Major Depressive Disorder
Conditions
Keywords
Major Depressive Disorder, Major Depression, Depression, Geodon, Ziprasidone
Brief summary
This is a study on the effectiveness, tolerability and safety of oral ziprasidone as monotherapy in patients with major depressive disorder (MDD). Outpatients suffering from MDD will be treated with either ziprasidone or placebo for 12 weeks. Hypothesis: There will be a statistically significant difference in the magnitude of response, as measured by a decrease in baseline 17-item Hamilton Depression Rating Scale (HAM-D-17) scores, between the two treatment groups; the reduction in HAM-D-17 scores will be greater in the ziprasidone monotherapy group than in the placebo group.
Detailed description
Exploratory hypothesis 1: There will be a statistically significant difference in the percentage of responders in the two treatment groups; response rates will be significantly higher for the ziprasidone monotherapy compared to the placebo group. Exploratory hypothesis 2: The change in 6-VAS-D scores during the trial will be highly correlated to the change in HAM-D-17 and QIDS-SR during the trial.
Interventions
DRUGZiprasidone
20mg-80mg a day. Dose increases of 20mg per day may occur at three study visits as directed by clinician. Maximum; 80mg per day per patient.
DRUGPlacebo
0mg Placebo per day. Dose increases and dose decreases may occur, but patient will remain at 0mg placebo
Sponsors
Cambridge Health Alliance
University of Connecticut
Vanderbilt University
Psychiatric Medicine Associates, L.L.C.
Cedars-Sinai Medical Center
Massachusetts General Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
1. Age 18-65. 2. Written informed consent. 3. MDD, current according to the fourth version of the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV) as diagnosed by the Mini International Neuropsychiatric Interview (MINI; Sheehan et al, 1998). 4. Quick Inventory of Depressive Symptomatology - Self-Rated (QIDS-SR- Trivedi et al, 2004) score of at least 10 at both screen and baseline visits.
Exclusion criteria
1. Pregnant women. 2. Women of child bearing potential who are not using a medically accepted means of contraception (to include oral contraceptive or implant, condom, diaphragm, spermicide, intrauterine device, tubal ligation, or a partner with vasectomy). 3. Treatment with antidepressants for 2 weeks prior to the screen visit. If interested in discontinuing their current medication, potential participants must discuss this possibility with the prescribing physician. Study doctors will not implement any form of treatment washout. 4. Patients who no longer meet DSM-IV criteria for MDD during the baseline visit, or patients who demonstrate a 25% or greater reduction in QIDS-SR scores, screening to baseline. 5. Serious suicide or homicide risk, as assessed by the evaluating clinician or a score of 4 on the third item of the HAM-D. 6. Unstable medical illness including cardiovascular, hepatic, renal, respiratory, endocrine, neurological, or hematological disease. 7. Patients who meet criteria for alcohol or substance dependence, active within the last month. 8. Any bipolar disorder (current or past). 9. Any psychotic disorder (current or past). 10. Psychotic features in the current episode or a history of psychotic features. 11. History of a seizure disorder. 12. Clinical or laboratory evidence of untreated hypothyroidism. 13. Patients requiring excluded medications (see table 1 for details). 14. Prior course of ziprasidone, or intolerance to ziprasidone at any dose. 15. Any investigational psychotropic drug within the last 3 months. 16. Patients with significant cardiac conduction problems on screening electrocardiogram such as atrial fibrillation, atrial flutter, atrio-ventricular block, prolonged or abnormal QTc interval (i.e. QTc\>450msec), or prolonged QRS interval. 17. Patients who have suffered a myocardial infarction within the past 12 months, with uncompensated heart failure, or a history of QTc prolongation. 18. Patients with abnormal serum potassium or magnesium levels upon screening. 19. Patients currently taking other drugs that prolong the QTc including dofetilide, sotalol, quinidine, class Ia antiarrhythmics, class III antiarrhythmics, mesoridazine, thioridazine, chlorpromazine, droperidol, pimozide, sparfloxacin, gatifloxacin, moxifloxacin, halofantrine, mefloquine, pentamidine, arsenic trioxide, levomethadyl acetate, dolasetron methylate, probucol or tacrolimus. 