Buprenorphine for Late-Life Treatment Resistant Depression (BUILD)

This study has been completed.
Sponsor:
Collaborators:
Reckitt Benckiser LLC
Information provided by (Responsible Party):
Jordan F. Karp, University of Pittsburgh
ClinicalTrials.gov Identifier:
NCT01071538
First received: February 17, 2010
Last updated: July 13, 2012
Last verified: July 2012
  Purpose

The goals of this pilot study are to gather data about the safety and clinical effect of low-dose buprenorphine in older adults with treatment resistant depression.


Condition Intervention Phase
Depression
Drug: Buprenorphine
Phase 2

Study Type: Interventional
Study Design: Allocation: Non-Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Buprenorphine for Late-Life Treatment Resistant Depression

Resource links provided by NLM:


Further study details as provided by University of Pittsburgh:

Primary Outcome Measures:
  • Montgomery Asberg Depression Rating Scale [ Time Frame: 16 weeks ] [ Designated as safety issue: No ]
  • Orthostatic blood pressure, Heart rate, and Respiratory rate [ Time Frame: 12 weeks ] [ Designated as safety issue: Yes ]
  • UKU Side Effect Rating Scale [ Time Frame: 12 weeks ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • Brief Symptom Inventory -- Anxiety Subscale [ Time Frame: 16 weeks ] [ Designated as safety issue: No ]
  • Positive and Negative Affect Scale [ Time Frame: 16 weeks ] [ Designated as safety issue: No ]
  • Pain Numeric Rating Scale (20 item) [ Time Frame: 16 weeks ] [ Designated as safety issue: No ]

Enrollment: 15
Study Start Date: May 2010
Study Completion Date: May 2012
Primary Completion Date: May 2012 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Buprenorphine
Older adults with treatment resistant depression will receive buprenorphine up to 1.6 mg/day for 8 weeks. Discontinuation of the buprenorphine will occur during weeks 9-12.
Drug: Buprenorphine
Sublingual buprenorphine 0.2 mg will be used for the first week. The dose will be increased by 0.2 mg/week based on safety and clinical response up to a maximal dose of 1.6 mg/day.

Detailed Description:

We are recruiting 20 participants for this pilot study. Subjects are recruited from either:

1) An ongoing study of Late-Life Depression(MH083660; PI: Reynolds) who did not meet research response criteria; and 2) community-dwelling individuals, at least 50 years old, who have tried at least two FDA-approved antidepressant medications at therapeutic doses each for at least 6 weeks, and who are currently in an episode of major depression.

Overview of intervention: To guide future placebo-controlled work, at this preliminary stage of research we will collect data about both buprenorphine (BUP) 1) augmentation pharmacotherapy, and 2) monotherapy. Subjects recruited from the community will have the buprenorphine prescribed as augmentation to any currently prescribed antidepressant medication.

BUP 0.2 mg will be used for the first week. The first dose will be administered at the clinic under the supervision of the PI. Because peak plasma levels occur 60 minutes after ingestion, subjects will be re-assessed after 1 hour for safety. Participants will be seen weekly for eight weeks to assess progress and monitor intervention-emergent side effects. Dosing increases will be guided by antidepressant response (e.g., continued MADRS scores > 10 will trigger an increase dose of BUP) and our protocolized use of the Frequency, Intensity, and Burden of Side Effect Rating (FIBSER) Scale score. For example, a score of 5 to 7 on the FIBSER will trigger additional assessment of side effects and require justification for increasing the dose, while a score of > 7 will signal no increase in dose, although specific side effects should be reviewed in detail before a final determination, including review if the UKU Side Effects Rating Scale.

We will increase the dose by 0.2 mg/week up to 1.6 mg/day based on MADRS and FIBSER scores. Every time the dose is increased, the first ingestion of the higher dose will be monitored in the clinic as described above.

