Augmentation of the Antidepressant Action of Sertraline With Triiodothyronine (T3)and Reboxetine: Clinical Efficacy, Adverse Effects and Predictors of Response.
Information source: Hadassah Medical Organization
ClinicalTrials.gov processed this data on August 23, 2015 Link to the current ClinicalTrials.gov record.
Condition(s) targeted: Major Depressive Disorder
Intervention: sertraline (Drug); triiodothyronine (T3) (Drug); reboxetine (Drug)
Phase: N/A
Status: Completed
Sponsored by: Hadassah Medical Organization Official(s) and/or principal investigator(s): Rena Cooper-Kazaz, MD, Principal Investigator, Affiliation: Hadassah Medical Organization
Summary
In this project we aim to further refine indications for the use of the thyroid hormone - T3
for patients suffering from depression. We aim to identify a sub-group of patients who are
more likely to respond to T3 and establish the time in the treatment course when T3 should
be added. The results of this project could have significant, direct clinical implications.
Clinical Details
Official title: Augmentation of the Antidepressant Action of Sertraline With Triiodothyronine (T3)and Reboxetine: Clinical Efficacy, Adverse Effects and Predictors of Response.
Study design: Allocation: Non-Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
Primary outcome: treatment outcome defined categorically as Remission: A Hamilton Depression Scale (HAM-D) less or equal to 6.
Secondary outcome: RESPONSE: Based on Hamilton Depression Scale (HAM-D)reduction of >50% from baseline to endpoint..REMISSION: Based on the other rating scales applied in this project. RESPONSE: Based on the other rating scales applied in this project.
Detailed description:
The lifetime risk for major depressive disorder (MDD) is 15% in the general population.
Current treatment approaches emphasize the achievement of remission. Remission implies
virtual absence of depressive symptoms and is associated with better function and a better
overall prognosis than response, which is usually defined as a 50% reduction in symptom
severity. Sixty percent or more of patients treated optimally with antidepressants remain
un-remitted and will need additional treatment. A potentially effective but under-exploited
strategy to augment antidepressant effects is concurrent administration of the thyroid
hormone, triiodothyronine (T3). We previously demonstrated the clinical efficacy and safety
of T3 administered concurrently with the SSRI, sertraline, in the context of a randomized,
double-blind placebo-controlled trial. Although all the patients were euthyroid, remission
rates were significantly higher in the sertraline plus T3 group and were associated with
significantly lower baseline T3 values and a significant decrease in serum thyroid
stimulating hormone (TSH) values during the course of treatment.
The study aims to:
- Delineate a sub-population of depressed patients treated with sertraline, who are more
likely to respond to T3 augmentation on the basis of thyroid function and genetic
variation in thyroid pathway genes.
- Investigate the appropriate timing for the addition of T3.
- Assess the efficacy of reboxetine, a specific noradrenaline reuptake inhibitor, as a
further supplement to the treatment of un-remitted patients. The results of this study
could have a significant, direct clinical impact on the pharmacological treatment of
MDD.
Eligibility
Minimum age: 18 Years.
Maximum age: 70 Years.
Gender(s): Both.
Criteria:
Inclusion Criteria:
1. Diagnosis of Major Depressive Episode (MDE) in the context MDD according to DSM-IV
criteria, without psychotic features.
2. Hamilton Depression Scale (21 items, HAM-D) total >16 with item 1 (depressed mood)
>2.
3. Age 18-70 years.
4. Male or female.
5. Competent and willing to give written informed consent.
Exclusion Criteria:
1. Clinical hyper- or hypothyroidism or any other thyroid illness.
2. Neurological or other medical illness that may impact upon the study or limit
prescription of the study medications.
3. Significant suicidal risk [HAM-D item 3 (suicide) >2].
4. Comorbidity with any Psychotic Disorder, Bipolar Disorder, Post Traumatic Stress
Disorder (PTSD), Eating Disorder.
5. Lifetime history of substance or alcohol dependence or of abuse in the preceding 12
months.
6. Treatment with the antidepressant, sertraline, in current episode.
7. More then one antidepressant trial or any augmentation treatment during current
episode.
8. Length of current episode >12 months
9. Female subjects pregnant or lactating or not using adequate contraception.
Locations and Contacts
Hadassah Medical Organization, Jerusalem, Israel
Additional Information
Starting date: September 2007
Last updated: March 21, 2013
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