Ignite Creation Date:
2024-05-05 @ 5:27 PM
Last Modification Date:
2024-10-26 @ 9:32 AM
Study NCT ID:
NCT00464191
Status:
TERMINATED
Last Update Posted:
2009-09-21
First Post:
2007-04-20
Brief Title:
Escitalopram in Bipolar Depression a Placebo-controlled Study of Acute and Maintenance Treatment
Sponsor:
Nordfjord Psychiatric Centre
Organization:
Nordfjord Psychiatric Centre
Study Overview
Official Title:
Escitalopram in Bipolar Depression a Placebo-controlled Study of Acute and Maintenance Treatment
Status:
TERMINATED
Status Verified Date:
2009-09
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
The study has been terminated because too few patients have been recruited
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
None
Brief Summary:
Funding An investigator-initiated trial funded by H Lundbeck AS
Study design Prospective randomised placebo-controlled parallel-group multicenter study
Aim To investigate efficacy and side effects especially mood switches of escitaloprama selective serotonin reuptake inhibitor in the acute and maintenance treatment of bipolar depression
Hypotheses
1 Escitalopram given in addition to mood stabilising medications is significantly more efficacious measured by response and remission rates than placebo in bipolar depression the acute phase study
2 Continuation therapy with escitalopram gives significantly longer mean time to depressive relapse and fewer depressive relapses compared to placebo the continuation study
3 The incidence of mood switching defined as development of mixed episodes mania or hypomania according to DSM-IV criteria do not differ significantly between escitalopram and placebo in either the acute or the continuation phases
Patients In- and outpatients receiving care in the specialised psychiatric services of Western Norway The population is intended to be representative of the patients treated for bipolar depression in ordinary specialist care Patients must have a MADRS score of at least 20 at baseline Patients with ongoing substance abuse or dependence organic mental illness and non-affective psychotic symptoms are excluded
Medication Escitalopram 10-20 mg daily or placebo in addition to mood stabilisers The dose of mood stabilisers must have been constant for the last six weeks prior to randomisation
Method Phase 1 is a eight-week acute treatment trial with six clinical assessments Patients treated with escitalopram who have not responded after eight weeks defined by at least 50 reduction of MADRS score compared to baseline leave the study Placebo non-responders are treated openly with escitalopram and repeat phase 1 Responders are re-randomised to 32 weeks of maintenance treatment phase 2 Phase 2 has nine clinical assessments Patients who develop hypomania mania or depressive episodes defined as episodes meeting DSM-IV criteria for Major Depressive Episode with MADRS scores of at least 20 points leave the study in this phase Patients leaving the study prematurely will be offered alternative treatment
Study design Prospective randomised placebo-controlled parallel-group multicenter study
Aim To investigate efficacy and side effects especially mood switches of escitaloprama selective serotonin reuptake inhibitor in the acute and maintenance treatment of bipolar depression
Hypotheses
1 Escitalopram given in addition to mood stabilising medications is significantly more efficacious measured by response and remission rates than placebo in bipolar depression the acute phase study
2 Continuation therapy with escitalopram gives significantly longer mean time to depressive relapse and fewer depressive relapses compared to placebo the continuation study
3 The incidence of mood switching defined as development of mixed episodes mania or hypomania according to DSM-IV criteria do not differ significantly between escitalopram and placebo in either the acute or the continuation phases
Patients In- and outpatients receiving care in the specialised psychiatric services of Western Norway The population is intended to be representative of the patients treated for bipolar depression in ordinary specialist care Patients must have a MADRS score of at least 20 at baseline Patients with ongoing substance abuse or dependence organic mental illness and non-affective psychotic symptoms are excluded
Medication Escitalopram 10-20 mg daily or placebo in addition to mood stabilisers The dose of mood stabilisers must have been constant for the last six weeks prior to randomisation
Method Phase 1 is a eight-week acute treatment trial with six clinical assessments Patients treated with escitalopram who have not responded after eight weeks defined by at least 50 reduction of MADRS score compared to baseline leave the study Placebo non-responders are treated openly with escitalopram and repeat phase 1 Responders are re-randomised to 32 weeks of maintenance treatment phase 2 Phase 2 has nine clinical assessments Patients who develop hypomania mania or depressive episodes defined as episodes meeting DSM-IV criteria for Major Depressive Episode with MADRS scores of at least 20 points leave the study in this phase Patients leaving the study prematurely will be offered alternative treatment
Detailed Description:
Aims
The study has two main aims
