Psilocybin for Treatment-Resistant Depression

Major Depressive Disorder Clinical Trial

Official title:

Effects of Psilocybin With Psychological Support on Anhedonia in Treatment-resistant Depression: a Randomized Controlled Pilot Trial

Clinical Trial Details — Status: Not yet recruiting

Administrative data

• NCT number: NCT06230757
• Other study ID #: 22-1681
• Status: Not yet recruiting
• Phase: Phase 2
• Start date: March 1, 2024
• Est. completion date: March 1, 2025

Study information

• Verified date: January 2024
• Source: University of Colorado, Denver
• Contact: Lily C Vonesh, BA
• Phone: 3037240658
• Email: lily.vonesh[@]cuanschutz.edu
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The purpose of this study is to evaluate the efficacy of psilocybin on the symptom of anhedonia in individuals with treatment-resistant major depressive disorder.

Recruitment information / eligibility

• Status: Not yet recruiting
• Enrollment: 40
• Est. completion date: March 1, 2025
• Est. primary completion date: March 1, 2025
• Accepts healthy volunteers: No
• Gender: All
• Age group: 21 Years and older

Eligibility

Inclusion Criteria:

• Adults = 21 years of age at Baseline Visit 1

• Major depressive disorder as determined by the Mini International Neuropsychiatric Interview (MINI), and of a moderate to severe degree (scoring at least 20 or greater on the MADRS)

• Score of at least 20 on two consecutive administrations approximately at least one week apart on the MADRS with less than 30% change indicating stability of depression severity

• Score of 29 or less on two consecutive administrations of the Dimensional Anhedonia Rating Scale (DARS) with less than 30% change from one administration to the next

• The participant's Major depressive disorder meets the criteria for being treatment-resistant, defined as not experiencing a 50% improvement to two or more antidepressant treatments for adequate duration (6 weeks minimum) within the current episode, as determined by the Antidepressant Treatment Response Questionnaire (Desseilles et al., 2011; Posternak et al., 2004)

• Sufficiently competent in English Language

• Currently under the care of a psychiatric practitioner who practices within the Department of Psychiatry at the University of Colorado Anschutz Medical Campus. Participants engaged in additional psychosocial treatments beyond seeing a psychiatric practitioner will be evaluated on a case-by-case basis.

• Right-handed

• Women of childbearing potential (WOCBP) must agree to practice an effective means of birth control throughout the duration of the study. A person of childbearing potential is anyone born female who has experienced menarche and who has not undergone surgical sterilization (eg, hysterectomy, bilateral salpingectomy, bilateral oophorectomy) or has not completed menopause. Menopause is defined clinically as 12 months of amenorrhea in a person over age 45 in the absence of other biological, physiological, or pharmacological causes.

• Have an identified support person and agree to be accompanied home (or to an otherwise safe destination) by the support person, or another responsible party, following dosing

• Written informed consent obtained from participant and ability for subject to comply with the requirements of the study.

• Ability to abstain from caffeine and nicotine for 2 hours prior to fMRI scan visits

Exclusion Criteria:

• Unstable medical conditions or serious abnormalities of complete blood count, chemistries, or EKG that in the opinion of the study physician would preclude safe participation in the trial. Some examples include:

1. Congestive heart failure

2. Clinically significant arrhythmias (e.g. ventricular fibrillation, torsades) or clinically significant EKG abnormality (i.e. QTC interval > 450)

3. Recent acute myocardial infarction or evidence of ischemia

4. Malignant hypertension

5. Congenital long QT syndrome

6. Acute renal failure

7. Severe hepatic impairment

8. Respiratory failure

• Risk for hypertensive crisis defined as Screening, Baseline, and Medication Session (prior to dosing) Blood Pressure >140/90 mmHg.

• High resting heart rate defined as Screening, Baseline, and Medication Session (prior to dosing) heart of rate of >90 BPM

• Significant CNS pathology as determined by self-report and confirmed by a history and physical examination and review of medical records. Current and historical psychiatric disorders will be determined by the MINI. Specific examples include:

1. Primary or secondary cerebral neoplasm

2. Epilepsy

3. History of stroke

4. Cerebral aneurysm

5. Dementia

6. Delirium

7. Post-traumatic Stress Disorder

8. Current or lifetime primary psychotic disorder, bipolar affective disorder, affective disorder with psychotic features. Some examples include:

9. Schizophrenia spectrum disorders

10. Schizoaffective disorder

11. Bipolar I or Bipolar II disorder

12. History of mania

13. Major depressive disorder with psychotic features

• Family history of first-degree relative with psychotic or serious bipolar spectrum illnesses. Examples include first-degree relative with:

1. Schizophrenia spectrum disorders

2. Schizoaffective disorder

3. Bipolar I disorder

• High risk of adverse emotional or behavioral reaction based on investigator's clinical evaluation. Examples include:

1. Agitation

2. Violent behavior

• Active SUDs evaluated by the MINI and defined as: DSM-5 criteria for moderate or severe alcohol or drug use disorder (excluding caffeine and nicotine) within the past year

• Extensive use of serotonergic hallucinogens (e.g. LSD, psilocybin) defined as:

1. Any use in the last 12 months

2. >25 lifetime uses

• History of hallucinogen persisting perception disorder (HPPD)

• Women who are pregnant, as indicated by a positive urine pregnancy test at Screening. Women who intend to become pregnant during the study or who are currently nursing.

• History of severe suicide attempt requiring hospitalization in the past year

• Have any suicidal ideation or thoughts, in the opinion of the study physician or PI, that presents a serious risk of imminent suicidal or self-injurious behavior

• Use of drugs or dietary supplements that per the discretion of the study team, have a mechanism of action that would interfere with procedures of study or have an adverse interaction with the study drug. Examples include direct agonists/antagonists of serotonin receptors such as those listed below. Selective Serotonin Re-uptake Inhibitors and Serotonin Norepinephrine Re-uptake Inhibitors are allowed at the discretion of the PI. Individuals need to be off all non-allowed drugs for a period of 5 half-lives prior to the baseline visit.

