CAN-D: Cellular Aging and Neurobiology of Depression Study

Sponsor

University of California, San Francisco (Other)

Overall Status

Recruiting

CT.gov ID

NCT00285935

Collaborator

National Institutes of Health (NIH) (NIH), National Institute of Mental Health (NIMH) (NIH)

228

Enrollment

Location

Arm

189

Duration (Months)

1.2

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

We are conducting an eight week longitudinal study to learn if blood levels of certain naturally occurring compounds and genetic markers differ between patients with depression and healthy adults who are not depressed, and if any such differences relate to memory performance, mood, and neurobiology.

We will do this by comparing the unmedicated depressed patients with matched healthy controls at baseline and then following the depressed patients over the course of eight weeks of standardized antidepressant treatment to gauge which baseline abnormalities normalize over the course of treatment.

Condition or Disease	Intervention/Treatment	Phase
Major Depressive Disorder	Other: Standard Clinical Care with an SRRI	N/A

Detailed Description

Following an initial telephone screen to assess inclusion and exclusion criteria, the evaluation will continue with an in-person evaluation to assess the presence or absence of active medical history and history of major psychiatric illness, as well as review of the consent document. If found to be eligible, participants would then be admitted to the study.

The next step for eligible, consenting depressed subjects and healthy controls is a baseline hospital visit and baseline MRI. The baseline hospital visit will last about 4 hours. We will begin the baseline visit by collecting a urine sample for a drug (and, for women, pregnancy) test. As long as that is negative, we will then collect a blood sample of about 155cc. After the blood draw, participants will complete cognitive tests and meet again with the study psychiatrist. Participants will also complete a baseline Magnetic Resonance Imaging (MRI) and Magnetic Resonance Spectroscopy (MRS) of their brain at the Veteran's Affairs (VA) Hospital in San Francisco.

After the baseline hospital visit and MRI, depressed subjects (but not healthy controls) will begin taking an FDA approved antidepressant, as prescribed by the study psychiatrist, for the next 8 weeks while they are enrolled in the study. The specific drug will be decided upon between the participant and the study psychiatrist at the in-person screening visit.

After 4 weeks, depressed participants will return to UCSF to meet again with the psychiatrist to discuss symptoms and how to continue treatment; at that visit, they will have another blood draw of 155cc (the same blood draw as at baseline). Healthy controls will return at week 4 only for the blood draw.

4 weeks later (after 8 weeks in total), we will bring both depressed and healthy participants back for an additional visit that will include the same blood draw, testing, and MRI as the baseline visit. A physician-investigator will meet with the depressed subjects to review their clinical responses to treatment and to make further treatment suggestions, which the subjects may use in discussions of their future treatment options with their personal physicians. If a decision is made to discontinue antidepressant treatment, the subjects will be given instructions on how to withdraw from the medication, and will be given up to a 4 week supply of the drug to facilitate this withdrawal.

Study Design

Study Type:

Interventional

Anticipated Enrollment :

228 participants

Allocation:

N/A

Intervention Model:

Single Group Assignment

Masking:

None (Open Label)

Primary Purpose:

Health Services Research

Official Title:

Neurosteroid Metabolism and the Antidepressant Effects of Serotonin Specific Reuptake Inhibitors (SSRI's)

Study Start Date :

Dec 1, 2010

Anticipated Primary Completion Date :

Aug 31, 2026

Anticipated Study Completion Date :

Aug 31, 2026

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Treatment with SSRI Depressed participants will receive 8 weeks of treatment with one of the following serotonin-specific reuptake inhibitors: fluoxetine (Prozac®), sertraline (Zoloft®), paroxetine (Paxil®), citalopram (Celexa®), escitalopram (Lexapro®) The specific drug used for treatment will be selected by the study clinician based on clinical interviews and the participants preferences. Participants will be monitored for response and side effects by study clinician and will return after 8 weeks for a follow up study visit.	Other: Standard Clinical Care with an SRRI Participants who enroll in this phase are treated with an FDA-approved SSRI in an open-label "treatment-as-usual" manner, in accordance with clinical practices and at a titration rate no more rapid than the manufacturer's recommendations. The duration of the treatment phase is 8 weeks. Other Name: fluoxetine (Prozac®), Sertraline (Zoloft®), paroxetine (Paxil®), citalopram (Celexa®), escitalopram (Lexapro®)

