Depression
Conditions
Keywords
Late-life Depression, Antidepressant medication response
Brief summary
The goal of this study is to find out if the antihistamine, clemastine, can make the white matter in the brain better in older adults with depression. The study will also determine whether this improvement can make antidepressant treatment work better, reduce depressive symptoms, and improve memory and thinking.
Detailed description
Geriatric depression, also known as late-life depression, is a type of major depression that affects people who are 60 years old or older. It can be difficult to treat and often comes back after treatment. It can also lead to problems with memory and thinking. Some studies have found that problems with the white matter in the brain can make it harder to treat depression in older adults. White matter helps with communication in the brain. A new study suggests that a medicine called clemastine might be able to improve the white matter in the brain. Clemastine is usually used as an antihistamine, but it might also help the brain repair itself. The goal of this study is to find out if clemastine can make the white matter in the brain better in older adults with depression. The study will also determine whether this improvement can make antidepressant treatment work better, reduce depressive symptoms, and improve memory and thinking. The study will involve two groups of participants. One group will receive the standard antidepressant treatment along with a placebo, while the other group will receive the standard antidepressant treatment along with clemastine. The investigators will compare the effects of these two treatments over a period of 12 weeks. The investigators will measure the improvement in white matter using special brain imaging techniques. The investigators will also assess the participants' mood, memory, and thinking abilities, and keep track of any side effects or problems caused by the treatments. Overall, this study has the potential to contribute valuable insights into the treatment of geriatric depression, alleviate depressive symptoms, enhance cognitive function, and potentially open up new avenues for future research and therapeutic approaches.
Interventions
Listed in arm/group description
DRUGPlacebo
Listed in arm/group description
Sponsors
University of Illinois at Chicago
Cures Within Reach
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Masking description
The design of this pilot study is a randomized double-blind. Only the study Pharmacist will be unblinded to the placebo-controlled design.
Intervention model description
The design of this pilot study is a randomized double-blind, placebo-controlled design with one arm standard antidepressant treatment plus placebo (n=20) and one arm standard antidepressant treatment plus clemastine (5.36 mg PO daily; n=60) for 12 weeks with primary outcomes related to improvement in the level of depression and white matter integrity.
Eligibility
Sex/Gender
ALL
Age
60 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age \> 60 years * Diagnosis of major depressive disorder, single or recurrent episode (DSM5) * Symptom Severity: MADRS ≥ 15 * Seeking antidepressant treatment * Cognition score of MoCA \>24 * Fluent in English or Spanish
Exclusion criteria
* Other Axis I psychiatric disorders, except for simple phobia or anxiety disorders present uniquely during the depressive episode (e.g., generalized anxiety disorder (GAD) or panic disorder symptoms) * History of alcohol or drug dependence or abuse in the last year * History of a developmental disorder or history of IQ (intelligence quotient) \<70 * Acute suicidality ideation within the past month as determined by the Columbia Suicide Severity Rating Scale (C-SSRS) * Acute grief (\<1 month) * Current or past psychosis * Primary neurological disorder, including dementia, clinical stroke, brain tumor, epilepsy, etc. * Presence of unstable medical illness requiring urgent treatment * Any MRI contraindication * Electroconvulsive Therapy (ECT) in last 6 months
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Frequency, Intensity and Burden of Side Effects Rating Scale | 12 weeks | The investigator will examine the safety of clemastine using the Frequency, Intensity, and Burden of Side Effects Rating Scale (FIBSER). The FIBSER is scored from 0-6, with higher scores indicating worse outcomes |
| Montgomery-Asberg Rating Scale for Depression | 12 weeks | The investigators will examine the effectiveness of an antidepressant plus clemastine (5.36 mg twice daily) compared to antidepressant plus placebo on clinical outcomes as indexed by the Montgomery-Asberg Rating Scale for Depression (MADRS). The MADRS is scored from 0-60, with higher scores indicating a worse outcome |
| Quantitative Anisotropy | 12 weeks | The investigators will measure the impact of an antidepressant plus clemastine (5.36 mg twice daily) compared to antidepressant plus placebo on white matter integrity as indexed by change in quantitative anisotropy (QA). QA has no units but is measured from 0 to 1 and a higher indicates better white matter integrity |
| Fractional Anisotropy | 12 weeks | The investigators will measure the impact of an antidepressant plus clemastine (5.36 mg twice daily) compared to antidepressant plus placebo on white matter integrity as indexed by change in fractional anisotropy (FA). FA has no units but is measured from 0 to 1 and a higher indicates better white matter integrity |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Trail Making Test Part A and Part B | 12 weeks | The investigators will examine the effectiveness of an antidepressant plus clemastine (5.36 mg twice daily) compared to antidepressant plus placebo on cognitive outcomes as indexed by Trail Making Test Parts A and B. The Trail Making Test A and B is scored by the time to completion (seconds) and number of errors, with higher scores indicating worse performance. For TMT Part A and Part B, the "average" and "deficient" scores are categorized as follows: TMT Part A 29 seconds (average) Over 79 seconds (Deficient) TMT Part B 75 seconds (average) Over 273 seconds (Deficient) |
| Orientation Dispersion Index | 12 weeks | The investigators will measure the impact of an antidepressant plus clemastine (5.36 mg twice daily) compared to antidepressant plus placebo on white matter integrity as indexed by change in neurite orientation dispersion and density imaging (NODDI)-derived orientation dispersion index (ODI). The ODI has no units but ranges from 0-1, with higher values indicating more neurite dispersion. |
| Neurite Density Index | 12 weeks | The investigators will measure the impact of an antidepressant plus clemastine (5.36 mg twice daily) compared to antidepressant plus placebo on white matter integrity as indexed by change in neurite orientation dispersion and density imaging (NODDI)-derived measured neurite density index (NDI). The NDI has no units but ranges from 0-1, with higher values indicating more intracellular diffusion |
Countries
United States
Contacts
CONTACTOlu A Ajilore, MD, PhD
Outcome results
None listed