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Cost- Effectiveness and Quality of Life Assessment in Major Depression Disorder

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT02901249
Recruitment Status : Completed
First Posted : September 15, 2016
Last Update Posted : September 15, 2016
Information provided by (Responsible Party):
Ana Flávia Barros da Silva Lima, Federal University of Rio Grande do Sul

Brief Summary:

To evaluate the effectiveness of one algorithm for Major Depression Disorder (MDD) using medications available in the Brazilian Public Healthcare System (SUS), and assessment of the quality of life of these patients.

A randomized pragmatic trial was conducted. An algorithm was developed for the treatment of episodes of unipolar depression episodes.

Condition or disease Intervention/treatment Phase
Depression Drug: sertraline Drug: Nortriptyline Drug: Lithium Carbonate Phase 4

Detailed Description:

The study design was that of a pragmatic randomized clinical trial to evaluate the effectiveness of treatments for mood disorders in a public healthcare context in the city of Porto Alegre, in southern Brazil. The algorithm was originally developed for the treatment of major depression by a Delphi panel of experts from psychiatric associations in Brazil. All subjects provided an informed consent form, in writing, in order to participate in the study protocol, which was approved by the institutional ethics committee.

Procedures and measurements of the study

The subjects under evaluation were selected and they followed the stages defined by the treatment protocol:

  1. Sample selection by being referred from the primary healthcare clinics in the municipality;
  2. Informative talk about mood disorders and the research, with the informed consent forms being provided to the subjects;
  3. Screening for unipolar depression episodes with the use of the Patient Health Questionnaire (PHQ-9), and Hypomanic Symptoms Checklist Brazilian Version (HCL -32-BV);
  4. Diagnostic evaluation through the Mini International Neuropsychiatric Interview (MINI) and clinical interview for individuals with positive results in the screening instruments;
  5. Baseline and demographic assessments using standardized semi-structured interviews in the first and second visits;
  6. In each clinic visit, the severity of the symptoms were evealuated using the Clinical Global Impression Scale (CGI), Hamilton Rating Scale for Depression (HRSD), and Young Manic Rating Scale (YMRS);
  7. Biweekly follow-up, changed to monthly after stabilization - with a maximum follow-up period of 52 weeks.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 68 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Assessment of Cost- Effectiveness Interventions and the Quality of Life in Patients With Major Depression Through Resources Available in Brazilian Public Health
Study Start Date : May 2010
Actual Primary Completion Date : November 2014
Actual Study Completion Date : September 2015

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Experimental: Sertraline

Group Started: sertraline (50mg-200mg)

Subjects evaluated for responsiveness every 2 weeks. Responsive to treatment patients remain in the same step. Max. step duration of 8 weeks.

First step: Monotherapy with sertraline (50-200mg). Non responsive patients: 2nd step.

Second step: Sertraline 200mg + lithium (900mg-1500mg)

Non responsive patients: 3rd step.

Third step: Nortriptyline 100mg

Non responsive patients: 4th step.

Fourth step: Nortriptyline 100mg + lithium (900mg-1500mg)

Non responsive patients : 5th step

Fifth step : Nortriptyline 100mg + sertraline 200mg Non responsive patients

sixth step: Nortriptyline 100mg + sertraline 200mg + Lithium ( 900mg- 1500mg)

Drug: sertraline
Drug: Nortriptyline
Drug: Lithium Carbonate

Primary Outcome Measures :
  1. Response to treatment [ Time Frame: 8 weeks ]
    The main outcomes were response to treatment and remission of symptoms. Response to treatment was defined as a 50% reduction from baseline in HRSD

Secondary Outcome Measures :
  1. Remission [ Time Frame: 8 months ]
    The remission outcome was established as obtaining three consecutive scores of values considered asymptomatic (HRSD <7 points) . The subjects that were asymptomatic for at least 6-8 month were considered to be in remission, according to the criteria for partial and complete remission in the DSM-IV.

  2. Quality of life [ Time Frame: 12 weeks ]
    QOL scores as measured by World Heath Organization Quality of Life - WHOQOL -BREF instrument.

Information from the National Library of Medicine

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, Learn About Clinical Studies.

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Ages Eligible for Study:   18 Years to 65 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  1. ages between 18 and 65;
  2. current acute unipolar depression episode;
  3. total capacity to understand and respond to self-applied instruments;
  4. the presence of symptoms in the last 30 days;
  5. abstinence for at least 30 days for drug addicts

Exclusion Criteria:

  1. presence of Organic Brain Syndrome (OBS);
  2. pregnancy or lactation;
  3. criteria for psychiatric hospitalization.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT02901249

Sponsors and Collaborators
Federal University of Rio Grande do Sul
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Principal Investigator: Marcelo Fleck, PhD Federal University of Rio Grande do Sul

Publications automatically indexed to this study by Identifier (NCT Number):
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Responsible Party: Ana Flávia Barros da Silva Lima, Principal Investigator, Federal University of Rio Grande do Sul Identifier: NCT02901249    
Other Study ID Numbers: 017/2009
First Posted: September 15, 2016    Key Record Dates
Last Update Posted: September 15, 2016
Last Verified: August 2016
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No
Keywords provided by Ana Flávia Barros da Silva Lima, Federal University of Rio Grande do Sul:
Cost effectiveness
Unipolar Depression
Major Depression Disorder
Quality of life disorder
Additional relevant MeSH terms:
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Depressive Disorder
Depressive Disorder, Major
Behavioral Symptoms
Mood Disorders
Mental Disorders
Lithium Carbonate
Antidepressive Agents
Psychotropic Drugs
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Antimanic Agents
Tranquilizing Agents
Central Nervous System Depressants
Physiological Effects of Drugs
Serotonin Uptake Inhibitors
Neurotransmitter Uptake Inhibitors
Membrane Transport Modulators
Neurotransmitter Agents
Serotonin Agents
Antidepressive Agents, Tricyclic
Adrenergic Uptake Inhibitors
Adrenergic Agents