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Microbiome of Depression & Treatment Response to Citalopram

Information source: Mayo Clinic
ClinicalTrials.gov processed this data on August 23, 2015
Link to the current ClinicalTrials.gov record.

Condition(s) targeted: Major Depressive Disorder

Intervention: citalopram (Drug)

Phase: N/A

Status: Recruiting

Sponsored by: Mayo Clinic

Official(s) and/or principal investigator(s):
Mark Frye, MD, Principal Investigator, Affiliation: Mayo Clinic

Overall contact:
Deanna Hofschulte, Phone: 507-255-2972, Email: hofschulte.deanna@mayo.edu


The purpose of this study is to evaluate the feasibility of developing a microbiome probe of depression and to evaluate the microbiome change in a preliminary analysis of treatment response (n=20) vs. non response (n=20) to the antidepressant citalopram. This study is a 12 week open trial that will enroll approximately 80 participants (anticipated 40 study completers with paired biomarker data) with an episode of major depression and 40 age- and sex-matched healthy controls.

Clinical Details

Official title: Microbiome of Depression &Amp; Treatment Response to Citalopram: A Feasibility Study

Study design: Observational Model: Case Control, Time Perspective: Prospective

Primary outcome: The potential differences in the microbiome between depressed patients and healthy controls

Secondary outcome:

Microbiome change in treatment response vs. non-response to citalopram

Inflammatory markers of depression and their relationship to the microbiome

Detailed description: The study will be conducted at Mayo Clinic Jacksonville Department of Psychiatry (recruit up to 10 patients and 10 controls with paired data) and Mayo Clinic Depression Center in Rochester (recruit up to 30 patients and 30 controls with paired data). Patients with major depression confirmed by structured diagnostic interview (SCID) and moderate symptom severity (Quick Inventory of Depressive Symptomatology or S-C16) will be enrolled in the 12 week study. We will explore the gut microbiome (and its genetic material) and gut-brain markers of inflammation (cortisol, cytokines) from stool specimens and serum samples, respectively. Collections will be at baseline, week 2, and week 12 of the study. Healthy controls matched for age, sex (including menopausal status of female subjects), and body-mass index (BMI) will have only baseline stool and serum collections. Statistical t-tests will be used to assess baseline differences between patient and controls in microbiome and inflammatory markers. Treatment response (50% reduction in QIDS), treatment remission (QIDS-C16 < 6) will be analyzed with change in microbiome and inflammation markers. Correlational analysis with multiple testing corrections will be conducted between depression symptom severity and measures of cortisol, cytokines, and gut microbiome composition. This study will focus on early translation of Dr. Fryer and Dr. Chia's research and will bring the gut-brain interface to the field of individualizing treatment to patients who struggle with depression. This project will provide insight into how gut microbiota may be implicated in depression, how antidepressant treatments alter microbiota composition, and how these factors impact key physiologic mediators of depression (i. e. cortisol and cytokine levels). The public health implications of more focused drug development and treatment for depression are substantial.


Minimum age: 18 Years. Maximum age: 55 Years. Gender(s): Both.


Inclusion Criteria:

- Outpatients or inpatients with nonpsychotic major depressive disorder (MDD).

- A score of >16 on the QIDS

- Outpatients or inpatients for whom antidepressant treatment is deemed appropriate by

the treating clinician

- Subjects who are between 18-55 years of age

Exclusion Criteria:

- Contraindications to citalopram treatment

- Axis I or II disorder other than depression that is the primary reason for seeking

treatment intervention and/or psychiatric care

- For healthy controls, a first degree relative who has been diagnosed with an Axis I


- Patients with schizophrenia, schizoaffective disorder, or bipolar I disorder

- Antidepressant treatment within 4 days of study (1 week if fluoxetine). Subjects

currently on antidepressant medication with subtherapeutic results in terms of depression management after providing informed consent, will undergo a medication taper and discontinuation prior to initiation of citalopram treatment. The subject must be off of previous antidepressants for at least 4 days week prior to starting citalopram (1 week if fluoxetine). The subject will be closely monitored by the research study psychiatrist (with or without additional monitoring from primary clinical psychiatric providers). The medication taper is left up to the research study psychiatrist in consultation with patient's primary care or psychiatric provider. Study subjects who cannot be safely tapered from their medication or experience adverse effects during the taper will be excluded from the study

- Study subjects using their antidepressant medication for management of nicotine

dependence, chronic pain, migraine prophylaxis, or other diagnoses will not be eligible for the study

- Subjects currently on antipsychotic medications (i. e., typical or atypical

antipsychotic drugs) and mood stabilizing(e. g., lithium, carbamazepine, valproate, lamotrigine, gabapentin, or other anticonvulsants) are not eligible for the study. Trazodone, melatonin, and diphenhydramine may be used as rescue medications for insomnia. Benzodiazepines may be used for treatment of anxiety, not to exceed 4 mg/24 hour of lorazepam

- Subjects who are currently on an antibiotic or an antibiotic within 2 weeks. (Topical

antibiotics are OK)

- Daily use of aspirin, NSAID's or Warfarin (low dose of baby aspirin OK)

- Subjects unable to give informed consent are excluded

- Pregnant subjects will be excluded

- Subjects who are currently breastfeeding and who plan to continue breastfeeding will

be excluded

- Postmenopausal women are not eligible for this study

Locations and Contacts

Deanna Hofschulte, Phone: 507-255-2972, Email: hofschulte.deanna@mayo.edu

Mayo Clinic in Florida, Jacksonville, Florida 32224, United States; Recruiting

Mayo Clinic in Rochester, Rochester, Minnesota 55905, United States; Recruiting

Additional Information

Starting date: December 2014
Last updated: May 14, 2015

Page last updated: August 23, 2015

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