Depression Clinical Trial
Official title:
Ketamine for Relapse Prevention in Recurrent Depressive Disorder: a Randomised, Controlled, Pilot Trial: the KINDRED Trial
Randomised, controlled, parallel-group, pilot clinical trial of ketamine vs. midazolam for depression relapse prevention in persons at high risk. The main purpose of the pilot study is to assess trial processes to help inform a future definitive trial.
Participants will be recruited at admission to St Patrick's University Hospital for treatment
of the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV)-diagnosed
recurrent unipolar depression and followed-up weekly to assess recovery according to standard
criteria. Blood samples for epigenetic studies will be taken at baseline. Treatment-as-usual
will continue throughout the entire trial. Participants who meet standardised response
criteria will then be invited to be randomised to course of four two-weekly ketamine or
midazolam (active comparator) infusions. Block randomisation will be independently performed.
Physical, psychotomimetic and cognitive outcomes will be monitored before, during and after
infusions. Blood samples will be taken at four time-points in the first infusion session and
before the final infusion for neuroplasticity biomarker studies.Trial Interventions:
participants will receive four two-weekly infusions of either ketamine at 0.05mg/kg or
midazolam at 0.045mg/kg. All infusions will be administered by a consultant anaesthetist.
Repeated infusions of ketamine have been shown to be safe and well-tolerated by patients with
mental illness. Minor haemodynamic changes and psychotomimetic side-effects can occur and
will be assessed regularly during infusions and for 200 minutes afterwards.
Participants will be followed up over six months to assess for relapse according to
standardised criteria. This is the highest-risk period for relapse and investigators
hypothesize that ketamine will provide additional neurotrophic support (assessed by the
laboratory biomarker project) which will result in lower relapse rates when compared to
midazolam.
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