1 To compare the efficacy and the risk of mood switching of escitalopram and placebo in the acute phase treatment of bipolar depression in patients already taking mood stabilising medication
2 To compare the efficacy of escitalopram and placebo in continuation phase therapy for bipolar depression using a placebo-controlled discontinuation design The study will compare the occurrence of syndromal and subsyndromal relapses mixed states mania hypomania and rapid cycling in a seven months maintenance study following response to acute phase treatment
Hypotheses
1 Escitalopram given in addition to mood stabilising medications is significantly more efficacious measured by response and remission rates than placebo in bipolar depression the acute phase study
2 Continuation therapy with escitalopram gives significantly longer mean time to depressive relapse and fewer depressive relapses compared to placebo the continuation study
3 The incidence of mood switching defined as development of mixed episodes mania or hypomania according to DSM-IV criteria do not differ significantly between escitalopram and placebo in either the acute or the continuation phases
Design This is a multi-center RCT with parallel-group design The study compares the efficacy of placebo and escitalopram given as add-on to mood stabilising medications in patients with bipolar depression without non-affective psychotic symptoms according to DSM-IV and with a baseline MADRS score of 20 points
The study has two phases The acute phase study lasts for eight weeks and compares the efficacy of escitalopram and placebo on depressive symptoms in bipolar depression Response is defined as at least 50 improvement on the MADRS compared to the baseline score Responders to escitalopram are re-randomised to escitalopram or placebo for the continuation phase while placebo responders continue taking placebo for the continuation phase Patients on escitalopram who do not respond in the acute phase leave the study whereas placebo non-responders are treated openly with escitalopram and repeat phase 1 Responders to this open-label treatment are then re-randomised double blind to escitalopram or placebo for the continuation study
The continuation phase study lasts for 32 weeks Patients who responded to placebo in the acute phase continue placebo and their usual mood stabilising medication for the remainder of the study Those who responded to escitalopram are re-randomised to continue taking placebo or escitalopram in unchanged doses Patients who develop new mood episodes DSM-IV-defined major depressive episode mania hypomania or mixed episodes or MADRS score 20 points leave the study
Method Screening includes sociodemographic variables medical and psychiatric history diagnosis made on the basis of clinical interview and verified by the MINI symptom intensity measured by the MADRS results of medical examination and laboratory tests ECG height weight blood pressure and blood tests Sociodemographic variables include age gender previous and concomitant disorders course and treatment of mental disorders bipolar disorder type I or II age of onset and history of psychotropic medication use
Study procedure As soon as the blood samples are analysed eligible patients can be randomised They are rated on the MADRS Clinical Global Impressions CGI Inventory of Depressive Symptoms - Self Report IDS-SR Medical Outcomes Study Short Form 12 SF-12 Global Assessment of Functioning GAF and Sheehan Disability Inventory SDI at the baseline visit Study medication is dispensed The patients will return to further visits as shown below Patients will receive study medication for a maximum of 40 weeks Adverse events and concomitant medications are recorded
Assessments
The following assessments will be carried out
1 MADRS GAF IDS-RS and CGI-I at week 1 2 4 6 8 9 10 12 16 20 24 28 34 and 40
2 SDI and QLDS at week 8 and 40
3 Diagnostic criteria for Mania and Hypomania at week 1 2 4 6 8 9 10 12 16 20 24 28 34 and 40
4 Diagnostic criteria for Major Depressive Episode at week 8 9 10 12 16 20 24 28 34 and 40
For the acute study response and remission rates as assessed by the MADRS are the primary outcome measures CGI-Improvement and IDS-SR are secondary outcome measures In the continuation study primary outcome measures include emergence of major depressive episodes and maniahypomania while time spent at different depressive symptom levels as assessed by the DSM-IV diagnostic criteria are secondary outcome measures
Definitions Response at least a 50 reduction of the baseline MADRS score at the end of phase 1 if the patient has completed at least four weeks of the study CGI-I 1 or 2 at the end of phase 1
Remission MADRS score of 12 or less at the end of the acute phase if the patient has completed at least four weeks of the study
New episode A patient who has previously responded to treatment meets the DSM-IV criteria for Major Depressive Episode The patient must score at least 15 points on the MADRS and have a CGI-S score of 3 or more during this episode
Mania and hypomania by DSM-IV criteria
The study has two main aims
1 To compare the efficacy and the risk of mood switching of escitalopram and placebo in the acute phase treatment of bipolar depression in patients already taking mood stabilising medication
