Treatment of Mild to Moderate Depression Symptoms in Patients With Spinal Cord Injury

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00735670
Recruitment Status : Completed
First Posted : August 15, 2008
Results First Posted : October 13, 2016
Last Update Posted : October 13, 2016
U.S. Department of Education
Information provided by (Responsible Party):
Denise Tate, University of Michigan

Brief Summary:
This study was initially designed to test the efficacy of Venlafaxine HCl in reducing incidence of the onset of major depression after a new spinal cord injury (SCI). After several protocol modifications, the purpose of the study is to test the effectiveness of a sub-therapeutic dose of Venlafaxine HCl to reduce mild to moderate symptoms in persons with SCI.

Condition or disease Intervention/treatment Phase
Spinal Cord Injury Drug: Venlafaxine HCl Other: Placebo Not Applicable

Detailed Description:

The successes of psychological and pharmacological modes of intervention in treating depression, both alone and combined, are well documented in the literature. While a great deal of research has identified specific clinical indications for many antidepressants currently available in the general population, little is known about the clinical indications of these agents in SCI. This study is proposed to test the benefits of Venlafaxine HCI (Effexor XR) for reducing mild to moderate symptoms of depression among people with SCI. The intervention will last 12 weeks and there will be 13 assessments and data collection points. Data will be collected at 26 weeks also. Eight face to face contacts are anticipated.

Because of the change in protocol to reducing mild to moderate symptoms and substantially lower enrollment than anticipated (1/6th of what we anticipated), we deleted a number of study outcomes listed in the 2011 posting of this study. Most of these were not part of the original posting in 2008, and those that were deleted were no longer relevant to new protocol's focus on reducing mild to moderate depression. The two outcomes reported here were most relevant to the revised protocol.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 34 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Treatment of Mild to Moderate Depression Symptoms in Patients With Spinal Cord Injury
Study Start Date : June 2008
Actual Primary Completion Date : June 2012
Actual Study Completion Date : August 2012

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Experimental: Venlafaxine
Venlafaxine HCl is classified as a selective serotonin and norepinephrine reuptake inhibitor (SSNRI) and has been approved by the FDA for the treatment of major depressive disorder. The treatment group will receive a sub-therapeutic dose over a two week period, with a two week titration, starting at 37.5 mg up to a maximum dose of 150 mg per day. At the end of the treatment period, dosage was tapered down in a step-wise fashion over a period of three weeks; 75 mg. for two weeks and 37.5 mg. for one week. While this was the standard protocol, study drug tapering was individualized based on side effects and the clinical judgment of the prescriber.
Drug: Venlafaxine HCl
Starting dose is 37.5 mg and ending dose is 150 mg at 13 weeks. From weeks 13 to 26 subjects no longer will receive the drug
Other Name: Effexor XR

Placebo Comparator: Placebo
Placebo capsules were compounded by filling a matching gelatin capsule with lactose. Titration up and down followed the same schedule as the treatment group.
Other: Placebo
Subjects received a placebo instead of Venlafaxine HCl until week 13 as did the Venlafaxine group.

Primary Outcome Measures :
  1. 16-Item Quick Inventory of Depressive Symptomatology - Self Report (QIDS-SR16) [ Time Frame: Baseline and Week 13 ]
    The QIDS assesses symptoms of depression across the nine DSM-IV criterion domains for major depressive episode. The primary end-point in this study was the number of participants who had a >50% change in scores on the QIDs from baseline to week 13 (end of treatment period).

Secondary Outcome Measures :
  1. Depression Scale of the Patient Health Questionnaire (PHQ-9) [ Time Frame: Baseline and weeks 1, 2, 3, 5, 9, 13, 14, 15, 16, 18, 20 and 26 weeks ]
    The nine items of the PHQ-9 are based directly on the nine diagnostic criteria for major depressive disorder in the DSM-IV. Higher total scores indicate more severe symptomatology, ranging from 0 (no symptoms) to 27 (most severe symptoms). Data in the tables begin with the overall mean for each group that includes all subjects, average across all assessment time points. Each subsequent row reports the mean and standard deviation of each time point by allocation, noting sample size for each group in the arm/group title given missing data in each time point after baseline.

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Having sustained an SCI at least six months prior to enrollment.
  • Neurological impairment ASIA Grades A-D.
  • Mild to moderate depressive symptoms.
  • English speaker
  • Age 18 years or older
  • Able to communicate with study personnel

Exclusion Criteria:

  • No neurological impairment due to SCI.
  • Presence of cognitive deficits precluding and giving informed consent and completion of survey based assessment tools.
  • Psychiatric contraindications (suicidal ideation, history of suicidal attempts, alcohol and drug dependency, other psychiatric diagnosis including bipolar disorder).
  • Medical contraindications (terminal illness or unstable medical condition as determined by medical history and/or examination).
  • Pregnant or unwilling to use birth control if female and sexually active.
  • Presence of glaucoma.
  • Prior use of study drug without success or being treated with another antidepressant medication and being unwilling to taper off to take the stud drug.
  • Willing to travel to Ann Arbor Michigan.
  • Expecting to take or currently taking another experimental study within 30 days
  • Major surgery scheduled within 12 weeks

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00735670

United States, Michigan
University of Michigan Model SCI Care System
Ann Arbor, Michigan, United States, 48109-5491
Sponsors and Collaborators
University of Michigan
U.S. Department of Education
Principal Investigator: Denise G Tate, Ph.D. University of Michigan Department of Physical Medicine and Rehabilitation
Study Director: Anthony Chiodo, M.D. University of Michigan

Responsible Party: Denise Tate, Professor, University of Michigan Identifier: NCT00735670     History of Changes
Other Study ID Numbers: NDNO60032SS
First Posted: August 15, 2008    Key Record Dates
Results First Posted: October 13, 2016
Last Update Posted: October 13, 2016
Last Verified: October 2016

Keywords provided by Denise Tate, University of Michigan:

Additional relevant MeSH terms:
Wounds and Injuries
Spinal Cord Injuries
Behavioral Symptoms
Spinal Cord Diseases
Central Nervous System Diseases
Nervous System Diseases
Trauma, Nervous System
Venlafaxine Hydrochloride
Serotonin and Noradrenaline Reuptake Inhibitors
Neurotransmitter Uptake Inhibitors
Membrane Transport Modulators
Molecular Mechanisms of Pharmacological Action
Neurotransmitter Agents
Physiological Effects of Drugs
Antidepressive Agents, Second-Generation
Antidepressive Agents
Psychotropic Drugs