Subjects will participate in the project at the Late-Life Depression Clinic on the 7th Floor of Bellefield Tower. Subjects will complete paper and pencil and clinician-administered psychiatric assessments before receiving the first dose of buprenorphine and at all subsequent visits. After the first ingestion and all subsequent first ingestions of higher doses of BUP, subjects will remain in the clinic for 60 minutes after ingestion and be re-assessed for the emergence of side effects and have vital signs re-checked. The duration of the first visit will be approximately 2.5 hours. If subsequent visits require observed ingestion of buprenorphine, they will last about 1.75 hours. If subsequent visits do not require observed ingestion of buprenorphine, these visits will last 30-45 minutes.

Prior to the first ingestion, the first ingestion of subsequent higher doses, and at study end, subjects will complete a 15 minute battery of computerized neuropsychological tests assessing reaction time and attention. These tests will be repeated 60 minutes after the ingestion. Prior to the first ingestion and after discontinuation of the buprenorphine, memory will be assessed with the Hopkins Verbal Learning Test (HVLT). The HVLT takes about 10 minutes to complete.

The discontinuation phase will occur during weeks 9-12. To minimize the risk of withdrawal symptoms, we will discontinue the buprenorphine slowly by reducing the dose to 0.4 mg/day for 7 days, then 0.2 mg/day every other day for 7 days, and then stop the buprenorphine. We will see subjects weekly over these four weeks.

The final visit will occur at week 16. This will be a telephone check in of mood and functioning. This call will take about 15-20 minutes.

  Eligibility

Ages Eligible for Study:   50 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Age >/= 50 years
  • Major depressive disorder
  • Non-responder to at least 2 FDA-approved antidepressants prescribed at a therapeutic dose, each for at least 6 weeks, or is a depression non-responder from an ongoing study of late-life depression at our research clinic.

Exclusion Criteria:

  • Concomitant use of strong or moderate CYP3A4 inhibitor.
  • Refusal to stop all opioids.
  • Refusal to discontinue all alcohol.
  • Refusal to discontinue benzodiazepines other than the equivalent of lorazepam 2 mg/day prescribed at a stable dose for at least the past 2 weeks.
  • Hepatic impairment (AST/ALT > 1.5 times upper normal.
  • Lung disease requiring supplemental oxygen.
  • Estimated creatinine clearance <30 mL/min.
  • Inability to provide informed consent.
  • Depressive symptoms not severe enough (i.e., MADRS < 10) at the baseline assessment.
  • Dementia.
  • Lifetime diagnosis of bipolar I or II disorder, schizophrenia, schizoaffective disorder, schizophreniform disorder, delusional disorder, or current psychotic symptoms.
  • Abuse of or dependence on alcohol or other substances within the past 3 months.
  • Meets criteria for history of abuse or dependence upon opioids.
  • High risk for suicide.
  • Contraindication to buprenorphine.
  • Inability to communicate in English.
  • Non-correctable clinically significant sensory impairment.
  • Unstable medical illness.
  • Subjects taking psychotropic medications that cannot be safely tapered and discontinued prior to study initiation.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01071538

Locations
United States, Pennsylvania
Western Psychiatric Institute and Clinica, University of Pittsburgh School of Medicine
Pittsburgh, Pennsylvania, United States, 15213
Sponsors and Collaborators
University of Pittsburgh
Reckitt Benckiser LLC
Investigators
Principal Investigator: Jordan F Karp, M.D. University of Pittsburgh
  More Information

Additional Information:
Publications:
Responsible Party: Jordan F. Karp, Associate Professor, University of Pittsburgh
ClinicalTrials.gov Identifier: NCT01071538     History of Changes
Other Study ID Numbers: BUILD, KL2RR024154
Study First Received: February 17, 2010
Last Updated: July 13, 2012
Health Authority: United States: Food and Drug Administration

Keywords provided by University of Pittsburgh:
Depressive Disorder, Major
Late-Life Depression
Geriatrics
Buprenorphine

Additional relevant MeSH terms:
Depression
Depressive Disorder
Behavioral Symptoms
Mood Disorders
Mental Disorders
Buprenorphine
Analgesics, Opioid
Analgesics
Sensory System Agents
Peripheral Nervous System Agents
Physiological Effects of Drugs
Pharmacologic Actions
Central Nervous System Agents
Therapeutic Uses
Central Nervous System Depressants
Narcotic Antagonists
Narcotics

ClinicalTrials.gov processed this record on July 20, 2014