Predictors of Antidepressant Response
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ClinicalTrials.gov Identifier: NCT02178696 |
Recruitment Status :
Completed
First Posted : July 1, 2014
Results First Posted : December 5, 2017
Last Update Posted : December 5, 2017
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Condition or disease | Intervention/treatment | Phase |
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Depression | Other: Placebo, identified as placebo to participants Drug: Celexa or other antidepressant as clinically indicated Other: Placebo, identifed to participants as "Active medication" | Phase 4 |
Study Type : | Interventional (Clinical Trial) |
Actual Enrollment : | 44 participants |
Allocation: | Randomized |
Intervention Model: | Crossover Assignment |
Masking: | Single (Participant) |
Primary Purpose: | Other |
Official Title: | Predictors of Antidepressant Response |
Study Start Date : | January 2011 |
Actual Primary Completion Date : | October 2015 |
Actual Study Completion Date : | October 2015 |

Arm | Intervention/treatment |
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Experimental: Known Placebo First
This arm gets a placebo that they know is a placebo (called inactive), then has 2 scans performed (FMRI and PET), then a 2-3 day washout, and then gets a so-called "active medication" (which is also actually a placebo), and another pair of scans. Following these, participants receive 10 weeks of open-label antidepressant administration (Celexa or alternative as explained in intervention description). First line antidepressant will be Celexa unless not clinically indicated.
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Other: Placebo, identified as placebo to participants
White tablets Drug: Celexa or other antidepressant as clinically indicated Open label s-citalopram, 20 mg start up dose, increasing to 40 mg as clinically indicated; If prior non-response to this medication is noted by the patient, alternative treatments may include another first-line antidepressant:fluoxetine 20 mg; paroxetine up to 60 mg; sertraline up to 200 mg; bupropion up to 300 mg
Other Name: S-citalopram 20-40 mg orally Other: Placebo, identifed to participants as "Active medication" Blue Capsule |
Experimental: "Active" (blinded) Placebo first group
This arm gets a placebo that they don't know is a placebo (called Active), then has 2 scans performed (FMRI and PET), then a 2-3 day washout, and then gets a so-called "inactive medication" (which participants know is a placebo), and another pair of scans. Following these, participants receive 10 weeks of open-label antidepressant administration (Celexa as explained in intervention description). First line antidepressant will be Celexa unless not clinically indicated.
|
Other: Placebo, identified as placebo to participants
White tablets Drug: Celexa or other antidepressant as clinically indicated Open label s-citalopram, 20 mg start up dose, increasing to 40 mg as clinically indicated; If prior non-response to this medication is noted by the patient, alternative treatments may include another first-line antidepressant:fluoxetine 20 mg; paroxetine up to 60 mg; sertraline up to 200 mg; bupropion up to 300 mg
Other Name: S-citalopram 20-40 mg orally Other: Placebo, identifed to participants as "Active medication" Blue Capsule |
- Changes in Mu-opioid Binding Potential During PET [ Time Frame: (90 minute PET scans) assessed at Weeks 1 and 2 ]
Binding Potential = Bmax/Kd (receptor concentration/affinity). This is the most common measure of in vivo receptor binding with positron emission tomography. Whole brain changes in mu-opioid receptors binding potential during PET from the Inactive to the Active placebo condition.
Positive numbers presented here represent reductions in binding potential from the inactive to the active condition.
- Changes in BOLD Response During Reward fMRI Task (Monetary Incentive Delay, MID) [ Time Frame: (90 minute fMRI scans) assessed at Weeks 1 and 2 ]% BOLD signal changes in the nucleus accumbens from the Inactive to the Active Placebo condition.
- Changes in Dopamine (D 2/3) Binding Potential During PET. [ Time Frame: (90 minute PET scan) assessed at Weeks 1 and 2 ]
Binding Potential= Bmax/Kd (receptor concentration/affinity). This is the most common measure of in vivo receptor binding with PET.
Striatal changes in D2/3 receptor binding potential during PET from the Inactive to the Active condition.
Positive numbers presented here represented reductions in binding potential from the inactive to the active condition.
- Changes From Baseline in Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR-16) Score [ Time Frame: From Pre to post- active placebo, and from pre to post- inactive placebo (1 week intervention) ]
This scale is a self-report measure of depression with 16 items.
Questions in the QIDS - SR-116 correlate with the nine DSM-IV symptom criterion domains, Including: Sleep disturbance (initial, middle, and late insomnia or hypersomnia) (Q 1 - 4), Sad mood (Q 5), Decrease/increase in appetite/weight (Q 6 - 9), Concentration (Q 10), Self-criticism (Q 11), Suicidal ideation (Q 12), Interest (Q 13), Energy/fatigue (Q 14), Psychomotor agitation/retardation (Q 15 - 16).
Severity of depression can be judged based on the total score: 1-5= No depression; 6-10= Mild depression; 11-15= Moderate depression; 16-20= Severe depression; 21-27= Very severe depression.
The PHQ-9 and QIDS were used to assess changes in mood during the placebo intervention (first 2 weeks), and therefore results are described as changes from the inactive to the active condition.
- Changes From Baseline in PHQ-9 Depression Scores. [ Time Frame: From Pre to post- active placebo, and from pre to post- inactive placebo (1 week intervention) ]
The Patient Health Questionnaire-9, is a multipurpose instrument for screening, diagnosing, monitoring and measuring the severity of depression, based on participant answers. PHQ-9 scores of 5, 10, 15, and 20 represents mild, moderate, moderately severe and severe depression, respectively. The minimum possible score is 0 and the maximum possible score is 27.
The PHQ-9 and QIDS were used to assess changes in mood during the placebo intervention (first 2 weeks), and therefore results are described as changes from the inactive to the active condition.
- Hamilton Depression Rating Scale Scores [ Time Frame: Screening, week 0, week 2, week 4, week 8 and week 10 ]
The total score is obtained by summing the score of each item, 0-4 (symptom is absent, mild, moderate, or severe) or 0-2 (absent, slight or trivial, clearly present). For the 17-item version, scores can range from 0 to 54, with 0 meaning no depression, and 54, severe depression.
The Hamilton Depression Rating Scale was used to assess symptoms during the open label antidepressant treatment phase, so results are described as mean scores at each bi-weekly visit.
- Montgomery-Asberg Depression Rating Scale [ Time Frame: Screening, week 0, week 2, week 4, week 8 and week 10 ]
Designed in 1979 by researchers as an adjunct to the Hamilton Rating Scale for Depression (HAMD) which would be more sensitive to the changes brought on by antidepressants and other forms of treatment than the Hamilton Scale. MADRS was used to assess symptoms during the open label antidepressant treatment phase, so results are described as mean scores at each bi-weekly visit.
Higher MADRS score indicates more severe depression, and each item yields a score of 0 to 6. The overall score ranges from 0 to 60 where 0 is no depression and 60 is most extreme depression.
The questionnaire includes questions on the following symptoms 1. Apparent sadness 2. Reported sadness 3. Inner tension 4. Reduced sleep 5. Reduced appetite 6. Concentration difficulties 7. Lassitude 8. Inability to feel 9. Pessimistic thoughts 10. Suicidal thoughts
Usual cutoff points are:
0 to 6 - normal[5] /symptom absent 7 to 19 - mild depression 20 to 34 - moderate depression >34 - severe depression

