Effectiveness of Nimodipine Plus Antidepressant Medication in Treating Vascular Depression

This study has been completed.
Sponsor:
Collaborator:
Information provided by (Responsible Party):
University of Pittsburgh
ClinicalTrials.gov Identifier:
NCT00781326
First received: October 27, 2008
Last updated: June 26, 2014
Last verified: June 2014
  Purpose

This study will examine whether combined use of an antidepressant medication and the medication nimodipine reduces risk of depression relapse in patients with vascular depression.


Condition Intervention Phase
Depression
Drug: Nimodipine
Drug: Placebo
Phase 4

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Treatment of Depression Occurring in the Setting of Cerebrovascular Risk -- A Pilot Study

Resource links provided by NLM:


Further study details as provided by University of Pittsburgh:

Primary Outcome Measures:
  • Nimodipine-related side effects [ Time Frame: Measured at Week 32 of Phase 2 ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • Hamilton Depression Rating Scale [ Time Frame: Measured at Week 32 of Phase 2 ] [ Designated as safety issue: No ]
  • Cognitive function, composite score [ Time Frame: Measured at Week 16 and Week 32 of Phase 2 ] [ Designated as safety issue: No ]

Enrollment: 9
Study Start Date: August 2008
Study Completion Date: February 2012
Primary Completion Date: February 2012 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: 1
In Phase 1, participants will be placed on antidepressant medication. In Phase 2, participants will continue with their antidepressant medication and also receive nimodipine.
Drug: Nimodipine
Nimodipine will be initiated at one, 30-mg tablet three times a day for 1 week, increased to 2 tablets three times a day for 1 week, and then increased to three tablets three times a day for the remaining 30 weeks of the study. Participants who cannot tolerate the maximum dose of 270 mg/day will be maintained at the highest tolerable dose.
Other Name: Nimotop
Placebo Comparator: 2
In Phase 1, participants will be placed on antidepressant medication. In Phase 2, participants will continue with their antidepressant medication and also receive a placebo.
Drug: Placebo
Placebo will be given in doses matching those of nimodipine.

Detailed Description:

Depressed elderly patients often show signs of cerebrovascular disease, commonly known as a stroke. Some scientists theorize that having cerebrovascular disease may affect depression in older adults in one of three ways: by causing depression, by making it more likely that people who have been depressed have a relapse, or by maintaining certain depressive symptoms in those already depressed. The combination of depression and cerebrovascular disease in older adults is referred to as vascular depression and is associated with psychomotor slowing, functional impairment, and cognitive impairment. Additionally, the likelihood of improvement or remission is lower in vascular depression and is more difficult to treat over time.

Nimodipine (NIM) is FDA approved to reduce incidence and severity of problems with blood flow resulting from a particular type of stroke. In addition to improving blood flow in the brain following a stroke, NIM also protects neurons from injury or degeneration and has cognitive and functional benefits. These positive effects of NIM may make it useful for treatment of vascular depression. In a previous study of people with vascular depression, pairing NIM with the antidepressant fluoxetine showed greater improvements in depression treatment outcomes, higher likelihood of full remission, and less incidence of depression recurrence than using fluoxetine alone. This study will examine whether pairing NIM with other antidepressants will reduce recurrence of vascular depression.

Participation in this study will last 56 weeks and will be divided into two phases. Before the first phase, participants will undergo a 2-hour psychiatric evaluation and a 1.5-hour medical examination that will involve a physical examination, blood test, electrocardiogram (EKG), and urine analysis. In the first phase, participants will receive antidepressant medication without NIM. Participants will begin taking escitalopram but may be switched to duloxetine or have lorazepam added to their regimen, depending on individual treatment effectiveness and side effects. The first phase will last between 6 and 24 weeks, ending when the individual participant either responds to medication or experiences 24 weeks of nonresponse. During the first phase, participants will attend weekly study visits, during which researchers will assess medication effectiveness and monitor side effects.

Before the second phase, participants will undergo a half-hour medical examination and a 1.5-hour test of cognitive and physical abilities. At the beginning of the second phase, participants will be randomly assigned to receive either NIM or a placebo in addition to continuing with the antidepressant medication already helping them. Participants will take NIM or the placebo for 8 months, undergoing weekly study visits for the first month and monthly study visits for the last 7 months. During these visits, researchers will monitor the participants' health and reactions to their medications. After 4, 16, and 32 weeks, an EKG test will be performed, and after 16 and 32 weeks, cognitive and physical tests will be performed again. After the 8 months, participants will attend three weekly study visits while their use of medication is lowered and then ended.