2 To compare the efficacy of escitalopram and placebo in continuation phase therapy for bipolar depression using a placebo-controlled discontinuation design The study will compare the occurrence of syndromal and subsyndromal relapses mixed states mania hypomania and rapid cycling in a seven months maintenance study following response to acute phase treatment
Hypotheses
1 Escitalopram given in addition to mood stabilising medications is significantly more efficacious measured by response and remission rates than placebo in bipolar depression the acute phase study
2 Continuation therapy with escitalopram gives significantly longer mean time to depressive relapse and fewer depressive relapses compared to placebo the continuation study
3 The incidence of mood switching defined as development of mixed episodes mania or hypomania according to DSM-IV criteria do not differ significantly between escitalopram and placebo in either the acute or the continuation phases
Design This is a multi-center RCT with parallel-group design The study compares the efficacy of placebo and escitalopram given as add-on to mood stabilising medications in patients with bipolar depression without non-affective psychotic symptoms according to DSM-IV and with a baseline MADRS score of 20 points
The study has two phases The acute phase study lasts for eight weeks and compares the efficacy of escitalopram and placebo on depressive symptoms in bipolar depression Response is defined as at least 50 improvement on the MADRS compared to the baseline score Responders to escitalopram are re-randomised to escitalopram or placebo for the continuation phase while placebo responders continue taking placebo for the continuation phase Patients on escitalopram who do not respond in the acute phase leave the study whereas placebo non-responders are treated openly with escitalopram and repeat phase 1 Responders to this open-label treatment are then re-randomised double blind to escitalopram or placebo for the continuation study
The continuation phase study lasts for 32 weeks Patients who responded to placebo in the acute phase continue placebo and their usual mood stabilising medication for the remainder of the study Those who responded to escitalopram are re-randomised to continue taking placebo or escitalopram in unchanged doses Patients who develop new mood episodes DSM-IV-defined major depressive episode mania hypomania or mixed episodes or MADRS score 20 points leave the study
Method Screening includes sociodemographic variables medical and psychiatric history diagnosis made on the basis of clinical interview and verified by the MINI symptom intensity measured by the MADRS results of medical examination and laboratory tests ECG height weight blood pressure and blood tests Sociodemographic variables include age gender previous and concomitant disorders course and treatment of mental disorders bipolar disorder type I or II age of onset and history of psychotropic medication use
Study procedure As soon as the blood samples are analysed eligible patients can be randomised They are rated on the MADRS Clinical Global Impressions CGI Inventory of Depressive Symptoms - Self Report IDS-SR Medical Outcomes Study Short Form 12 SF-12 Global Assessment of Functioning GAF and Sheehan Disability Inventory SDI at the baseline visit Study medication is dispensed The patients will return to further visits as shown below Patients will receive study medication for a maximum of 40 weeks Adverse events and concomitant medications are recorded
Assessments
The following assessments will be carried out
1 MADRS GAF IDS-RS and CGI-I at week 1 2 4 6 8 9 10 12 16 20 24 28 34 and 40
2 SDI and QLDS at week 8 and 40
3 Diagnostic criteria for Mania and Hypomania at week 1 2 4 6 8 9 10 12 16 20 24 28 34 and 40
4 Diagnostic criteria for Major Depressive Episode at week 8 9 10 12 16 20 24 28 34 and 40
For the acute study response and remission rates as assessed by the MADRS are the primary outcome measures CGI-Improvement and IDS-SR are secondary outcome measures In the continuation study primary outcome measures include emergence of major depressive episodes and maniahypomania while time spent at different depressive symptom levels as assessed by the DSM-IV diagnostic criteria are secondary outcome measures
Definitions Response at least a 50 reduction of the baseline MADRS score at the end of phase 1 if the patient has completed at least four weeks of the study CGI-I 1 or 2 at the end of phase 1
Remission MADRS score of 12 or less at the end of the acute phase if the patient has completed at least four weeks of the study
New episode A patient who has previously responded to treatment meets the DSM-IV criteria for Major Depressive Episode The patient must score at least 15 points on the MADRS and have a CGI-S score of 3 or more during this episode
Mania and hypomania by DSM-IV criteria
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
None
Is a FDA Regulated Device?:
None
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None
Secondary IDs
| Secondary ID | Type | Domain | Link |
|---|---|---|---|
| NPS 2005-1 | None | None | None |
| Lundbeck 10968 | None | None | None |