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Ages Eligible for Study: | 18 Years to 60 Years (Adult) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | No |
Inclusion Criteria: Inclusion criteria will include:
- Participants diagnosed with Major Depressive Disorder and will include Hamilton Depressive Rating Scale (HDRS) scores >15
Exclusion Criteria:
- Comorbid conditions that are medical, neurological or psychiatric, pregnancy, use of hormones (including birth control) or use of psychotropic agents
- We will only permit certain past anxiety disorder diagnoses, including generalized anxiety, panic, agoraphobia, social phobia
- We also will exclude left-handed individuals and patients who have used any centrally acting medications or recreational drugs with the past 2 months
- No history of an implant, pacemaker or pacemaker wires, open heart surgery, artificial heart valve, brain aneurysm surgery, middle ear implant, hearing aid, braces or extensive dental work, cataract surgery or lens implant, implanted mechanical or electrical device, or artificial limb or joint
- No metallic object in their body (such as braces) or have a history of foreign metallic object in the body such as bullets, BB's, pellets, shrapnel, or other metal fragments

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 ClinicalTrials.gov identifier (NCT number): NCT02178696
United States, Michigan | |
Department of Psychiatry | |
Ann Arbor, Michigan, United States, 48108 |
Principal Investigator: | Jon-Kar Zubieta, MD, PhD | University of Michigan |
Responsible Party: | Jon-Kar Zubieta, MD PhD, University of Michigan |
ClinicalTrials.gov Identifier: | NCT02178696 |
Other Study ID Numbers: |
HUM00033328 |
First Posted: | July 1, 2014 Key Record Dates |
Results First Posted: | December 5, 2017 |
Last Update Posted: | December 5, 2017 |
Last Verified: | October 2017 |
Depression Behavioral Symptoms Citalopram Antidepressive Agents Serotonin Uptake Inhibitors Neurotransmitter Uptake Inhibitors Membrane Transport Modulators |
Molecular Mechanisms of Pharmacological Action Neurotransmitter Agents Serotonin Agents Physiological Effects of Drugs Antidepressive Agents, Second-Generation Psychotropic Drugs |