The Effects of Bupropion on Residual and Cognitive Symptoms in SSRI-treated Depression
Many people with depression are treated with a serotonin-specific reuptake inhibitor anti-depressant (SSRI) and feel 'better'. Although many people feel 'better', they do not feel completely 'well'. Often, individuals continue to complain of cognitive problems such as lack of attention, diminished motivation, and impaired problem-solving. This study looks at whether residual and cognitive symptoms of depression in individuals are affected by the addition of bupropion.
Major Depressive Disorder
|Study Design:||Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Crossover Assignment
Masking: Double Blind (Subject, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
|Official Title:||The Effects of Bupropion on Residual and Cognitive Symptoms in SSRI-treated Depression|
- Montgomery-Asberg Depression Rating Scale (MADRS) overall and question-specific scores [ Time Frame: 8 weeks ] [ Designated as safety issue: No ]
- neuropsychiatric assessment changes [ Time Frame: 8 weeks ] [ Designated as safety issue: No ]
- symptom self-report [ Time Frame: 8 weeks ] [ Designated as safety issue: No ]
- hyperactivity measures [ Time Frame: 8 weeks ] [ Designated as safety issue: No ]
|Study Start Date:||August 2005|
|Study Completion Date:||December 2011|
|Primary Completion Date:||January 2010 (Final data collection date for primary outcome measure)|
As many as 65-75% of treated patients continue to experience residual symptoms of depression. Cognitive impairments feature frontal cognitive dysfunction. Many experts believe that executive functions are better predictors of functional level than psychiatric diagnoses.
Frontal cognitive impairment and changes in neuroimaging are seen in individuals depleted of tryptophan, a serotonin precursor. These cognitive changes do not improve following serotonin-specific reuptake inhibitor treatment and at least one study has found that executive dysfunction predicts non-response to fluoxetine. In many patients, remission of mood symptoms in depression requires medications to target non-serotonergic neurotransmitter systems. Brain areas mediating executive functions receive rich noradrenergic inputs, and norepinephrine is known to be intimately involved in many of the executive functions.
A better understanding of serotonergic and catecholaminergic interactions would enable evidence-based treatment of depression which maximizes executive cognitive functions. This study examines the hypothesis that individuals treated with bupropion will have higher scores on tests of executive functions and lower scores on depression indices.
|United States, Massachusetts|
|Belmont, Massachusetts, United States, 02478|
|Principal Investigator:||Beth L Murphy, MD, PhD||Mclean Hospital|