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Optimizing the Effectiveness of Selective Serotonin Reuptake Inhibitors (SSRIs) in Treatment-Resistant Depression

This study has been completed.
National Institute of Mental Health (NIMH)
Information provided by (Responsible Party):
George I. Papakostas, Massachusetts General Hospital Identifier:
First received: October 6, 2004
Last updated: October 10, 2014
Last verified: October 2014
This study will determine the effectiveness of adding S-adenosyl methionine to antidepressant drug treatment in reducing depressive symptoms in depressed people who have not responded to antidepressants alone.

Condition Intervention Phase
Drug: S-adenosyl methione (SAMe)
Drug: Placebo
Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double Blind (Participant, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: S-adenosyl Methionine (SAMe) Augmentation of Selective Serotonin Reuptake Inhibitors (SSRIs) for Treatment-Resistant Depression (TRD)

Resource links provided by NLM:

Further study details as provided by George I. Papakostas, Massachusetts General Hospital:

Primary Outcome Measures:
  • Hamilton Depression Rating Scale Remission Rates [ Time Frame: Measured at Week 6 ]
    The proportion of remitters for SAMe versus placebo was 46.1% versus 17.6%. Remission is defined as a final score of 7 or less on Hamilton Depression Rating Scale 17 item .

Secondary Outcome Measures:
  • HDRS17 Responders [ Time Frame: Measured at Week 6 ]
    35.8% versus 11.7%. Response is defined as a 50 percent or more score reduction on on Hamilton Depression Rating Scale 17 item .

Enrollment: 73
Study Start Date: May 2004
Study Completion Date: February 2009
Primary Completion Date: February 2009 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: 1 Oral SAMe Tosylate
Participants receiving the oral SAMe tosylate
Drug: S-adenosyl methione (SAMe)
Oral SAMe tosylate, up to 1600 mg per day for 6 weeks
Other Name: Oral SAMe tosylate
Placebo Comparator: 2 Oral Placebo Pill Twice Daily
Participants receiving placebo
Drug: Placebo
Placebo to be taken daily for 6 weeks
Other Name: Pill identical in appearance to drug but placebo

Detailed Description:

Some people with depression do not respond well to antidepressant treatment. S-adenosyl methionine (SAMe) is a naturally occurring compound that may have antidepressant effects. SAMe may also enhance the effectiveness of other antidepressants, such as selective serotonin reuptake inhibitors (SSRIs). This study will determine the effectiveness of oral SAMe in enhancing the effects of SSRIs in patients currently not responding to SSRI treatment.

This study will last 6 weeks. No follow-up visits will occur. Participants will be randomly assigned to add either oral SAMe or placebo to their existing SSRI regimen for 6 weeks. Depression scales and self-report questionnaires regarding depressive symptoms will be used to assess participants at the end of the study.


Ages Eligible for Study:   18 Years to 80 Years   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Major depressive disorder
  • Use of an SSRI for at least 6 weeks prior to study entry with partial or no response

Exclusion Criteria:

  • History of psychosis
  • Allergy to SAMe
  • Alcohol or drug abuse in the past 3 months prior to study entry
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Please refer to this study by its identifier: NCT00093847

United States, Massachusetts
Massachusetts General Hospital
Boston, Massachusetts, United States, 02114
Sponsors and Collaborators
Massachusetts General Hospital
National Institute of Mental Health (NIMH)
Principal Investigator: George I. Papakostas, MD Massachusetts General Hospital
  More Information

Publications automatically indexed to this study by Identifier (NCT Number):
Responsible Party: George I. Papakostas, Principal Investigator, Massachusetts General Hospital Identifier: NCT00093847     History of Changes
Other Study ID Numbers: K23MH069629 ( US NIH Grant/Contract Award Number )
Study First Received: October 6, 2004
Results First Received: April 25, 2012
Last Updated: October 10, 2014

Keywords provided by George I. Papakostas, Massachusetts General Hospital:
Selective Serotonin Reuptake Inhibitors
S-adenosyl Methionine

Additional relevant MeSH terms:
Depressive Disorder
Depressive Disorder, Treatment-Resistant
Behavioral Symptoms
Mood Disorders
Mental Disorders
Serotonin Uptake Inhibitors
Neurotransmitter Uptake Inhibitors
Membrane Transport Modulators
Molecular Mechanisms of Pharmacological Action
Neurotransmitter Agents
Serotonin Agents
Physiological Effects of Drugs
Serotonin Receptor Agonists processed this record on May 25, 2017