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L-DOPA vs. Placebo for Depression and Psychomotor Slowing in Older Adults

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ClinicalTrials.gov Identifier: NCT03761030
Recruitment Status : Recruiting
First Posted : December 3, 2018
Last Update Posted : February 6, 2019
Sponsor:
Collaborator:
National Institute of Mental Health (NIMH)
Information provided by (Responsible Party):
Bret Rutherford, New York State Psychiatric Institute

Brief Summary:
Individuals with Late Life Depression (LLD) often have cognitive problems, particularly problems with memory, attention, and problem solving, all of which contribute to antidepressant non-response. Our group and others have shown that decreased thinking speed is the central cause of functional problems in patients with LLD. Similarly, decreased walking speed is associated with depression and carries additional risk for falls, hospitalization, and death. Available evidence suggests that declining functionality in the brain's dopamine system contributes to age-related cognitive and motor slowing. The central hypothesis of this study is that by enhancing dopamine functioning in the brain and improving cognitive and motor slowing, administration of carbidopa/levodopa (L-DOPA) will improve depressive symptoms in older adults.

Condition or disease Intervention/treatment Phase
Major Depressive Disorder Dysthymia Depression Drug: L-Dopa Drug: Placebo Oral Tablet Phase 4

Detailed Description:
90 adults aged > 60 years with (1) a DSM 5 depressive disorder, (2) significant depressive symptoms, and (3) decreased thinking or walking speed will receive 8 weeks of treatment with L-DOPA up to 450mg. We will test whether L-DOPA increases brain dopamine release using neuroimaging and whether it speeds up thinking and walking speed. Data collected in the proposed studies may help identify a new treatment for LLD, which could have large public health ramifications given the prevalence, frequent treatment resistance, and chronicity characteristic of LLD. This project also will elucidate the neurobiology of slowing at molecular, structural, and functional levels of analysis, increasing our understanding of the interplay between these aging-associated processes and the pathophysiologic changes underlying late life neuropsychiatric disorders. Exploring patient characteristics that predict response to L-DOPA may provide useful information to guide differential therapeutics and develop personalized medicine for LLD

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 90 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Participant, Investigator)
Masking Description: Double Blind
Primary Purpose: Treatment
Official Title: Targeting Dopaminergic Mechanisms of Slowing to Improve Late Life Depression
Actual Study Start Date : January 9, 2019
Estimated Primary Completion Date : May 31, 2021
Estimated Study Completion Date : November 30, 2021

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: L-Dopa Arm
Those assigned to L-DOPA will begin taking 37.5mg carbidopa/150 mg levodopa once daily (with placebo twice daily) for one week, then increase to 75mg carbidopa/300mg levodopa (37.5 mg carbidopa/150mg levodopa twice daily and placebo once daily) for one week, and finally increase to 112.5mg carbidopa/450mg levodopa (37.5 mg carbidopa/150mg levodopa three times daily and no placebo) for the final six weeks.Each subject assigned to the L-DOPA arm will be titrated to 450mg L-DOPA unless they cannot tolerate higher doses, in which case subjects will have their dosage reduced to the maximum tolerable dose
Drug: L-Dopa
We will be using generic sinemet 25/100 tablets in this study.
Other Name: carbidopa/levodopa (Sinemet)

Placebo Comparator: Placebo Arm
Subjects assigned to the placebo arm will take placebo oral tablet three times daily throughout the study.
Drug: Placebo Oral Tablet
25/100 placebo tablets
Other Name: Placebo




Primary Outcome Measures :
  1. Hamilton Rating Scale for Depression (HRSD) [ Time Frame: 8 Weeks ]
    Our target is depressive symptomatology as measured by the Hamilton Rating Scale for Depression (HRSD). The HRSD is a 24-item questionnaire used as an indication of depression and a guide to evaluate recovery. Total scores range from 0-74, not including atypical symptoms sub-scale. A score of 16 or above is typically considered to indicate the presence of depressive symptoms. Higher scores indicate greater severity.



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Ages Eligible for Study:   59 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Age >59 years
  • DSM 5 non-psychotic Major Depressive Disorder, Dysthymia, or Depression Not Otherwise Specified
  • Center for Epidemiological Studies Depression (CES-D) Rating Scale >9
  • decreased processing speed (defined as performance > 0.5SD below age-adjusted norms on Digit Symbol Substitution Test or Trail Making Test Part A) OR decreased gait speed (defined as average walking speed over 15' course < 1m/s)
  • willing to and capable of providing informed consent and complying with study procedures
  • prefer not to be treated with a standard treatment for MDD, Dysthymia, or Depression NOS (e.g., antidepressant medication or psychotherapy).

Exclusion Criteria:

  • diagnosis of substance abuse
  • history of or current psychosis, psychotic disorder, mania, or bipolar disorder
  • diagnosis of probable Alzheimer's Disease, Vascular Dementia, or PD
  • Mini Mental Status Exam (MMSE) < 25
  • HRSD ≥ 25 or the presence of significant suicide risk
  • current or recent (within the past 4 weeks) treatment with antidepressants, antipsychotics, dopaminergic agents, or mood stabilizers
  • history of allergy, hypersensitivity reaction, or severe intolerance to L-DOPA
  • acute, severe, or unstable medical or neurological illness
  • mobility limiting osteoarthritis of any lower extremity joints, symptomatic lumbar spine disease, mobility limiting history of joint replacement surgery, or history of spine surgery

FOR SUBJECTS RECEIVING PET/MRI SCANS ONLY:

  • having contraindication to MRI scanning (such as metal in body) or unable to tolerate the scanning procedures
  • history of significant radioactivity exposure (nuclear medicine studies or occupational exposure)

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 ClinicalTrials.gov identifier (NCT number): NCT03761030


Contacts
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Contact: Emily Valente, MS 646-774-6704 emily.valente@nyspi.columbia.edu
Contact: Bret R Rutherford, MD 646774-8660 brr8@cumc.columbia.edu

Locations
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United States, New York
New York State Psychiatric Institute Recruiting
New York, New York, United States, 10032
Contact: Emily Valente, MA    646-772-6704    emily.valente@nyspi.columbia.edu   
Principal Investigator: Bret R Rutherford, MD         
Sub-Investigator: Patrick Brown, PHD         
Sponsors and Collaborators
New York State Psychiatric Institute
National Institute of Mental Health (NIMH)
Investigators
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Principal Investigator: Bret R Rutherford, MD Associate Professor of Clinical Psychiatry

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Responsible Party: Bret Rutherford, Associate Professor, New York State Psychiatric Institute
ClinicalTrials.gov Identifier: NCT03761030     History of Changes
Other Study ID Numbers: 7733
4R33MH110029-03 ( U.S. NIH Grant/Contract )
First Posted: December 3, 2018    Key Record Dates
Last Update Posted: February 6, 2019
Last Verified: February 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: No
Keywords provided by Bret Rutherford, New York State Psychiatric Institute:
Depressive symptoms
Cognitive problems
Antidepressant non-response
Dopamine system
Older Adults
Motor slowing
Additional relevant MeSH terms:
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Depression
Depressive Disorder
Depressive Disorder, Major
Behavioral Symptoms
Mood Disorders
Mental Disorders
Levodopa
Carbidopa
Carbidopa, levodopa drug combination
Antiparkinson Agents
Anti-Dyskinesia Agents
Dopamine Agents
Neurotransmitter Agents
Molecular Mechanisms of Pharmacological Action
Physiological Effects of Drugs
Aromatic Amino Acid Decarboxylase Inhibitors
Enzyme Inhibitors
Adjuvants, Immunologic
Immunologic Factors
Dopamine Agonists