Arm

Intervention/Treatment

Experimental: Treatment with SSRI

Depressed participants will receive 8 weeks of treatment with one of the following serotonin-specific reuptake inhibitors: fluoxetine (Prozac®), sertraline (Zoloft®), paroxetine (Paxil®), citalopram (Celexa®), escitalopram (Lexapro®) The specific drug used for treatment will be selected by the study clinician based on clinical interviews and the participants preferences. Participants will be monitored for response and side effects by study clinician and will return after 8 weeks for a follow up study visit.

Other: Standard Clinical Care with an SRRI

Participants who enroll in this phase are treated with an FDA-approved SSRI in an open-label "treatment-as-usual" manner, in accordance with clinical practices and at a titration rate no more rapid than the manufacturer's recommendations. The duration of the treatment phase is 8 weeks. Other Name: fluoxetine (Prozac®), Sertraline (Zoloft®), paroxetine (Paxil®), citalopram (Celexa®), escitalopram (Lexapro®)

Outcome Measures

Primary Outcome Measures

Depression ratings at baseline and Week 8 [baseline and Week 8]
Serum levels of steroids and neurosteroids at baseline and Week 8 [baseline and Week 8]

Secondary Outcome Measures

Serum levels of oxidative stress markers at baseline and Week 8 [baseline and Week 8]
Serum levels of cytokines and immune markers at baseline and Week 8 [baseline and Week 8]

Eligibility Criteria

Criteria

Ages Eligible for Study:

21 Years to 60 Years

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Yes

All participants must meet the following criteria:

Age 21-60 and able to give informed consent.
Not "needle phobic," by self-report.
English-speaking (to allow accurate use of behavioral rating scales and verbal cognitive tests).
Females of child-bearing capacity must be non-pregnant (confirmed by urine pregnancy test) and using effective non-hormonal birth control (e.g. abstinence, condoms, IUD).
• Good general medical health; no significant uncontrolled illnesses that will invalidate the designated outcome measures.
Clinical labs (electrolytes, liver function test, CBC) with no clinically significant abnormalities that result in medical treatment that will invalidate the designated outcome measures.
Negative urine toxicology (drugs of abuse) screen.
Taking no medication or drugs likely to interfere with the study objectives (including statins or medications that affect hormones [e.g. birth control pills or steroids]).
Free of all psychotropic medications (including antidepressants) for at least 6 weeks (with the exception of prn short-acting benzodiazepines or sedative-hypnotics, < 3 doses per week, and none for 5 drug half-lives before the study).
No vaccines for at least 4 weeks prior to baseline blood draw (including the flu shot).
Not currently anemic (Hct of 36-48 for females and 38-54 for males, or Hgb of 12.5-20) and has not donated blood for at least 8 weeks prior to baseline blood draw.
No MRI exclusions (e.g. severe claustrophobia, metal implants, pacemakers, BMI >38).
No neurological disorders and no history of concussion with a black-out that lasted > 10 minutes.

Additional criteria for Depressed Participants:

Current DSM-5 diagnosis of Major Depressive Disorder, unipolar, with non-psychotic features.
Baseline 17-item Hamilton Depression Rating Scale (HDRS) rating of >= 17, or Baseline 25-item HDRS rating of >= 20.
Current depressive episode duration of > 6 weeks.
No current, active suicidal intent; HDRS "suicidality" item rating <= 2 OR by clinician determination.
No recent (< 6 month) history of substance or alcohol use disorder(s), with the exception of tobacco use (DSM-5 criteria).
No current (in the last month) diagnosis of Post-Traumatic Stress Disorder (DSM-5 criteria).
No anticipated changes in psychotherapeutic interventions during the course of the study.