Reward Emotion Learning and Ketamine Study (RELAKS)

• ClinicalTrials.gov Identifier: NCT04850911
• Recruitment Status: Not yet recruiting
• First Posted: April 20, 2021
• Last Update Posted: April 20, 2021
• Sponsor: University of Oxford
• Collaborators: Medical Research Council; Johnson & Johnson Pharmaceutical Research & Development, L.L.C.
• Information provided by (Responsible Party): CatherineHarmer, University of Oxford

Study Description

Brief Summary:

Ketamine's efficacy as an antidepressant is now well established yet the mechanisms underlying its antidepressant effect are yet to be fully described. Work in the animal literature and research in humans is suggestive of specific effects on anhedonia and memory reconsolidation. In this study the investigators will further explore the effects of ketamine on learning and memory as well as measuring the associated changes at neural level in a sample of healthy volunteers. Participants will be assigned to receive ketamine or placebo and complete a set of tasks which will allow the investigators to quantify the effect of ketamine on learning about reward and punishment and memory for learned reward associations 24 hours after ketamine infusion. This study will help the investigators to understand the basis of ketamine's antidepressant effects and aid the development of new treatments for depression.

Condition or disease	Intervention/treatment	Phase
Depression; Major Depressive Disorder; Treatment Resistant Depression	Drug: Ketamine Hydrochloride; Other: No intervention (placebo)	Not Applicable

Study Design

• Study Type: Interventional (Clinical Trial)
• Estimated Enrollment: 35 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Intervention Model Description: Participants will be assigned to receive either ketamine or placebo. Ketamine is not being administered for treatment purposes, the purpose is to understand the mechanisms underpinning its effects.
• Masking: Double (Participant, Investigator)
• Masking Description: All members of the study team will be blinded to the condition a participant is allocated to with the exception of the team member responsible for administering the drug/placebo.
• Primary Purpose: Basic Science
• Official Title: Reward Emotion Learning and Ketamine Study
• Estimated Study Start Date: April 2021
• Estimated Primary Completion Date: November 2022
• Estimated Study Completion Date: November 2022

Arms and Interventions

Arm	Intervention/treatment
Experimental: Ketamine; Participants in this arm will receive a single intravenous, antidepressant dose of ketamine hydrochloride (0.5mg/kg)	Drug: Ketamine Hydrochloride; Ketamine is a high trapping NMDA receptor antagonist which has rapid and reliable antidepressant effects in patients with major depressive disorder (MDD) who have failed to respond to conventional monoaminergic agents.
Placebo Comparator: Placebo; Participants in this arm will receive a single intravenous injection of an inactive placebo (0.9% sodium chloride).	Other: No intervention (placebo); Placebo injection (0.9% sodium chloride)

Outcome Measures

Primary Outcome Measures :

1. Activation of the habenula during the Pavlovian conditioning task in response to the conditioned stimulus associated with pain stimuli and in response to the receipt of shock. [ Time Frame: 24 hours after ketamine infusion ]
   Blood Oxygen Level Dependent (BOLD) signal in the habenula at the time of the shock-associated conditioned stimulus presentation and at the time of shock delivery.
2. Habenula response to the absence of expected reward and the receipt of an unexpected loss (i.e. a negative prediction error signal) in both the reward maximisation and loss minimisation tasks. [ Time Frame: 24 hours after ketamine administration ]
   BOLD signal in the habenula at the time of outcome presentation in both the reward maximisation and loss minimisation tasks.
3. Preference for high-reward probability shapes learned after winning money (in the Wheel of Fortune draw) during the preference test. [ Time Frame: +/- 24 hours after ketamine administration ]
   Proportion of choices where high-reward probability shapes are selected. This will be based on the difference between the perceived reward probability of shapes learned after the winning and losing of money (an area under the curve measure).

Secondary Outcome Measures :

1. Ventral striatum response to the expected reward and the omission an unexpected loss (i.e. a positive prediction error signal) in both the reward maximisation and loss minimisation tasks. [ Time Frame: 24 hours after ketamine administration ]
   BOLD signal in the ventral striatum at the time of outcome presentation in both the reward maximisation and loss minimisation tasks.
2. Pupil dilation (measured by an eye tracker device) in response to decision values in the affective memory preference test. [ Time Frame: 24 hours after ketamine administration ]
   Baseline corrected pupil dilation measured at the time of option presentation during each choice trial of the affective memory preference test.
3. Difference in pupil response to shapes learned after winning versus losing money. [ Time Frame: 24 hours after ketamine administration ]
   Between groups comparison of pupil dilation in response to shapes learned after a loss and shapes learned after a win in Wheel of Fortune draw that induces experimental change in negative/positive affect.
4. Amount of money earned in the learning and memory task. [ Time Frame: Final component completed 24 hours after ketamine administration before scanning ]
   Between groups comparison of the total amount of money earned during the learning and memory task.
5. Change in bio-behavioral measures of stress following laboratory induced stress administered. [ Time Frame: 1-week after ketamine infusion ]
   Between groups comparison of salivary cortisol in response to Oxford Cognition Stress Task.
6. Change in bio-behavioral measures of stress following laboratory induced stress administered. [ Time Frame: 1-week after ketamine infusion ]
   Between groups comparison of salivary alpha amylase in response to Oxford Cognition Stress Task.
7. Change in bio-behavioral measures of stress following laboratory induced stress administered. [ Time Frame: 1-week after ketamine infusion ]
   Between groups comparison of heart rate in response to Oxford Cognition Stress Task.
8. Change in bio-behavioral measures of stress following laboratory induced stress administered. [ Time Frame: 1-week after ketamine infusion ]
   Between groups comparison of visual analogue scale ratings in response to Oxford Cognition Stress Task.
9. Recognition of positive and negative facial expressions. [ Time Frame: Immediately and 24 hours after ketamine infusion ]
   Recognition accuracy for positive and negative facial expressions
10. Recognition of positive and negative facial expressions. [ Time Frame: Immediately and 24 hours after ketamine infusion ]
    Reaction time to recognise positive and negative facial expressions
11. Categorisation of emotional words. [ Time Frame: 24 hours after ketamine infusion ]
    Accuracy of categorisation for positive and negative descriptor words.
12. Recognition of emotional words. [ Time Frame: 24 hours after ketamine infusion ]
    Reaction time to categorise positive and negative descriptor words.
13. Recall of emotional words. [ Time Frame: 24 hours after ketamine infusion ]
    Number of words correctly (hits) and incorrectly (false alarms) recalled.

Eligibility Criteria

• Ages Eligible for Study: 18 Years to 45 Years (Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: Yes

Criteria

Inclusion Criteria:

• BMI between 18 and 30
• Participant is willing and able to give informed consent for participation in the study
• Sufficient knowledge of English language to understand and complete study tasks
• Willingness to refrain from driving, cycling, or operating heavy machinery, until the following morning or a restful sleep has occurred, whichever is later.
• Willingness to refrain from signing legal documents within 7 days after the infusion visit.
• Willingness to refrain from drinking alcohol for 3 days before the infusion visit and one day before any of the other visits throughout the study

Exclusion Criteria:

• Any current or past DSM-V significant psychiatric disorder including any psychotic, mood and anxiety and borderline personality disorders
• History of, or current medical conditions which in the opinion of the investigator may interfere with the safety of the participant or the scientific integrity of the study, including epilepsy/seizures, brain injury, hepatic or renal disease, severe gastro-intestinal problems, Central Nervous System (CNS) tumours, neurological conditions
• First-degree relative with a diagnosis of schizophrenia-spectrum or other psychotic disorder, or bipolar disorder
• History of unexplained hallucinations or impulse control problems (e.g. pathological gambling)
• Current or past history of heart rhythm disorders
• Clinically significant hypertension
• Increased intraocular pressure/glaucoma
• Current pregnancy (as determined by urine pregnancy test taken during Screening and Infusion Visits) or breastfeeding
• Clinically significant abnormal values for clinical chemistry (e.g. liver function tests), urine drug screen, blood pressure measurement and ECG. A participant with a clinical abnormality or parameters outside the reference range for the population being studied may be included only if the Investigator considers that the finding is unlikely to introduce additional risk factors and will not interfere with the study procedures
• Current or previous intake (last three months) of any medication that has a significant potential to affect mental functioning (e.g. benzodiazepines, antidepressants, neuroleptics etc.)
• Any intake of recreational drugs in the last 3 months (e.g. marijuana, ecstasy etc.)
• Lifetime recreational use of ketamine or phencyclidine
• Regular alcohol consumption of more than 14 units a week or excessive alcohol consumption up to three days before any of the in-person study visits
• Inability to abstain from alcohol for more than 1 week
• Regular smoker (> 5 cigarettes per day)
• Excessive caffeine user (> 6 caffeinated drinks per day)
• History of recurrent rashes or history of allergic reactions to relevant substances (ketamine treatment, placebo treatment)
• Previous participation in a study using the same or similar tasks
• Current participation in another study or participation in similar study within the last 6 months
• Participant is unlikely to comply with the clinical study protocol or is unsuitable for any other reason, in the opinion of the Investigator
• Claustrophobia
• Any implants (including dental implants) or pacemaker
• Tattoos above the chest
• Any other MRI contraindications outlined in FMRIB 7 Tesla scanning safety form

Contacts and Locations

Contacts

Contact: Erdem Pulcu, PhD; 01865613154; erdem.pulcu@psych.ox.ac.uk

Sponsors and Collaborators

University of Oxford

Medical Research Council

Johnson & Johnson Pharmaceutical Research & Development, L.L.C.

Investigators

• Principal Investigator: Catherine Harmer, PhD; University of Oxford

More Information

• Responsible Party: CatherineHarmer, Professor, University of Oxford
• ClinicalTrials.gov Identifier: NCT04850911
• Other Study ID Numbers: RELAKS_HV
• First Posted: April 20, 2021
• Last Update Posted: April 20, 2021
• Last Verified: April 2021

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: Undecided

• Studies a U.S. FDA-regulated Drug Product: No
• Studies a U.S. FDA-regulated Device Product: No

Keywords provided by CatherineHarmer, University of Oxford:

Ketamine; Learning; Memory; Habenula

Additional relevant MeSH terms:

Depression; Depressive Disorder; Depressive Disorder, Major; Depressive Disorder, Treatment-Resistant; Behavioral Symptoms; Mood Disorders; Mental Disorders; Ketamine; Analgesics; Sensory System Agents; Peripheral Nervous System Agents; Physiological Effects of Drugs; Anesthetics, Dissociative; Anesthetics, Intravenous; Anesthetics, General; Anesthetics; Central Nervous System Depressants; Excitatory Amino Acid Antagonists; Excitatory Amino Acid Agents; Neurotransmitter Agents; Molecular Mechanisms of Pharmacological Action