms.
Higher scores indicate greater severity.
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Week 8
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Quick Inventory of Depressive Symptoms (QIDS-SR)
Aikaikkuna: Baseline
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QIDS-SR is a 16 item scale self-report form that was used to measure depression outcomes.
This self-report is valuable in this study, because it is less susceptible to clinician and rater bias.
The QIDS-SR has been increasingly used in antidepressant studies due to its equivalent weightings for each symptom item, clearly understandable anchor points, and inclusion of all DSM criteria for depression.
The scores range from 0-27 with 27 being worse depressive symptoms.
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Baseline
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Quick Inventory of Depressive Symptoms (QIDS-SR)
Aikaikkuna: Week 8
|
QIDS-SR is a 16 item scale self-report form that was used to measure depression outcomes.
This self-report is valuable in this study, because it is less susceptible to clinician and rater bias.
The QIDS-SR has been increasingly used in antidepressant studies due to its equivalent weightings for each symptom item, clearly understandable anchor points, and inclusion of all DSM criteria for depression.
The scores range from 0-27 with 27 being worse depressive symptoms.
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Week 8
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Credibility and Expectancy Scale-Better (CES)
Aikaikkuna: Pre-Baseline
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CES is an 8 item scale in which subjects rate their impression of the credibility of the treatment and how they estimate their expectation of improvement.
The CES is the most widely used measure of expectancy and has demonstrated good psychometric properties in multiple studies.
Question 2 ('Better') asks the patient the chances of their depression being completely better at the end of this study, from 1 = very poor to 7 = very good.
The higher the number, the higher the expectancy that they will be better.
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Pre-Baseline
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Credibility and Expectancy Scale-Better (CES)
Aikaikkuna: Week 0
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CES is an 8 item scale in which subjects rate their impression of the credibility of the treatment and how they estimate their expectation of improvement.
The CES is the most widely used measure of expectancy and has demonstrated good psychometric properties in multiple studies.
Question 2 ('Better') asks the patient the chances of their depression being completely better at the end of this study, from 1 = very poor to 7 = very good.
The higher the number, the higher the expectancy that they will be better.
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Week 0
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Credibility and Expectancy Scale-Depression
Aikaikkuna: Pre-baseline
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CES is an 8 item scale in which subjects rate their impression of the credibility of the treatment and how they estimate their expectation of improvement.
The CES is the most widely used measure of expectancy and has demonstrated good psychometric properties in multiple studies.
CES question 3 ('Depression') asks how the patient's depression will be at the end of the study, compared with now, from 1 = much worse to 7= much better.
The higher the number, the higher the expectancy that their depression will be much better.
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Pre-baseline
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Credibility and Expectancy Scale-Depression
Aikaikkuna: Week 0
|
CES is an 8 item scale in which subjects rate their impression of the credibility of the treatment and how they estimate their expectation of improvement.
The CES is the most widely used measure of expectancy and has demonstrated good psychometric properties in multiple studies.
CES question 3 ('Depression') asks how the patient's depression will be at the end of the study, compared with now, from 1 = much worse to 7= much better.
The higher the number, the higher the expectancy that their depression will be much better.
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Week 0
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Quick Inventory of Depression Scale (QIDS-SR): Expectancy
Aikaikkuna: Pre-Baseline
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This 16-items assessment is used to rate the 9 criterion symptom domains of a major depressive episode: 4 items are used to rate sleep disturbance (early, middle, and late insomnia plus hypersomnia); 2 items are used to rate psychomotor disturbance (agitation and retardation); 4 items are used to rate appetite/weight disturbance (appetite increase or decrease and weight increase or decrease).
Only 1 item is used to rate the remaining 6 domains (depressed mood, decreased interest, decreased energy, worthlessness/guilt, concentration/decision making, and suicidal ideation).
Each item is rated 0-3.
For symptom domains that require more than 1 item, the highest score of the item relevant for each domain is taken.
The total score ranges from 0-27.
A lower rating indicates higher expectancy of improvement and lower expectation of depressive symptomatology, and a higher rating indicates lower expectancy of improvement, higher expectation of depression.
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Pre-Baseline
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Quick Inventory of Depression Scale (QIDS-SR): Expectancy
Aikaikkuna: Week 0
|
This 16-items assessment is used to rate the 9 criterion symptom domains of a major depressive episode: 4 items are used to rate sleep disturbance (early, middle, and late insomnia plus hypersomnia); 2 items are used to rate psychomotor disturbance (agitation and retardation); 4 items are used to rate appetite/weight disturbance (appetite increase or decrease and weight increase or decrease).
