Online Program to Reduce Depression in MS

Multiple Sclerosis Clinical Trial

Official title:

International Deprexis Trial in Multiple Sclerosis (IDEMS) - a Multicenter Randomized Controlled Trial

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT02740361
• Other study ID #: IDEMS
• Secondary ID: RG-1507-05418
• Status: Active, not recruiting
• Phase: N/A
• Start date: February 15, 2017
• Est. completion date: December 31, 2021

Study information

• Verified date: July 2021
• Source: Charite University, Berlin, Germany
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This is an international, multicenter, randomized controlled trial of an internet-based CBT intervention for depression (Deprexis) conducted in five MS centers in the US and Germany. The trial consists of a three-arm primary trial phase and an extension phase targeted at maintenance.

Description:

Depression is highly common in MS with a lifetime risk for major depressive disorder (MDD) as high as 25-50% and a 12-month prevalence of up to 25%, particularly in younger patients. Depression in MS has been linked to biological as well as psychological factors and substantially impacts psychosocial function. Importantly, depressive symptoms correlate with decreased quality of life, absence from work, and lower social support and are among the strongest predictors for suicidal ideation in MS patients. Despite its immediate clinical relevance, depression in MS remains underdiagnosed and often untreated and evidence for the efficacy of pharmacological or non-pharmacological interventions for MS-associated depression is scarce. For example, guidelines recently published by the AAN concluded that evidence for pharmacotherapy and individual or group therapies for MS-depression was insufficient but recommended cognitive behavioral therapy (CBT) delivered by phone with weak level of evidence. Such approaches, however, still require availability of a trained psychotherapist. Given the mobility problems, cognitive impairment, and fatigue typically associated with MS as well as the limited availability of psychotherapists, self-guided, automated, internet-based interventions may help to overcome treatment barriers often encountered by patients with MS. In a recent phase II randomized controlled trial (RCT) in Germany, the investigators found one such internet-based CBT program, Deprexis, to significantly reduce depressive symptoms in MS (Fischer et al., Lancet Psychiatry 2015). Despite these encouraging results, large, definitive trials of the most promising therapeutic approaches for MS-associated depression that could inform clinical practice are completely lacking. Here, the investigators conduct a large, international, multicenter RCT of the Deprexis program to treat depression in MS patients. Patients will be recruited in five specialized MS centers in Germany (Charité Berlin and University Medical Center Hamburg) and the US (Cedars Sinai Los Angeles, University of Missouri - Kansas City, and Penn State University). The investigators plan to enroll n=400 patients who will be randomly assigned to two different versions of Deprexis (either Deprexis alone or Deprexis plus regular Email support, DeprexisPlus) for 3 months or a waitlist control group and undergo clinical assessments at baseline and month 3. In addition, the investigators will conduct long-term online follow up at month 6 and month 12. The trial will address the following three main aims: Aim 1: To definitively test the effectiveness of Deprexis for reducing depressive symptoms in MS at the end of treatment. Aim 2: To determine the added value of email support for Deprexis (DeprexisPlus) in MS. Aim 3: To explore the long-term stability of therapeutic effects (12 months) and the potential of a booster session to enhance maintenance.

Recruitment information / eligibility

• Status: Active, not recruiting
• Enrollment: 400
• Est. completion date: December 31, 2021
• Est. primary completion date: January 30, 2021
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 65 Years

Eligibility

Inclusion criteria

• age > 18
• neurologist-confirmed diagnosis of MS (all forms)
• self-reported depressive symptoms (BDI-Fastscreen > 4)
• fluent in German or English (depending on study site),
• willingness to engage in self-administration of an iCBT intervention for 3 months and complete follow-up
• ability to travel to the outpatient center for two clinical assessments (baseline and month 3)
• internet access at home

Exclusion criteria:

• unwilling or unable to consent,
• diagnosis of bipolar or psychosis (as determined by M.I.N.I structured interview),
• substantial neurocognitive impairments such as dementia or autism
• moderate or high risk of suicide (according to MINI module C) or by clinical impression
• very severe depression that would interfere with the ability to participate in the study (based on clinical judgment by the physician at the recruitment site).
• current psychotherapy/behavioral treatments for depression
• started pharmacotherapy for depression within the last 2 months
• MS relapse or steroid treatment in the last 4 weeks
• concurrent participation in another clinical trial that includes an intervention
• refusal to saving, processing and forwarding of pseudonymized data

Related Conditions & MeSH terms

• Multiple Sclerosis
• Sclerosis

Intervention

Behavioral:
• Deprexis, DeprexisPlus
Online program Deprexis, either as a stand-alone internet-based intervention (Deprexis) or with added standardized email support by a clinical psychologist (DeprexisPlus). In this trial, we will use a Version of Deprexis that has been adapted to MS-specific needs.

Locations

Country	Name	City	State
Germany	Charité University	Berlin
Germany	Universitätsklinikum Hamburg-Eppendorf	Hamburg
United States	University of Missouri, Kansas City	Kansas City	Kansas
United States	Cedars-Sinai Medical Center	Los Angeles	California
United States	Penn State University	State College	Pennsylvania

Sponsors (9)

Lead Sponsor	Collaborator
Charite University, Berlin, Germany	Cedars-Sinai Medical Center, King's College London, National Multiple Sclerosis Society, NeuroCure Clinical Research Center, Charite, Berlin, Penn State University, Universitätsklinikum Hamburg-Eppendorf, University Medical Center Goettingen, University of Missouri, Kansas City

Countries where clinical trial is conducted

United States,  Germany, 

References & Publications (1)

Fischer A, Schröder J, Vettorazzi E, Wolf OT, Pöttgen J, Lau S, Heesen C, Moritz S, Gold SM. An online programme to reduce depression in patients with multiple sclerosis: a randomised controlled trial. Lancet Psychiatry. 2015 Mar;2(3):217-23. doi: 10.1016/S2215-0366(14)00049-2. Epub 2015 Feb 25. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS)	Consists of 3 subtests. 1. SMDT (total score), CVLT-II (2 scores: learning score and delayed recall), and BVMT-R (2 scores: learning score and delayed recall)	Month 0 to Month 3
Other	Suicide Behaviors Questionnaire-Revised (SBQ-R)		Month 3
Other	Mini International Neuropsychiatric Interview, clinician rating, Version 5.0.0	Dichotomous variable "Major Depressive Episode, Current (yes/no)" according to module A of the MINI.	Month 0 to Month 3
Primary	Beck Depression Inventory-II		Month 0 to Month 3
Secondary	WHO Quality of Life scale (WHO-QOL BREF)	4 subscales (Physical, Psychological, Social Relationships, Environmental)	Month 0 to Month 3
Secondary	Multiple Sclerosis Impact Scale (MSIS)	2 subscales (Physical and Psychological)	Month 0 to Month 3
Secondary	Fatigue Scale for Motor and Cognitive Functions (FSMC)	Total score and 2 subscales (Motor and Cognitive)	Month 0 to Month 3
Secondary	Chalder Fatigue Scale		Month 0 to Month 3