1. Antipsychotics

2. Trazodone

3. Nefazodone

4. Cyproheptadine

5. Mirtazapine

6. Buspirone

7. Flibanserin

8. Vilazodone

9. Fluoxetine (no use in past 4 weeks prior to Visit 1)

10. Tricyclic antidepressants

11. Ondansetron

12. Monoamine oxidase inhibitors

13. Lithium

14. Efavirenz

15. Serotonergic dietary supplements including St. John's Wort, L-tryptophan and 5-Hydroxytryptophan (5-HTP)

• Psychiatric condition judged to be incompatible with establishment of rapport with therapy team and/or safe exposure to psilocybin based on investigator's clinical evaluation

• Have an allergy or intolerance to any of the materials contained in either drug product

• Have a positive urine drug test including Amphetamines, Barbiturates, Buprenorphine, Benzodiazepines, Cocaine, Methamphetamine, MDMA, Methadone, Opiates (Morphine, Oxycodone), Phencyclidine (PCP).

1. Note: Prescribed benzodiazepine medications and non-benzodiazepine sleeping medications will be allowed to continue through the study period for participants who have been on a stable dose of such a medicine for at least 6 weeks prior to Screening, as determined during review of concomitant medications.

2. Note: Participants using cannabis, including legal cannabis, for any purposes and who do not screen positive for a moderate to severe substance use disorder must agree to refrain from use beginning at Screening and through to the end of the study.

3. Note: Participants using prescribed psychostimulants (amphetamines and Ritalin), must agree to refrain from use for five half-lives of the drug as confirmed with a negative Baseline drug test, and through to the end of the study.

• Have any psychological or physical symptom, medication or other relevant finding prior to baseline visit based on the clinical judgment of the PI or relevant clinical study staff that would make a participant unsuitable for the study.

• Claustrophobia

• Lack of internet access

• Weight over 300 pounds

• Metal in body unsafe for MRI or conditions that would make MRI unsafe for participants (e.g. aneurysm clip, cardiac pacemaker, etc.).

• Known contraindication to the drugs clonidine, diazepam, or olanzapine including:

1. Hypersensitivity or allergy to clonidine, diazepam, or olanzapine

2. Myasthenia gravis

3. Severe respiratory insufficiency

4. Severe hepatic insufficiency

5. Sleep apnea syndrome

6. Acute narrow-angle glaucoma 23. History of valvular heart disease

Related Conditions & MeSH terms

• Anhedonia
• Depression
• Depressive Disorder
• Depressive Disorder, Major
• Depressive Disorder, Treatment-Resistant
• Major Depressive Disorder
• Treatment Resistant Depression

Intervention

Drug:
• Psilocybin 25mg
25mg psilocybin capsule
• Placebo (active placebo)
1mg psilocybin capsule

Locations

Country	Name	City	State
United States	University of Colorado Anschutz Medical Campus	Aurora	Colorado

Sponsors (1)

Lead Sponsor	Collaborator
University of Colorado, Denver

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Change from baseline in self-reported anhedonia scores on the Dimensional Anhedonia Rating Scale (DARS).	The DARS is a 17-item scale that captures multiple domains of anhedonia found in depression. Scores range from 0 to 68 with lower scores indicating greater anhedonia and 68 indicating no anhedonia.	One week post-dosing
Secondary	Change from baseline in self-reported anhedonia scores on the Dimensional Anhedonia Rating Scale (DARS).	The DARS is a 17-item scale that captures multiple domains of anhedonia found in depression. Scores range from 0 to 68 with lower scores indicating greater anhedonia and 68 indicating no anhedonia.	Eight weeks post-dosing
Secondary	Change from baseline in self-reported anhedonia scores on the Snaith-Hamilton Pleasure Scale (SHAPS).	The SHAPS is a 14-item scale that assesses the pleasure component of hedonic experience across multiple domains. Scores range from 0 to 14 with 0 indicating no anhedonia and high scores indicating greater anhedonia.	One week and eight weeks post-dosing
Secondary	Change from baseline in response bias for the high reward condition on the Probabilistic Reward Task (PRT)	The PRT is a behavioral task that assesses the capacity to develop a response bias towards more highly rewarded stimuli, in which individuals with MDD demonstrate reduced bias towards highly rewarded stimuli.	One and eight weeks post-dosing
Secondary	Change from baseline in nucleus accumbens neural activation during expectation of reward versus expectation of non-reward during the Monetary Incentive Delay Task (MID).	The MID is used in conjunction with fMRI to assess neural activity during reward processing and reliably induces neural activation in brain regions related to reward.	One week post-dosing
Secondary	Change from baseline in depression scores of the clinician-rated Montgomery-Asberg Depression Rating Scale (MADRS).	The MADRS is a standard 10-item clinician-rated scale that assesses severity of depression in anti-depressant trials. Scores range form 0-60, with scores of 0-6 indicating no depression, 7-19 indicating mild depression, 20-34 indicating moderate depression and 35 or greater indicating severe depression.	One and eight weeks post-dosing
Secondary	Change from baseline in depression scores as measured by self-report on the Quick Inventory of Depressive Symptomatology (QIDS-SR-16).	The QIDS-SR-16 is a widely used 16-item self-report scale of depressive symptoms. Scores range form 0-27, with scores of 0-5 indicating no depression, 6-10 indicating mild depression, 11-15 indicating moderate depression, 16-20 indicating severe depression, and 21-27 indicating very severe depression.	One, four, and eight weeks post-dosing