Only 1 item is used to rate the remaining 6 domains (depressed mood, decreased interest, decreased energy, worthlessness/guilt, concentration/decision making, and suicidal ideation).
Each item is rated 0-3.
For symptom domains that require more than 1 item, the highest score of the item relevant for each domain is taken.
The total score ranges from 0-27.
A lower rating indicates higher expectancy of improvement and lower expectation of depressive symptomatology, and a higher rating indicates lower expectancy of improvement, higher expectation of depression.
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Week 0
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Executive Dysfunction: Stroop Color Word
Aikaikkuna: Pre-Baseline
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Stroop Color Word test asks patients to name the color of a word rather than reading the word.
Stroop Color Word is how many colors they can name in 45 sec (higher is better, e.g., less executive dysfunction).
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Pre-Baseline
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Executive Dysfunction: Stroop Interference
Aikaikkuna: Pre-Baseline
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The Stroop is a measure of inhibition under distracting conditions that is sensitive to frontal lobe dysfunction.
in Stroop Color Word test patients are to name the color of a word rather than reading the word.
Stroop Color Word is how many colors they can name in 45 sec (higher is better, e.g., less executive dysfunction).
Stroop Interference is this score adjusted for age and education.
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Pre-Baseline
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White Matter Hyperintensity (WMH) Outcome- Total WMH
Aikaikkuna: Pre-Baseline
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Magnetic Resonance Imaging (MRI) of the Brain was acquired.
We rated the severity of WMH on axial T2 FLAIR images using the Fazekas modified Coffey Rating Scale.
Deep WMH are scored as 0 (absent), 1 (punctate foci), 2 (beginning confluence of foci), and 3 (large confluent areas); subcortical gray matter HIs (basal ganglia) are scored as 0 (absent), 1 (punctate), 2 (multipunctate), and 3 (diffuse); periventricular HIs are scored as 0 (absent), 1 (caps), 2 (smooth halo), and 3 (irregular and extending into the deep white matter).
Our primary measure of WMH burden will be DWMH score, which has been used to establish the only empirically validated diagnostic criteria for vascular depression, where scores of 0-1 were normal, but 2-3 indicated WHM.
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Pre-Baseline
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Yhteistyökumppanit ja tutkijat
Sponsori
Sponsori
Julkaisuja ja hyödyllisiä linkkejä
Opintojen ennätyspäivät
Opi tärkeimmät päivämäärät
Opiskelun aloitus (Todellinen)
Opiskelun aloitus
Ensisijainen valmistuminen (Todellinen)
Ensisijainen valmistuminen
Opintojen valmistuminen (Todellinen)
Opintojen valmistuminen
Opintoihin ilmoittautumispäivät
Ensimmäinen lähetetty
Ensimmäinen lähetetty
Ensimmäinen toimitettu, joka täytti QC-kriteerit
Ensimmäinen toimitettu, joka täytti QC-kriteerit
Ensimmäinen Lähetetty (Arvio)
Ensimmäinen Lähetetty
Tutkimustietojen päivitykset
Viimeisin päivitys julkaistu (Todellinen)
Viimeisin päivitys julkaistu
Viimeisin lähetetty päivitys, joka täytti QC-kriteerit
Viimeisin lähetetty päivitys, joka täytti QC-kriteerit
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Viimeksi vahvistettu
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Tähän tutkimukseen liittyvät termit
Muita asiaankuuluvia MeSH-ehtoja
- Mielenterveyshäiriöt
- Mielialahäiriöt
- Masennushäiriö
- Masennus, majuri
- Huumeiden fysiologiset vaikutukset
- Neurotransmitterit
- Farmakologisen vaikutuksen molekyylimekanismit
- Psykotrooppiset lääkkeet
- Serotoniinin sisäänoton estäjät
- Neurotransmitterien sisäänoton estäjät
- Kalvon kuljetusmodulaattorit
- Serotoniinin aineet
- Masennuslääkkeet
- Toisen sukupolven masennuslääkkeet
- Sitaloprami
Muut tutkimustunnusnumerot
Muut tutkimustunnusnumerot
- 6836 (Sponsor ref)
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