Major Depressive Disorder Clinical Trial
Official title:
Treatment Resistant Geriatric Depression in Primary Care: Is NAAG (N-Acetylaspartylglutamate), Measured by Proton Magnetic Resonance Spectroscopy (1H-MRS) at 3 Tesla, a Predictor of Treatment Response?
Verified date | January 2017 |
Source | Mclean Hospital |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
This study involves collaboration between McLean Hospital, Geriatric Medicine at the
Cambridge Health Alliance (CHA) and other sites within the Partners and Harvard Medical
School network. The investigators plan to recruit individuals 55 to 89 years old with
treatment resistant depression. Someone with "treatment resistant" depression for this study
may be someone who still has sad or low feelings and thoughts even though he/she is taking
an antidepressant medication for at least 8 weeks to help relieve his/her depression. During
the study, subjects will gradually add memantine hydrochloride in dosages up to 20 mg/day
for 8 weeks to their standard antidepressant treatment.
The investigators are doing this research study to help answer 3 questions:
1. Do older adults with treatment resistant Major Depression have lower levels of a
chemical in the brain called NAAG than older adults without Major Depression?
2. Do older adults with naturally low NAAG levels do better on memantine hydrochloride
treatment than older adults with higher amounts of this chemical on memantine
hydrochloride treatment?
3. Do older adults with treatment resistant depression have more problems with memory and
concentration than older adults without depression?
The investigators are also interested in looking at electrical and neuronal activity of the
brain, spiritual beliefs, and fatigue in relationship to depression.
The investigators hypothesize that:
1. Older individuals with treatment resistant Major Depression will have lower levels of
NAAG compared with age-matched older control subjects.
2. Older adults with treatment resistant depression and low NAAG levels will do better on
treatment with memantine hydrochloride than older adults on memantine with higher NAAG
levels.
3. Older adults with depression will do better on tests of attention and executive
functioning after treatment with memantine hydrochloride.
4. Healthy controls will do better on tests of attention and executive functioning than
older adults with depression.
Status | Completed |
Enrollment | 12 |
Est. completion date | April 2012 |
Est. primary completion date | April 2012 |
Accepts healthy volunteers | Accepts Healthy Volunteers |
Gender | All |
Age group | 55 Years to 89 Years |
Eligibility |
Inclusion Criteria for Depression Subjects: - Ability to provide informed consent - Age 55 to 89, inclusive - DSM-IV Diagnosis of Major Depressive Disorder - MADRS score of >16 at screening and baseline* - Must speak, read, and write in English - On standard antidepressant medication for at least 8 weeks prior to beginning memantine hydrochloride treatment Exclusion Criteria for Depression Subjects: - Serious or unstable medical illness, including cardiovascular, hepatic, renal, respiratory, endocrine, neurologic or hematologic disease - History of seizure disorder - History or current diagnosis of the following psychiatric illnesses: any organic mental disorder (including dementia), schizophrenia, schizoaffective disorder, delusional disorder, psychotic disorder not otherwise specified, bipolar disorder, patients with substance dependence disorders, including alcohol, active within the last 12 months - History of drug hypersensitivity or intolerance to memantine hydrochloride - Use of the following class of medications: barbiturates.** - Inability to complete the screening procedures - Contraindications to magnetic resonance imagining (MRI), including any of the exclusion criteria mentioned in the MRI risks section of this protocol - MRI abnormality that compromises integrity of imaging data (eg. intracranial lesions, hydrocephalus) - Non-English speaking participants Notes for Study Criteria (Depressed Subjects): *Depressed subjects that score below a 16 on the MADRS at baseline may be reevaluated within two weeks. After reevaluation, study staff will exclude subjects that continue to score below a 16 on the MADRS. All subjects who score 16 or above at reevaluation may be included in the study at that point, provided they still meet study criteria. **Benzodiazepines and non-benzodiazepine sedative hypnotics (such as zolpidem/Ambien), may be used by depressed subjects throughout the study as long as they are not taken within 12 hours of any MRI scan. Inclusion Criteria for Control Subjects: - Ability to provide informed consent - Age 55 to 89, inclusive - MADRS score <4 - Must speak, read, and write in English - Must match with a depression subject previously enrolled on age (+/- 5 years) and sex Exclusion Criteria for Control Subjects: - Any evidence of current or past psychiatric disorders - Serious or unstable medical illness, including cardiovascular, hepatic, renal, respiratory, endocrine, neurologic or hematologic disease - History of seizure disorder - History or current diagnosis of the following psychiatric illnesses: any organic mental disorder (including dementia), major depressive disorder, depression NOS, dysthymia, bipolar disorder( type I or II), schizophrenia, schizoaffective disorder, delusional disorder, psychotic disorder not otherwise specified, bipolar major depressive disorder, patients with substance dependence disorders, including alcohol. - Use of any class of psychotropic medication. - Inability to complete the screening visit - MRI abnormality that compromises integrity of imaging data - Contraindications to magnetic resonance imagining (MRI), including any of the exclusion criteria mentioned in the MRI risks section of this protocol - Non-English speaking participants |
Country | Name | City | State |
---|---|---|---|
United States | McLean Hospital | Belmont | Massachusetts |
Lead Sponsor | Collaborator |
---|---|
Mclean Hospital | Cambridge Health Alliance, Harvard University |
United States,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Mean Differences in NAAG Levels between Subject Groups at Baseline and Week 8 | Are NAAG levels are lower in older adults with treatment resistant depression compared with healthy age-matched controls? | Baseline / Study Entry | |
Secondary | Relationship of NAAG Levels and MADRS Scores between Subject Groups at Baseline and Week 8 | Do subjects with low NAAG levels within the treatment resistant depression group prior to memantine hydrochloride augmentation respond better to treatment with memantine hydrochloride? | 8-week trial | |
Secondary | Cognitive Impairment between Subject Groups at Baseline and Week 8 | Do older adults with Major Depression have evidence of cognitive impairment (in particular in the realm of executive functioning and attention) compared with older healthy controls from baseline to study endpoint? | 8-week trial |
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