Major Depressive Disorder Clinical Trial
Official title:
The Antidiabetic Metformin as a Novel Adjunct to Antidepressants in Major Depressive Disorder Patients: A Proof-of-Concept, Randomized, Double-Blind, Placebo-Controlled Trial
The aim of our study was to test whether the combined administration of the SSRI fluoxetine and metformin, a drug improving metabolic profile and therefore potentially able to mimic the influence of supportive living conditions on treatment outcome, results in an improved antidepressant efficacy compared with fluoxetine alone.
Selective Serotonin Reuptake Inhibitors (SSRIs) represent the standard treatment for Major
Depressive Disorder (MDD). However, their efficacy is variable and incomplete. In order to
explain, at least in part, such variable efficacy, we have shown that SSRI administration
does not affect mood per se but, by enhancing neural plasticity, amplifies the influence of
the living conditions on mood. Consequently, in a favorable environment, SSRI treatment leads
to a reduction of symptoms while, in stressful conditions, it could lead to a worse
prognosis. Here, we test the hypothesis that, given the clear association between living
conditions and metabolic profile, the modulation of the latter may mimic the effect of the
environment on SSRI outcome, determining treatment efficacy.
Metformin is widely used as a first line treatment for patients with type 2 diabetes mellitus
for more than 60 years for the reduction of hepatic glucose output and increase of the
insulin mediated utilization of glucose. Previous studies demonstrated that metformin can
rapidly cross the blood brain barrier and has several beneficial effects in the brain such as
anti-inflammatory and neuroprotective effects. Furthermore, metformin, along with its
anti-glycemic effects, has been documented to possess anti-depression effects in patients
with type 2 diabetes. In Guo's study, 58 participants diagnosed with depression and type 2
diabetes were divided into two groups: one treated with metformin and the other with a
placebo for 24 weeks. Analysis of MADRS and HRSD-17 scores showed that metformin
significantly reduced MADRS scores and HRSD-17 scores. Metformin administration improves
depressive symptoms in type 2 diabetes mellitus.
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