20. Patients who have failed to experience significant clinical improvement following 3 or more antidepressant trials of adequate duration (at least 6 weeks) and dose (minimal effective doses defined as: fluoxetine, paroxetine, citalopram 20mg; sertraline, fluvoxamine 50mg, escitalopram 10mg, paroxetine CR 25mg, venlafaxine 75mg, duloxetine 60mg, bupropion 150mg, 15mg of mirtazapine, trazodone or nefazodone 300mg).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Hamilton Depression Rating Scale (HAM-D-17) Scores | 6 weeks | Higher numbers represent more symptoms of a major depressive episode. Minimum is 0. Maximum is 52. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Responder/Non-responder | 6 weeks | A responder during phase 1 or phase 2 is someone who demonstrated a 50% or greater decrease in HAMD-17 scores during phase 1 or phase 2 (corresponding). |
| Change in 6-VAS-D Scores During Each Phase. | 6 weeks | — |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Placebo/Ziprasidone Received placebo in first phase and ziprasidone in second phase | 47 |
| Placebo Subjects received placebo throughout study | 44 |
| Ziprasidone Subjects received ziprasidone throughout study | 29 |
| Total | 120 |
Baseline characteristics
| Characteristic | Placebo | Ziprasidone | Placebo/Ziprasidone | Total |
|---|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 2 Participants | 0 Participants | 0 Participants | 2 Participants |
| Age, Categorical Between 18 and 65 years | 42 Participants | 29 Participants | 47 Participants | 118 Participants |
| Age, Continuous | 44.6 years STANDARD_DEVIATION 11 | 41.5 years STANDARD_DEVIATION 10.6 | 44.1 years STANDARD_DEVIATION 11.1 | 43.7 years STANDARD_DEVIATION 11 |
| Region of Enrollment United States | 44 participants | 29 participants | 47 participants | 120 participants |
| Sex: Female, Male Female | 22 Participants | 13 Participants | 18 Participants | 53 Participants |
| Sex: Female, Male Male | 22 Participants | 16 Participants | 29 Participants | 67 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 31 / 125 | 22 / 80 |
| serious Total, serious adverse events | 0 / 80 | 1 / 125 |
Outcome results
Primary
Hamilton Depression Rating Scale (HAM-D-17) Scores
Higher numbers represent more symptoms of a major depressive episode. Minimum is 0. Maximum is 52.
Time frame: 6 weeks
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Ziprasidone Phase I | Hamilton Depression Rating Scale (HAM-D-17) Scores | Mean phase baseline score | 20.1 points | Standard Deviation 5.5 |
| Ziprasidone Phase I | Hamilton Depression Rating Scale (HAM-D-17) Scores | Mean phase score reduction | -8.8 points | Standard Deviation 7.3 |
| Placebo Phase I | Hamilton Depression Rating Scale (HAM-D-17) Scores | Mean phase score reduction | -7.1 points | Standard Deviation 7 |
| Placebo Phase I | Hamilton Depression Rating Scale (HAM-D-17) Scores | Mean phase baseline score | 19.9 points | Standard Deviation 4.8 |
| Ziprasidone Phase II | Hamilton Depression Rating Scale (HAM-D-17) Scores | Mean phase baseline score | 14.7 points | Standard Deviation 3.9 |
| Ziprasidone Phase II | Hamilton Depression Rating Scale (HAM-D-17) Scores | Mean phase score reduction | -2.1 points | Standard Deviation 5.2 |
| Placebo Phase II | Hamilton Depression Rating Scale (HAM-D-17) Scores | Mean phase baseline score | 15.6 points | Standard Deviation 5.9 |
| Placebo Phase II | Hamilton Depression Rating Scale (HAM-D-17) Scores | Mean phase score reduction | -4.3 points | Standard Deviation 6 |
Secondary
Change in 6-VAS-D Scores During Each Phase.
Time frame: 6 weeks
Population: Forms not analyzable due to insufficient standardization across sites.
Secondary
Responder/Non-responder
A responder during phase 1 or phase 2 is someone who demonstrated a 50% or greater decrease in HAMD-17 scores during phase 1 or phase 2 (corresponding).
Time frame: 6 weeks
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Ziprasidone Phase I | Responder/Non-responder | 44.8 percentage of patients |
| Placebo Phase I | Responder/Non-responder | 31.8 percentage of patients |
| Ziprasidone Phase II | Responder/Non-responder | 23.8 percentage of patients |
| Placebo Phase II | Responder/Non-responder | 28.0 percentage of patients |