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Switching Medication and Augmentation Strategies for SSRI-Resistant Adolescent Depression(SMART-I)

Switching Medication and Augmentation Strategies for SSRI-Resistant Adolescent Depression(SMART-I): An Open-Label, Multicenter, Randomized Controlled Trial

Status
Not yet recruiting
Phases
Phase 4
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT07011693
Acronym
SMART-I
Enrollment
400
Registered
2025-06-10
Start date
2025-06-20
Completion date
2027-12-31
Last updated
2025-06-10

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Major Depressive Disorder (MDD)

Keywords

adolescent, SSRI, depression

Brief summary

This project aims to investigate the effectiveness of existing common antidepressants in adolescents with MDD who did not respond to their first treatment.

Detailed description

This project aims to investigate the effectiveness of existing common antidepressants in adolescents with MDD who did not respond to their first treatment. Adolescents ages 12 to 17, currently taking a prescribed selective serotonin reuptake inhibitor (SSRI) at least 8 weeks and still experiencing depression, participate in a 8-week randomized treatment study that includes one of three conditions: (1) switching to sertraline , (2) switching to duloxetine , (3) augmentation of their original SSRI with aripiprazole.

Interventions

DRUGSertraline

Commonly used oral antipsychotics intervention therapy.

Commonly used oral antipsychotics intervention therapy.

DRUGAripiprazole

Commonly used oral antipsychotics intervention therapy.

Sponsors

Xinyu Zhou
Lead SponsorOTHER

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)

Eligibility

Sex/Gender
ALL
Age
12 Years to 17 Years
Healthy volunteers
No

Inclusion criteria

1. Aged 12-17; 2. As assessed by K-SADS-PL, it meets the DSM-5 criteria for MDD; 3. CDRS-R≥45; 4. CGI-S≥4; 5. Failed to respond to an initial SSRI trial: the trial at least 8 weeks, with the last of which were at a dosage of at least 40 mg per day of fluoxetine or its equivalent.

Exclusion criteria

1. Current or lifetime diagnosis of bipolar disorder, schizophrenia, autism, attention-deficit/hyperactivity disorder or obsessive-compulsive disorder or psychosis not otherwise specified; 2. MDD with psychotic symptoms; 3. YMRS\>13; 4. Current or lifetime diagnosis of serious neurologic diseases such as epilepsy, brain trauma or other serious physical illnesses; 5. Failure to respond adequately to two or more antidepressant treatment trials of recommended dose and length (at least 8 weeks, with the last 4 of which were at a dosage of at least 40 mg per day of fluoxetine or its equivalent); 6. History of clear-cut intolerability of, or lack of effect with, an adequate trial of sertraline, agomelatine, or aripiprazole; 7. Current depressive episode with clear suicidal plans or behaviors; 8. Received modified electroconvulsive therapy within 3 months; 9. Taking any medicine that contraindicates in combination with or interferes with the efficacy of the treatment; 10. Substance abuse or dependence; 11. Female patients with pregnancy.

Design outcomes

Primary

MeasureTime frameDescription
response rate of Children's Depression Rating Scale (CDRS-R) scoresBaseline of treatment period, 4 weeks, 8 weeksThe primary outcomes are the treatment response rate (reduction rate of CDRS-R≥50%). The CDRS-R is a scale consisting of 17 items that are evaluated by clinicians to assess the intensity of depressive symptoms in adolescents, with items scored on scales of 1 to 5 or 1 to 7, resulting in a possible total score range of 17 to 113,higher scores mean a worse outcome.

Secondary

MeasureTime frameDescription
Change in Baker Depression Scale(BDI-II) scores from baselineBaseline of treatment period, 4 weeks, 8 weeksChange in BDI-II scores from baseline,The BDI is a self-report rating scale containing 21 items. Based on the BDI scores, depression can be classified into six levels: normal (1-10), mild mood disorder (11-16), borderline clinical depression (17-20), moderate depression (21-30), severe depression (31-40), and extreme depression (over 40).Higher scores mean a worse outcome.
Change in The Screen for Child Anxiety-Related Emotional Disorders (SCARED) scores from baselineBaseline of treatment period, 4 weeks,8 weeksThe SCARED is employed to evaluate child anxiety symptoms. Each question is rated from 0 to 2, with 0 denoting not true or hardly ever true, 1 denoting somewhat true or sometimes true, and 2 denoting extremely true or often true. The maximum total score is 63. Higher scores mean a better or worse outcome.
Change in CGI-S (Clinical Global Impressions-Severity Scales) scores from baselineBaseline of treatment period, 4 weeks, 8 weeks,Improvement in overall clinical impression severity( 7-point scale, with 1 being normal and 7 being among the most severely damaged
Adverse Event (AE) or Serious Adverse Event (SAE)Baseline of treatment period, 1 month, 2 months,Change in suicide risk from baseline on the C-SSRS (Columbia Suicide Severity Rating Scale), Adverse Event (AE) or Serious Adverse Event (SAE)

Countries

China

Contacts

Primary ContactXinyu Zhou
zhouxinyu@cqmu.edu.cn2912-89012912

Outcome results

None listed

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026