S&I: Late-Life Stress and Inflammation
Study Details
Study Description
Brief Summary
Over 18% of Americans aged 65 years and older have depression. Recent evidence suggests that there is a link between depression and inflammatory disease. This study investigates the relationship between inflammation in the brain and depression. Comparing biological and psychological differences in depressed and non-depressed people allows researchers to find better ways to treat and prevent depression. All participants will have: neuropsychological tests, an EKG, a spinal tap, a blood draw, and, if depressed, given either an antidepressant coupled with an anti-inflammatory medication or an anti-depressant coupled with a placebo for six weeks. The investigators are trying to correlate brain function with depression levels and biomarkers from the blood and spinal fluid.
Condition or Disease | Intervention/Treatment | Phase |
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Phase 4 |
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
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No Intervention: Control This arm is for participants who are not depressed. |
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Experimental: Experimental - treatment Depressed participants will receive an antidepressant (escitalopram) AND either a non-steroidal anti-inflammatory drug (celecoxib) OR placebo (sugar pill) for 6 weeks. |
Drug: Escitalopram + Celecoxib
Participants will receive celecoxib in addition to escitalopram
Drug: Escitalopram + Placebo
Participants will receive a placebo in addition to escitalopram.
|
Outcome Measures
Primary Outcome Measures
- Cytokine Levels [up to week 6]
Blood and cerebrospinal fluid will be analyzed for levels of cytokines (inflammatory proteins) including IL-6 and IL-10.
- Montgomery Asberg Depression Rating Scale (MADRS) [up to week 6]
This depression rating scale will be used to determine clinical outcome for depressed participants.
Eligibility Criteria
Criteria
Inclusion Criteria:
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Age 18-80, male or female, any race;
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Absence of clinical dementia
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English speaking
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Blood pressure not exceeding 150/90 mmHg, treated or untreated
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Weight greater than 110 lbs
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Normal result on liver-function test
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No history of ulcer disease or GI bleeding
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No renal insufficiency
Additional Inclusion Criteria for Depressed Participants:
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DSM-IV criteria for Major Depressive Disorder
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HAM-D greater than 18
Exclusion Criteria:
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Known history of relevant severe drug allergy or hypersensitivity (e.g. to Citalopram or Escitalopram, and/or to celecoxib, aspirin, or other NSAIDs only for Phase 2; known demonstration of allergic-type reactions to sulfonamides);
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Does not speak English;
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Cannot give informed consent;
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MRI contraindications (e.g., foreign metallic implants, pacemaker);
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Known primary neurological disorders, such as Parkinson's disease, Alzheimer's disease, traumatic brain injury, cognitive impairment or dementia,
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Known severe inflammatory disease such as systemic lupus erythematosis, known autoimmune diseases, such as multiple sclerosis, rheumatoid arthritis; Screen + for RF, ANA, HIV, Hepatitis B or C.
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Clinical Dementia Rating Scale score greater than 0;
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Diagnosis of a chronic psychiatric illness other than MDD at the discretion of the study doctor;
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Significant handicaps (e.g. uncorrected hearing or visual impairment, mental retardation) that would interfere with testing;
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Bleeding diathesis;
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Severe Medical problem, which in the opinion of the investigator would pose a safety risk to the subject;
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Clinically significant cardiovascular disease that will be assessed on a case-by-case basis. Clinically significant cardiovascular disease usually includes one or more of the following: cardiac surgery or myocardial infarction within the last 4 weeks; unstable angina; acute decompensated congestive heart failure or class IV heart failure; current significant cardiac arrhythmia or conduction disturbance, particularly those resulting in ventricular fibrillation, or causing syncope or near syncope; uncontrolled high blood pressure; QTc greater than 450msec (by history for subjects with cardiac disease); documented prior stroke;
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Clinically significant abnormalities on EKG. Primary AV block or Right bundle branch block are not necessarily exclusionary;
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Current diagnosis of cancer
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Current diagnosis of HIV, active Hepatitis B and/or Hepatitis C
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Use of an Investigational medicine within the past 30 days;
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Use of Coumadin, Warfarin within the past 2 months;
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Current treatment with psychotropic drugs or drugs that affect the CNS such as beta-blockers, mood stabilizers, antipsychotics, steroids or non-steroidal anti-inflammatory medications or other antidepressants. No subjects will be included in the study unless they have been off all psychotropics for at least 3 weeks, except in the case of fluoxetine, where 5 weeks off treatment will be required;
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Current alcohol or substance abuse disorder, schizophrenia or other psychotic disorder, bipolar disorder, or current OCD;
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Abnormal liver-function test
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History of ulcer disease, Chron's disease, GI bleeding or anemia
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Weight less than 110 lbs
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Renal insufficiency
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Any other factor that in the investigator's judgment may affect patient safety or compliance (e.g. distance greater than 100 miles from this facility);
Additional Exclusion Criteria for Depressed Subjects:
- Active suicidality or current suicidal risk as determined by the investigator
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
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1 | University of Pennsylvania | Philadelphia | Pennsylvania | United States | 19104 |
Sponsors and Collaborators
- University of Pennsylvania
Investigators
- Principal Investigator: Yvette Sheline, University of Pennsylvania
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- 5R01MH098260-02