For information on a related study, please follow this link:

http://clinicaltrials.gov/show/NCT00177424

  Eligibility

Ages Eligible for Study:   50 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Current DSM-IV diagnosis of major depression
  • Score greater than 15 on the 24-item Hamilton Depression Rating Scale (HDRS24)
  • Significant cerebrovascular disease risk factors, as defined by the presence of more than three of the following:

    1. Arterial hypertension, defined by a systolic blood pressure higher than 140 mm Hg or a diastolic blood pressure higher than 90 mm Hg, or by both a self-reported hypertension diagnosis and use of antihypertensive medication
    2. Diabetes mellitus, defined by a fasting blood glucose level higher than 126 mg/dl or treatment with hypoglycemic agents or insulin in the year before study entry
    3. Obesity, defined by a current body mass index (BMI) greater than 30
    4. Hyperlipidemia, defined by either a confirmed prior diagnosis or a current fasting cholesterol level higher than 200 mg/dl
    5. Current smoker
  • Able to swallow oral medication
  • Identification of a family member or friend willing and able to participate as a source of corroborating information
  • Able to speak English
  • A hearing capacity adequate to respond to a raised conversational voice

Exclusion Criteria:

  • Current diagnosis of major depression with psychosis, schizophrenia, bipolar disorder, schizophreniform disorder, schizoaffective disorder, schizotypal disorder, or obsessive compulsive disorder
  • Meets DSM-IV criteria for dementia or has a score of 17 or lower on the Mini Mental State Examination
  • Met DSM-IV criteria for drug or alcohol dependence within the past 6 months
  • Not responsive to therapeutic trials of either escitalopram or duloxetine for the current major depressive episode
  • Acute, severe, or unstable medical disorder likely to interfere with treatment, such as untreated thyroid disorder
  • History of epilepsy
  • Clinically reported stroke within the past year
  • First-degree heart block, determined after correcting for age
  • Symptomatic hypotension or symptomatic orthostatic hypotension
  • History of nontolerance or allergy to both escitalopram and duloxetine therapy, including history of selective serotonin reuptake inhibitor (SSRI)-related syndrome of inappropriate anti-diuretic hormone secretion (SIADH)
  • Significant allergy to NIM or other ingredients contained in the study medication
  • Taken monoamine oxidase inhibitors (MAOIs) within the 2 weeks prior to the first administration of double-blind study medication
  • Requires treatment with amiodarone, protease inhibitors, dalfopristin or quinupristin, valproic acid, triazole antifungal agents (e.g., itraconazole), reserpine, methyldopa, guanethidine, or clonidine during the course of the study
  • May require drugs known to interact with NIM during the course of the study
  • Refusal to allow the research team to contact participant's primary medical provider
  • Planning to become pregnant during the course of the study
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00781326

Locations
United States, Pennsylvania
University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania, United States, 15213
Sponsors and Collaborators
University of Pittsburgh
Investigators
Principal Investigator: Ellen M. Whyte, MD University of Pittsburgh
  More Information

Publications:

Responsible Party: University of Pittsburgh
ClinicalTrials.gov Identifier: NCT00781326     History of Changes
Other Study ID Numbers: K23 MH067710-01, K23MH067710-01, DATR AK-TNGP1
Study First Received: October 27, 2008
Last Updated: June 26, 2014
Health Authority: United States: Federal Government

Keywords provided by University of Pittsburgh:
Depressive Disorder, Major
Cerebrovascular Disorders
Risk Factors
Nimodipine

Additional relevant MeSH terms:
Depression
Depressive Disorder
Behavioral Symptoms
Mental Disorders
Mood Disorders
Antidepressive Agents
Nimodipine
Antihypertensive Agents
Calcium Channel Blockers
Cardiovascular Agents
Central Nervous System Agents
Membrane Transport Modulators
Molecular Mechanisms of Pharmacological Action
Pharmacologic Actions
Psychotropic Drugs
Therapeutic Uses
Vasodilator Agents

ClinicalTrials.gov processed this record on October 30, 2014