Ketamine as an Adjunctive Therapy for Major Depression

Phase 1

Completed

• Conditions: Bipolar Depression; Major Depressive Episode; Unipolar Depression
• Interventions: Drug: Ketamine; Drug: Midazolam

• Registration Number: NCT03256162
• Lead Sponsor: St Patrick's Hospital, Ireland

Brief Summary

Randomised, controlled, parallel-group, pilot clinical trial of ketamine vs. midazolam as an adjunctive therapy for depression. The main purpose of the pilot study is to assess trial processes to help inform a future definitive trial.

Detailed Description

Pragmatic, randomised, controlled, parallel-group, pilot trial. Trial participants will be patients admitted to St Patrick's University Hospital for treatment of a depressive episode. The investigators aim to recruit up to 20 participants who will be eligible for this study and randomly allocate 10 patients to each group. The participants will undergo usual inpatient care as prescribed by their treating team for the index acute depressive episode. Both participants and assessors will be blind to treatment allocation. Consented participants will be randomly allocated in a 1:1 ratio to a four week course of either once-weekly ketamine or midazolam 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. Both groups will continue treatment as usual. Participates will also be followed up over a three month period.

Basic Information
|
Recruitment & Eligibility
|
Study & Design
|
Trial Locations

Study Timeline

• Study First Submitted: 2017-08-02
• Study First Submitted QC: 2017-08-16
• Study First Posted: 2017-08-21
• Study Start: 2017-09-07
• Primary Completion: 2018-09-21
• Study Completion: 2018-09-21
• Status Verified: 2020-01
• Results First Submitted: 2020-01-02
• Results First Submitted QC: 2020-01-15
• Last Update Submitted: 2020-01-15
• Results First Posted: 2020-01-18
• Last Update Posted: 2020-01-18

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 25

Inclusion Criteria

• ≥18 years old
• Hamilton Rating Scale for Depression-24 item version (HRSD-24) score of ≥21
• Voluntary admission for treatment of an acute depressive episode
• Meet Diagnostic and Statistical Manual of Mental Disorders , Fifth Edition (DSM-V) criteria for a major depressive disorder (MDD) and bipolar affective disorder (current episode depression)

Read More

Exclusion Criteria

• Current involuntary admission
• Medical condition rendering unfit for ketamine/midazolam
• Active suicidal intention
• Dementia
• History of Axis 1 diagnosis other than major depression
• Electroconvulsive Therapy (ECT) administered within the last two months
• Alcohol/substance dependence in previous six-months
• Pregnancy or inability to confirm use of adequate contraception during the trial
• Breastfeeding women

Read More

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Ketamine	Ketamine	Participants will receive four once-weekly infusions of ketamine at 0.05mg/kg. All infusions will be administered by a consultant anaesthetist.
Midazolam	Midazolam	Participants will receive four once-weekly infusions of midazolam at 0.045mg/kg. All infusions will be administered by a consultant anaesthetist.

Primary Outcome Measures

Name	Time	Method
The Hamilton Rating Scale for Depression-24 Item Version (HRSD-24)	15 weeks	The HRSD assesses severity of depressive symptoms and is commonly used to measure depression severity. It was initially a 17-item format with the optional addition of 4 items making up the 21-item version. In addition to the original 21 items, the 24-item HRSD includes items on helplessness, hopelessness and worthlessness; its score range is 0-77, with higher scores reflecting greater burden of depressive symptoms.; Response to antidepressant treatment is defined as achieving ≥60% decrease from baseline HRSD-24 and score ≤16. Remission criteria are ≥60% decrease in HRSD from baseline and score ≤10. Criteria for relapse are ≥10 point increase in HRSD-24 compared to responder baseline score plus HRSD ≥16; in addition, increase in the HRSD should be maintained one week later.; Participants will have a baseline (T0) HRSD-24 score. This will be repeated 1 week after each of 4 once-weekly infusions (T1-4) and follow-up measures after another 5 (T9) and 11 (T15) weeks, week 15 is reported.

Secondary Outcome Measures

Name	Time	Method
The Quick Inventory of Depressive Symptoms, Self-report Version (QIDS-SR16)	15 weeks	The QIDS-SR16 is a validated self-report measure of depressive symptoms. This consists of 16 questions rated 0-3. Its score range is 0-48, with higher scores reflecting greater burden of depressive symptoms.; Participants will have a baseline (T0) QIDS-SR16 score. This will be repeated one week after each of four once-weekly infusions (T1-4) and follow-up measures after another five (T9) and 11 (T15) weeks. Week 15 scores are reported.
The Clinician-Administered Dissociative States Scale (CADSS)	4 weeks	The CADSS measures dissociative symptoms. It will be administered before, during and after infusions in order to capture the range of possible subjective side effects of either agent. This consists of 23 questions and scores for each question range from 0-4. The maximum score is 92 with higher scores indicating more dissociative symptoms.; Participants will have the CADSS performed before, during (+30mins) and after (+60mins) each of the four once-weekly infusions.
The Brief Psychiatric Rating Scale (BPRS)	4 weeks	The BPRS measures psychotomimetic effects. The investigators will use the positive symptoms subscale of the Brief Psychiatric Rating Scale. The 4-item positive symptoms subscale measures suspiciousness, hallucinations, unusual thought content, and conceptual disorganisation. Each question is scored between 0-7. The maximum score in this 4-item questionnaire is 28. Higher scores indicate more severe psychotic symptoms.; Participants will have the BPRS performed before, during (+30mins) and after (+60mins) each of the four once-weekly infusions.
Young Mania Rating Scale (YMRS; Mood Item)	4 weeks	Investigators will use the mood item of them YMRS to assess for psychotomimetic effects. This item is rated 0-4. The higher scores reflect elevated mood.; Participants will have the YMRS performed before, during (+30mins) and after (+60mins) each of the four once-weekly infusions.
The Patient-Rated Inventory of Side Effects (PRISE)	4 weeks	The PRISE will be used to document other general adverse events by patients before, during and after infusions. This is a patient self-report used to qualify side effects by identifying and evaluating the tolerability of each symptom. It is a 9 item assessment of the side effects in the following symptom domains; Gastrointestinal, Heart, Skin, Nervous System, Eyes/Ears, Genital/Urinary, Sleep, Sexual Functioning, and Other. Each domain has multiple symptoms which can be endorsed. For each domain the patient rates whether or not the symptoms are tolerable or distressing. Data below represent the number of participants from which there was an endorsement of each listed event.; Participants will have the PRISE performed before, during (+30mins) and after (+60mins) each of the four once-weekly infusions.
The Montreal Cognitive Assessment (MoCA)	15 weeks	The MOCA was designed as a rapid screening instrument for mild cognitive dysfunction. It assesses different cognitive domains: attention and concentration, executive functions, memory, language, conceptual thinking, calculations, and orientation. It is scored out of a maximum of 30. The higher scores indicate better cognition.; The MOCA will be performed at baseline, one day after infusions 1 and 4 and 12 weeks after the final infusion.

Trial Locations

Locations (1)

St Patrick's University Hospital; 🇮🇪 Dublin, Ireland