A Pilot Study of Citicoline add-on Therapy in Patients With Bipolar Disorder or Major Depressive Disorder and Amphetamine Abuse or Dependence - Full Text View

Purpose

Bipolar disorder (BD) is a common and severe psychiatric illness. Drug and alcohol abuse are very common in people with BD and other mood disorders and are associated with increased rates of hospitalization, violence towards self and others, medication non-adherence and cognitive impairment. However, few studies have investigated the treatment of dual-diagnosis patients as substance use is frequently an exclusion criterion in clinical trials of patients with BD. To address this need, we have developed a research program that explores the pharmacotherapy of people with BD and substance related-disorders. A potentially very interesting treatment for BD is citicoline. Some data suggest that this supplement may stabilize mood, decrease drug use and craving, and improve memory. We found promising results with citicoline in patients with BD and cocaine dependence. In recent years the use of amphetamine and methamphetamine has become an important public health concern. However, virtually no research has been conducted on the treatment of amphetamine abuse. We propose a double-blind placebo controlled prospective trial of citicoline in a group of 60 depressed outpatients with bipolar disorder, depressed phase or major depressive disorder and amphetamine abuse/dependence, to explore the safety and tolerability of citicoline, and its efficacy for mood symptoms, stimulant use and craving and its impact on cognition. Our goal is to determine which symptoms (e.g. mood, cognition, substance use) citicoline appears to be most effective and estimate effect sizes for future work.

Condition	Intervention
Amphetamine Abuse Amphetamine Dependence Bipolar Disorder Major Depressive Disorder	Drug: Citicoline Drug: Placebo


Study Type:	Interventional
Study Design:	Allocation: Randomized Endpoint Classification: Efficacy Study Intervention Model: Parallel Assignment Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor) Primary Purpose: Treatment
Official Title:	A Double-blind, Placebo-controlled Pilot Study of Citicoline add-on Therapy in Patients With Bipolar Disorder or Major Depressive Disorder and Amphetamine Abuse or Dependence

Resource links provided by NLM:

MedlinePlus related topics: Bipolar Disorder

Drug Information available for: Amphetamine sulfate Amphetamine

U.S. FDA Resources

Further study details as provided by University of Texas Southwestern Medical Center:

Primary Outcome Measures:

Depression Symptoms [ Time Frame: 12 weeks ] [ Designated as safety issue: No ]
Inventory of Depressive Symptomatology-Clinician Rated (IDS-C), (a clinician-administered depression scale) is used to assess the severity of depressive symptoms.Scores can range from 0 to 84. The higher the score, the worse the depressive symptoms(worse outcome).

Secondary Outcome Measures:

Amphetamine Craving [ Time Frame: 12 Weeks ] [ Designated as safety issue: No ]
Visual Analog Scale (VAS) assessing Methamphetamine craving with a 1-100 scale.Higher values on the VAS scale indicate a higher Methamphetamine craving(worse outcome).
Amphetamine Use [ Time Frame: 12 weeks ] [ Designated as safety issue: No ]
Participant reported days per 7-day week of methamphetamine use.
Hopkins Auditory Verbal Learning Test (HVLT) [ Time Frame: 12 weeks ] [ Designated as safety issue: No ]
The Hopkins Auditory Verbal Learning Test (HVLT) is a measure of cognition (memory/recall). Raw scores are derived for Total Recall, Delayed Recall, Retention (% retained), and a Recognition Discrimination Index. Raw scores are calculated into T-scores. T-scores are standardized scores on each dimension for each type. A score of 50 represents the mean. A difference of 10 from the mean indicates a difference of one standard deviation. Thus, a score of 60 is one standard deviation above the mean, while a score of 30 is two standard deviations below the mean.
Stroop Color Word Test [ Time Frame: 12 weeks ] [ Designated as safety issue: No ]
The Stroop Color Word Test measures the individual's ability to separate the word and color naming stimuli thus the ability to sort information from the environment and selectively react to this information. The scoring is a measure of time to complete 100 items and the numbers of items that can be completed. THe scores are converted into T-scores which have a mean of 50 and a standard deviation of 10.


Enrollment:	60
Study Start Date:	October 2006
Study Completion Date:	May 2009
Primary Completion Date:	May 2009 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Experimental: Citicoline Citicoline is an over the counter supplement that may have neuroprotective properties and may have antidepressant effects.	Drug: Citicoline Citicoline is an over the counter supplement that may have neuroprotective properties and may have antidepressant effects. Citicoline or placebo (identical in appearance) add-on therapy was given beginning at one tablet (500mg/day) with an increase to two tablets (1000 mg/day) at week 2, three tablets (1500 mg/day) at week 4 and four tablets (2000 mg/day) at week 6. Doses were decreased, if needed, due to side effects.
Placebo Comparator: Placebo Placebo matching active medication.	Drug: Placebo Placebo matching active medication in all other physical aspects

Arms

Assigned Interventions

Experimental: Citicoline

Citicoline is an over the counter supplement that may have neuroprotective properties and may have antidepressant effects.

