Nuedexta in Treatment-Resistant Major Depression
This study has been completed.
Information provided by (Responsible Party):
James Murrough, Icahn School of Medicine at Mount Sinai
First received: June 14, 2013
Last updated: April 19, 2016
Last verified: April 2016
There is an urgent need, therefore, to identify well-tolerated, orally available compounds that target the NMDA receptor as a novel treatment approach for TRD. The current project aims to test the safety, tolerability and efficacy of Nuedexta - containing the NMDA antagonist dextromethorphan.
Major Depressive Disorder
||Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
||Targeting the NMDA Glutamate Receptor as Novel Antidepressant Strategy: A Pilot Clinical Trial of Nuedexta in Treatment-Resistant Major Depression
Primary Outcome Measures:
- Change in Montgomery-Asberg Depression Rating Scale [ Time Frame: At baseline and visit 6 (week 10) ]
The Montgomery-Asberg Depression Rating Scale is a 10-item instrument used for the evaluation of depressive symptoms in adults and for the assessment of any changes to those symptoms. Each of the 10 items is rated on a scale of 0 to 6, with differing descriptors for each item. These individual item scores are added together to form a total score, which can range between 0 and 60 points. The MADRS is specifically designed to detect changes in depression severity in the context of a medication treatment trial and is the used as the primary outcome of the current study.
Primary outcome is change in MADRS at Visit 6 (Week 10)
Secondary Outcome Measures:
- Change in Quality of Life Enjoyment and Satisfaction Questionnaire Short Form [ Time Frame: At baseline and Visit 6 (week 10) ]
The Quality of Life Enjoyment and Satisfaction Questionnaire Short Form is a reliable and valid self-report measure designed to obtain sensitive measures of the degree of enjoyment and satisfaction experienced by individuals.
- Change in Range of Impaired Functioning Tool [ Time Frame: At baseline and Visit 6 (week 10) ]
The Range of Impaired Functioning Tool a brief scale for assessing functional impairment related to medical or psychiatric illness and has been demonstrated to possess good psychometric properties.
- Change in Sheehan Disability Scale [ Time Frame: At baseline and Visit 6 (week 10) ]
The Sheehan Disability Scale is a self-rated scale which assesses illness-related disability in three areas of functioning: work, social and family.
- Patient Rated Inventory of Side Effects (PRISE) [ Time Frame: up to 12 weeks ]
Frequency of observed adverse events over the study treatment period as captured by the PRISE. The Patient Rated Inventory of Side Effects (PRISE) assesses the presence of treatment side effects in nine organ/function systems (gastrointestinal, nervous system, heart, eyes/ears, skin, genital/urinary, sleep, sexual functioning, and other).
- Columbia-Suicide Severity Rating Scale (C-SSRS) [ Time Frame: up to 12 weeks ]
The Columbia-Suicide Severity Rating Scale (C-SSRS) is a comprehensive, semi-structured interview measure that uniquely measures the full spectrum of suicidality including passive and active suicidal ideation, suicidal intent as well as suicidal behaviors.
- Quick Inventory of Depressive Symptomatology, Self Report (QIDS-SR) [ Time Frame: up to 12 weeks ]
The Quick Inventory of Depressive Symptomatology, Self Report (QIDS-SR) is a 16-item self rated instrument designed to assess the severity of depressive symptoms (30). The 16 items cover the nine symptom domains of major depression, and are rated on a scale of 0-3. Total score ranges from 0 to 27, with ranges of 0-5 (normal), 6-10 (mild), 11-15 (moderate), 16-20 (moderate to severe), and 21+ (severe).
- Clinical Global Impression (CGI) scale [ Time Frame: up to 12 weeks ]
The Clinical Global Impression (CGI) scale assesses overall treatment response in psychiatric patients and has good reliability and validity metrics. The administration time is 2 minutes. This scale consists of three items: Severity of Illness (item 1); Global Improvement (item 2); and Efficacy Index (item 3). Item 1 is rated on a seven-point scale (1 = normal, 7 = among the most extremely ill patients) as is item 2 (1 = very much improved, 7 = very much worse).
