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Metyrapone as Additive Treatment in Major Depression

This study has been completed.
Sponsor:
Information provided by:
Universitätsklinikum Hamburg-Eppendorf
ClinicalTrials.gov Identifier:
NCT00125554
First received: July 29, 2005
Last updated: August 11, 2005
Last verified: July 2005

July 29, 2005
August 11, 2005
May 1998
Not Provided
  • Two psychometric criteria defined by the number of responders and time to onset-of-action. The number of responders was considered twice after 3 and 5 weeks by defining the treatment response as a 30% and 50% reduction
  • the course of concentrations of ACTH, cortisol, 11-deoxycortisol and DHEA.
  • two psychometric criteria defined by the number of responders and time to onset-of-action. The number of responders was considered twice after 3 and 5 weeks by defining the treatment response as a 30% and 50% reduction
  • the course of concentrations of ACTH, cortisol, 11-deoxycortisol and DHEA.
Complete list of historical versions of study NCT00125554 on ClinicalTrials.gov Archive Site
Other psychometric scores, demographic parameters and side effects were considered as secondary variables.
Same as current
Not Provided
Not Provided
 
Metyrapone as Additive Treatment in Major Depression
Double-Blind, Placebo Controlled Trial of Metyrapone as Augmenting Agent in the Treatment of Major Depression

The purpose of this study is to test whether metyrapone is an effective and safe augmenting agent in the treatment of major depression.

The investigators' understanding of the neuroendocrine pathophysiology of depression has made significant progress in recent years, which should help to develop new remedies. Alterations of the hypothalamic-pituitary-adrenocortical (HPA) axis are the most consistent pathological endocrine findings in depression. Hence, attempts have been made to treat depression by directly targeting HPA-axis activity. Currently, three major pathways are investigated:

  • Administration of CRH-antagonists;
  • Administration of glucocorticoid-receptor-antagonists; and
  • Treatment with steroid-synthesis inhibitors like ketoconazole, aminogluthethimide or metyrapone.

The investigators' aim was to conduct the first prospective, randomized, placebo-controlled, double-blind clinical trial of metyrapone as additive treatment in depression. Metyrapone was preferred, since this compound inhibits selectively the 11β-hydroxylase and the 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD-1), thereby exerting direct effects within the central nervous system (CNS). The additive approach was applied because the intended inclusion of severely depressed patients made a pure placebo group ethically challenging. Furthermore, the continuous use of an antidepressant allowed a standardized follow up after the double-blind period.

The hypotheses to be tested were, whether metyrapone exerts potentiating effects during a standard antidepressant therapy and whether an earlier onset-of-action and an improved overall and sustained treatment response can be achieved. Since GR/MR distribution as well as 11β-HSD-1 activities are subject to sexual dimorphism in humans, the sample was prospectively stratified for gender and balanced for treatment with two selected serotonergic antidepressants, allowing further analysis of gender effects and neuroendocrine treatment effects.

Interventional
Phase 2
Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double-Blind
Primary Purpose: Treatment
Major Depressive Disorder
Drug: Metyrapone
Not Provided
Jahn H, Schick M, Kiefer F, Kellner M, Yassouridis A, Wiedemann K. Metyrapone as additive treatment in major depression: a double-blind and placebo-controlled trial. Arch Gen Psychiatry. 2004 Dec;61(12):1235-44.

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Completed
63
July 2001
Not Provided

Inclusion Criteria:

  • Diagnosis of major depressive disorder; single or recurrent according to DSM-IV criteria (296.2 or 296.3)
  • A minimum baseline Hamilton score of 18 points on the Hamilton Rating Scale for Depression (HamD; 21-item version)
  • Age from 18 to 75 years
  • A drug free period of at least 5 days from antidepressants, antipsychotics, mood stabilizers and all other medications except for mild antihypertensive agents
  • A negative urinary drug screening diagnosis

Exclusion Criteria:

  • A current DSM-IV diagnosis for other axis I psychiatric disorders
  • Serious medical conditions, especially those associated with adrenal insufficiency
  • Pregnancy, nursing or refusal to use a reliable method of birth control in women.

Participants were randomly assigned to a study group if they met these criteria.

Both
18 Years to 75 Years
No
Contact information is only displayed when the study is recruiting subjects
Germany
 
NCT00125554
HH-PSY-ja-007
Not Provided
Not Provided
Universitätsklinikum Hamburg-Eppendorf
Not Provided
Study Director: Holger Jahn, MD University Hospital Hamburg-Eppendorf, Germany
Universitätsklinikum Hamburg-Eppendorf
July 2005

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP