Brain Energy Metabolism in Individuals With Major Depressive Disorder Receiving Escitalopram

The recruitment status of this study is unknown because the information has not been verified recently.
Verified June 2009 by National Institute of Mental Health (NIMH).
Recruitment status was  Active, not recruiting
Information provided by:
National Institute of Mental Health (NIMH) Identifier:
First received: September 13, 2005
Last updated: June 9, 2009
Last verified: June 2009
This study will evaluate changes in brain energy metabolism due to treatment with escitalopram in people with major depressive disorder.

Condition Intervention Phase
Drug: Escitalopram
Phase 4

Study Type: Interventional
Study Design: Allocation: Non-Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Biochemical Brain Changes Correlated With the Antidepressant Effect of Escitalopram: A Magnetic Resonance Spectroscopic Imaging Study

Resource links provided by NLM:

Further study details as provided by National Institute of Mental Health (NIMH):

Primary Outcome Measures:
  • Score on the depression rating scale [ Time Frame: Measured at Week 12 ] [ Designated as safety issue: No ]
  • Brain energy metabolism [ Time Frame: Measured at Weeks 2 and 12 ] [ Designated as safety issue: No ]

Estimated Enrollment: 200
Study Start Date: July 2003
Estimated Study Completion Date: June 2009
Estimated Primary Completion Date: June 2009 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: 1
Participants will receive treatment with escitalopram.
Drug: Escitalopram
Escitalopram 10 to 30 mg per day for 12 weeks

Detailed Description:

Major depressive disorder (MDD) is a severe form of depression. MDD can significantly interfere with an individual's thoughts, behavior, mood, and physical health. People who suffer from MDD often experience feelings of worthlessness; they may feel hopeless and may be unable to cope with problems in their life. In addition, they often experience sleep disruption, loss of appetite, and chronic pain.

Antidepressant medications are often prescribed for treating MDD; however, 30% to 40% of individuals fail to respond adequately to medication. Preliminary research has shown that lower levels of brain energy metabolism are often associated with MDD. No studies have yet shown whether there is a difference in brain energy metabolism between individuals who respond well to antidepressants versus those who do not. Escitalopram is an antidepressant medication often used to treat MDD. It causes a calming effect and reduces anxiety by increasing the amount of serotonin in the brain. This study will compare the changes in brain energy metabolism due to treatment with escitalopram in individuals with MDD. In turn, these findings may aid in understanding the relationship between brain energy metabolism and depression, and may guide future antidepressant trials.

This 12-week study will enroll individuals diagnosed with MDD, as well as healthy individuals. During Weeks 1 through 4, participants with MDD will receive 10 mg of escitalopram on a daily basis. If a participant does not respond well to the medication, as determined by the study clinician, the dose may be increased to 20 mg per day for Weeks 5 through 8. If a participant continues to not respond to the medication after 8 weeks, the dose may be increased to 30 mg per day for Weeks 9 through 12. Study visits will occur every other week throughout the 12 weeks. Laboratory tests, physical examinations, and vital sign measurements will be performed at each study visit. Outcome measurements will include depression levels as assessed by standardized psychological tests and questionnaires, as well as brain energy metabolite levels as assessed by magnetic resonance spectroscopy (MRS) and magnetic resonance imaging (MRI) scans. The MRS and MRI scans will occur at baseline, Week 2, and Week 12; the entire scanning procedure will last 70-80 minutes. Following the end of the study, all participants will be offered follow-up medical care for 3 months. Participants who responded well to escitalopram will be offered continued treatment with the drug, while those who did not respond well to escitalopram will be offered treatment with another antidepressant.


Ages Eligible for Study:   18 Years to 65 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   Yes

Inclusion Criteria:

For depressed subjects:

  • Meets DSM-IV diagnostic criteria for major depressive disorder
  • Score of greater than 16 on the Hamilton Depression Rating scale (17 items) at study entry
  • Agrees to use an effective form of contraception throughout the study

For healthy volunteers:

  • Not currently taking any medications
  • No lifetime history of major neurological, medical, psychiatric disorder, or head injury
  • Agrees to use an effective form of contraception throughout the study

Exclusion Criteria:

  • Current suicidal ideation that may make study participation unsafe
  • Current serious or unstable medical illness (e.g., cardiovascular, kidney, liver, respiratory, endocrine, neurologic, or blood-related disease)
  • History of seizure disorder
  • History of or current DSM-IV diagnosis of any of the following psychiatric illnesses within 12 months of study entry: organic mental disorder, schizophrenia, schizoaffective disorder, delusional disorder, psychotic disorders not otherwise specified, bipolar disorder, mood congruent or mood incongruent psychotic features, substance dependence disorders (including alcohol)
  • History of or current diagnosis of dementia, or a score of less than 26 on the Mini Mental Status Examination at screening
  • History of multiple adverse drug reactions or allergic reaction to the study drugs
  • Currently taking psychotropic drugs or antidepressant medications
  • Clinical or laboratory evidence of hypothyroidism
  • Failure to respond during current major depressive episode to at least one adequate antidepressant trial, defined as 6 weeks or more of treatment with 40 mg of citalopram per day (or its antidepressant equivalent)
  • History of electroconvulsive therapy (ECT) within the 6 months prior to study entry
  • Pregnant
  • Subjects with a CGI score a 6 ("severely depressed") or 7 ("among the most extremely depressed patients")
  • A BMI of 39 or greater, for comfort in scanner
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Please refer to this study by its identifier: NCT00183677

United States, Massachusetts
Massachusetts General Hospital
Boston, Massachusetts, United States, 02114
Sponsors and Collaborators
National Institute of Mental Health (NIMH)
Principal Investigator: Dan V. Iosifescu, MD Massachusetts General Hospital
  More Information

Additional Information:
Responsible Party: Dan Iosifescu, Massachusetts General Hospital Identifier: NCT00183677     History of Changes
Other Study ID Numbers: K23MH067111  DATR AK-TNNS1 
Study First Received: September 13, 2005
Last Updated: June 9, 2009
Health Authority: United States: Federal Government

Keywords provided by National Institute of Mental Health (NIMH):
Brain Bioenergetic Metabolism
Magnetic Resonance Spectroscopy
Major Depressive Disorder
Treatment Response

Additional relevant MeSH terms:
Depressive Disorder
Depressive Disorder, Major
Mental Disorders
Mood Disorders
Anti-Dyskinesia Agents
Antidepressive Agents
Antidepressive Agents, Second-Generation
Antiparkinson Agents
Autonomic Agents
Central Nervous System Agents
Cholinergic Agents
Cholinergic Antagonists
Molecular Mechanisms of Pharmacological Action
Muscarinic Antagonists
Neurotransmitter Agents
Neurotransmitter Uptake Inhibitors
Peripheral Nervous System Agents
Pharmacologic Actions
Physiological Effects of Drugs
Psychotropic Drugs
Serotonin Agents
Serotonin Uptake Inhibitors
Therapeutic Uses processed this record on May 04, 2016