Dichotic Listening as a Predictor of Medication Response in Depression

Phase 4

Completed

Brief Summary: This study will recruit 100 depressed patients to test whether the previous finding of an association between treatment response (with treatment groups including placebo, imipramine, and fluoxetine) and preferences of hemispheric laterality in perceptual processing are also found with a different type of commonly used anti-depressant, bupropion.

Detailed Description: Preliminary data suggest that depressed patients with increased left hemispheric laterality of perceptual processing are unlikely to improve during 6 weeks' treatment with placebo, while being very responsive to either imipramine or fluoxetine. Depressed patients who do not show evidence of poor right hemispheric functioning respond significantly more often to placebo than those with poor right hemispheric functioning , and do not show an advantage of drug over placebo. 100 patients will be tested with verbal and nonverbal dichotic tests, and then treated sequentially with bupropion, escitalopram, and imipramine. Preferential hemisphere for auditory processing will be correlated with treatment outcome.

Recruitment & Eligibility

Inclusion Criteria

Ages between 18-65
Meets Diagnostic and Statistical Manual, Fourth Edition (DSM-IV) criteria for current Major Depression, Dysthymia or Depression Not Otherwise Specified

Exclusion Criteria

Known Hearing impairment
Active suicidal ideation (history of suicide attempts will be evaluated on a case by case basis).
Hamilton Rating Scale for Depression (HAMD), 21-item total score >20
Current (past 6 months)alcohol and/or drug abuse or dependence
Medical condition likely to require intervention contraindicated with study medication (e.g., known arrhythmia likely to be exacerbated by Imipramine)
Bipolar I
Psychosis
Non-response to adequate trial of study medication (i.e., > or = 4 weeks on > or = bupropion 300mg/d, escitalopram 30mg/d, or imipramine 200mg/d)
Premenopausal women not using known effective birth control
Not currently depressed (whether considered due to current treatment or not)
History of seizure, seizure disorder, anorexia nervosa, or bulimia
Left-handed -

Arm && Interventions

Group	Intervention	Description
escitalopram	escitalopram	escitalopram 10 mg/d for 1 week, then increasing by 10 mg/week if tolerated and not remitted to maximal dose of 40 mg/d
bupropion	bupropion	bupropion extended release (XL) 150 mg/d for a week, then 300 mg/d for a week and then 450 mg/d; all dose increases if tolerated and not remitted
imipramine	imipramine	imipramine 50 mg/d increasing twice weekly by 50 mg/increase to 200 mg/d, then by 50 mg/week to a maximum dose of 300 mg/d; all dose increases if tolerated and not remitted

Primary Outcome Measures

Name	Time	Method
Hamilton Depression Scale (HAM-D)	6 weeks or last visit in Phase	Hamilton Depression Scale, 21 item version Summary of all 21 items and higher score means worse depression. Scores range from 0 to a maximum of 63.

Secondary Outcome Measures

Name	Time	Method
Clinical Global Impression Scale (CGI)	6 weeks or last visit in Phase	The CGI is a standard measure of global psychopathology. CGI-severity scores rated on a 7-point scale, with the severity of illness scale using a range of responses from 1 (normal) through to 7 (amongst the most severely ill patients). CGI-improvement scores range from 1 (very much improved) through to 7 (very much worse).