Drug: Citicoline

Citicoline is an over the counter supplement that may have neuroprotective properties and may have antidepressant effects. Citicoline or placebo (identical in appearance) add-on therapy was given beginning at one tablet (500mg/day) with an increase to two tablets (1000 mg/day) at week 2, three tablets (1500 mg/day) at week 4 and four tablets (2000 mg/day) at week 6. Doses were decreased, if needed, due to side effects.

Placebo Comparator: Placebo

Placebo matching active medication.

Drug: Placebo

Placebo matching active medication in all other physical aspects

Detailed Description:

Sixty outpatients meeting the inclusion and exclusion criteria will be enrolled after completing an Institutional Review Board (IRB)-approved informed consent process. Baseline evaluation will include a medical and psychiatric history, structured clinical interview for Diagnostic and Statistical Manual (DSM-IV) (SCID), mood assessment with the Inventory of Depressive Symptomatology-Self Report (IDS-C), Young Mania Rating Scale (YMRS), and cognitive assessment with the Hopkins Auditory Verbal Learning Test (HVLT) (similar to the Rey Auditory Verbal Learning Test (RAVLT) but more alternative equivalent versions are available), Stroop and computer assessments including Sternberg Memory Task and the Running Memory Continuous Performance Test. Alternate but equivalent versions of all cognitive tests, except the Stroop, will be used to minimize practice effects with repeated administration. Days and amounts of amphetamine and other substance use will be assessed at each visit with urine drug screens, and through self-report using the timeline follow-back method. Amphetamine, and other drug, craving will be assessed with a visual analogue scales. Citicoline or placebo add-on therapy will be given beginning at one tablet (500mg)/day with an increase to two tablets 1000 mg/day at week 2, three tables 1500 mg/day at week 4 and four tablets 2000 mg/day at week 6.

Eligibility


Ages Eligible for Study:	18 Years to 70 Years (Adult, Senior)
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	Yes

Criteria

Inclusion Criteria:

Men and women ages 18-70 years
Meeting criteria for a current major depressive episode (bipolar I,II, not otherwise specified (NOS)

, depressed phase) or major depressive disorder on the Structured Clinical Interview for the Diagnostic and Statistical Manual for Mental Disorders (SCID) with a duration of at least 4 weeks
Meeting criteria for amphetamine abuse or dependence with use within 14 days prior to baseline
No psychotropic medication changes within 14 days prior to study entry

Exclusion Criteria:

Pregnant or nursing women
Current citicoline therapy
Active suicidal or homicidal ideation with plan and intent
Dementia, mental retardation or other severe cognitive impairment that might interfere with the informed consent process
Currently incarcerated at a prison or jail
Severe or life threatening medical condition (e.g. terminal cancer, congestive heart failure)

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: NCT00377299

Locations


United States, Texas
Psychoneuroendocrine Research Program
Dallas, Texas, United States, 75390

Sponsors and Collaborators

University of Texas Southwestern Medical Center

Stanley Medical Research Institute

Investigators


Principal Investigator:	Sherwood Brown, M.D., Ph.D.	University of Texas Southwestern Medical Center

More Information


Responsible Party:	University of Texas Southwestern Medical Center
ClinicalTrials.gov Identifier:	NCT00377299 History of Changes
Other Study ID Numbers:	052006-27
Study First Received:	September 14, 2006
Results First Received:	September 8, 2011
Last Updated:	July 5, 2013
Health Authority:	United States: Institutional Review Board

Keywords provided by University of Texas Southwestern Medical Center:


Amphetamine Abuse Amphetamine Dependence Bipolar Disorder Major Depressive Disorder Citicoline

Additional relevant MeSH terms:


Disease Depressive Disorder Depression Depressive Disorder, Major Bipolar Disorder Amphetamine-Related Disorders Pathologic Processes Mood Disorders Mental Disorders Behavioral Symptoms Bipolar and Related Disorders Substance-Related Disorders Chemically-Induced Disorders Amphetamine Cytidine Diphosphate Choline	Central Nervous System Stimulants Physiological Effects of Drugs Sympathomimetics Autonomic Agents Peripheral Nervous System Agents Dopamine Agents Neurotransmitter Agents Molecular Mechanisms of Pharmacological Action Adrenergic Agents Adrenergic Uptake Inhibitors Neurotransmitter Uptake Inhibitors Membrane Transport Modulators Dopamine Uptake Inhibitors Nootropic Agents

ClinicalTrials.gov processed this record on September 27, 2016