- Change in Massachusetts General Hospital Cognitive and Physical Functioning Questionnaire (CPFQ) [ Time Frame: At baseline and Visit 6 (week 10) ]
The Massachusetts General Hospital Cognitive and Physical Functioning Questionnaire (CPFQ) is a brief scale to measure cognitive and executive dysfunction in mood and anxiety disorders, and possesses good reliability and validity.
| Study Start Date:
| Study Completion Date:
| Primary Completion Date:
||March 2016 (Final data collection date for primary outcome measure)
Experimental: Nuedexta (dextromethorphan/quinidine)
45/10 mg every 12 hours x 8 weeks
up to 45/10 mg every 12 hours in patients with TRD with a short 7 day tapering period in which subjects are tapered off 45/10 mg dose from twice a day to once daily for an additional 7 days at post 8-week treatment period to minimize the potential for discontinuation effects
Other Name: Nuedexta
Approximately one-third of patients with major depressive disorder do not achieve adequate symptom control despite a series of multiple treatment trials with currently available antidepressant medication (for example a serotonin-selective reuptake inhibitor). This group of patients - representing treatment-resistant depression (TRD) - accounts for an alarmingly high public health burden and signifies a critical area of need in pharmaceutical treatment development. While current treatments are slow to act and only partially effective, new basic and clinical research focusing on the glutamate system is yielding promising new avenues for novel drug discovery. Ketamine - a glutamate N-methyl-d-aspartate (NMDA) receptor antagonist - has now been demonstrated in several studies to bring about a rapid and robust antidepressant effect, even in patients suffering from TRD. Ketamine is limited as a treatment for TRD by the need for intravenous administration and the potential for untoward medical or psychiatric adverse effects. There is an urgent need, therefore, to identify well-tolerated, orally available compounds that target the NMDA receptor as a novel treatment approach for TRD. The current project aims to test the safety, tolerability and efficacy of Nuedexta - containing the NMDA antagonist dextromethorphan.
|Ages Eligible for Study:
||18 Years to 65 Years (Adult)
|Sexes Eligible for Study:
|Accepts Healthy Volunteers:
- Male or female participants, 18-65 years of age;
- Current primary Axis I diagnosis of major depressive disorder according to DSM-IV-TR criteria as determined by a psychiatrist and confirmed with the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID);
- Current treatment-resistant depression defined by a history of inadequate response to a minimum of 2 adequate antidepressant treatment trials determined by patient history and chart review and confirmed with the Antidepressant Treatment History Form (ATHF);
- Participants must be willing to discontinue treatment with concomitant medications that are disallowed by the study protocol;
- Participants must have a level of understanding of the English language sufficient to agree to all tests and examinations required by the study and must be able to participate fully in the informed consent process.
- Lifetime diagnosis of schizophrenia or any psychotic disorder, bipolar disorder, pervasive developmental disorders or mental retardation
- Diagnosis of a substance use disorder within the past 1 year ;
- Female participants who are pregnant, nursing, for may become pregnant;
- Any unstable medical illnesses including hepatic, renal, gastroenterologic, respiratory, cardiovascular (including ischemic heart disease); endocrinologic, neurologic (including history of severe head injury), immunologic, or hematologic disease;
- Participants with clinically significant abnormalities of laboratories, physical examination, or ECG;
- Prolonged QT interval, congenital long QT syndrome, history suggestive of torsades de pointes, or heart failure;
- Complete atrioventricular (AV) block without implanted pacemaker, or patients at high risk of complete AV block
- Participants with a history of quinidine, quinine or mefloquine-induced thrombocytopenia, hepatitis, or other hypersensitivity reactions;
- Participants judged to be at serious suicidal risk by the PI;
- Concomitant use with quinidine, quinine, or mefloquine;
- Participants with known hypersensitivity to dextromethorphan;
- Use with an MAOI or within 14 days of stopping an MAOI;
- Concomitant use with drugs that prolong QT interval and are metabolized by CYP2D6
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Please refer to this study by its ClinicalTrials.gov identifier: NCT01882829
|Icahn School of Medicine at Mount Sinai
|New York, New York, United States, 10029 |
||James Murrough, MD
||Icahn School of Medicine at Mount Sinai
||James Murrough, Assistant Professor, Icahn School of Medicine at Mount Sinai
History of Changes
|Other Study ID Numbers:
|Study First Received:
||June 14, 2013
||April 19, 2016
Keywords provided by Icahn School of Medicine at Mount Sinai:
major depressive disorder
Additional relevant MeSH terms:
ClinicalTrials.gov processed this record on March 22, 2017
Depressive Disorder, Major
Respiratory System Agents
Excitatory Amino Acid Antagonists
Excitatory Amino Acid Agents
Molecular Mechanisms of Pharmacological Action
Physiological Effects of Drugs