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Effectiveness of Methylphenidate in Improving Cognition and Function in Older Adults With Depression

Primary Purpose

Depression

Status

Completed

Phase

Phase 4

Locations

United States

Study Type

Interventional

Intervention

Citalopram

Methylphenidate (MPH)

Placebo

About this trial

This is an interventional treatment trial for Depression focused on measuring Major Depression, Geriatric Major Unipolar Depression, Executive Cognitive Dysfunction, Elderly, Geriatric, Executive Cognitive Impairment, Quality of Life, Disability, Comorbidity, Medical Burden, Safety, Candidate Genes

Eligibility Criteria

60 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

Meets Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) criteria for major depressive disorder (recurrent and nonrecurrent course will be identified)
Score of 16 or higher on the 24-item Hamilton Depression Rating Scale (HDRS) at study entry
Score of 26 or higher on the Mini-Mental State Exam (MMSE)

Exclusion Criteria:

History of psychiatric illness or a substance abuse disorder other than unipolar depression, diagnosed prior to the onset of the first depressive episode
Presence of psychotic symptoms
Severe or acute medical illness (e.g., major surgery, metastatic cancer, stroke, heart attack) 6 months prior to study entry
Acute suicidal or violent behavior or history of suicide attempt within the year prior to study entry
Presence of delirium, neurodegenerative dementia, Parkinson's disease, or any other central nervous system (CNS) diseases
Toxic or metabolic abnormalities on laboratory examination
Medications taken or medical illnesses present that could account for depression
Active heart failure categorized as Class III or greater according to New York Heart Association criteria
Heart attack or crescendo angina within the 3 months prior to study entry
Symptomatic cardiac arrhythmias or symptomatic, hemodynamically significant mitral or aortic valvular disease
Resting heart rate less than 50 beats per minute and a corrected QT (QTc) interval greater than 0.45 seconds
Second or third degree atrioventricular block
Systolic blood pressure greater than 180 mmHg or less than 90 mmHg and diastolic blood pressure greater than 105 mmHg or less than 50 mmHg at study entry
Treated with depot neuroleptic therapy within 6 months prior to study entry
Treated with any neuroleptic, antidepressant, anxiolytic medication (other than lorazepam), or over-the-counter CNS-active medications used for treatment of depression (e.g, St. John's Wort, kava-kava, melatonin) within 2 weeks (4 weeks for fluoxetine or monoamine-oxidase inhibitors (MAOIs)) prior to the first administration of study medication
Known allergy to citalopram or MPH or history of ineffective treatment with citalopram or MPH for current depressive episode
Requires concomitant therapy with any prescription or over-the-counter medications that have potentially dangerous interactions with either citalopram or MPH
Requires electroconvulsive therapy (ECT) or received ECT within 3 months prior to study entry
Initiated psychotherapy within 3 months prior to study entry or will be initiating or terminating psychotherapy during the study

Sites / Locations

UCLA Semel Institute - Neuropsychiatric Institute (NPI)

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Active Comparator

Arm Label

1 - Citalopram and placebo

2 - Methylphenidate and placebo

3 - Methylphenidate and Citalopram

Arm Description

Participants will take a combination of citalopram and placebo for 16 weeks

Participants will take a combination of methylphenidate and placebo for 16 weeks

Participants will take a combination of methylphenidate and citalopram for 16 weeks

Outcomes

Primary Outcome Measures

Hamilton Depression Rating Scale (HDRS) Maintained Scores at Week 16

The Hamilton Depression Rating Scale (HDRS) is a 24-item depression scale and the total score is summed with a minimum score=0 and maximum score=76. There are no subscales and the higher values represent a worse outcome. Outcomes are measured and defined as follows: 1) Response will be defined as HDRS scores of 10 or less; 2) Sustained response will be defined as maintained response at week 16; 4) Remission will be defined as HDRS scores of 6 or less.

Secondary Outcome Measures

Quality of Life Assessment

The Quality of Life Enjoyment and Satisfaction Questionnaire - Short Form (Q-LES-Q-SF) is a 16 item self-administered questionnaire that captures life satisfaction over the past week. Each question is rated on a 5 point scale from 1 (Very Poor) to 5 (Very Good). The total score is reported for items 1-14. The minimum raw score on the Q-LES-Q-SF is 14, and the maximum score is 70 with higher values representing a better outcome.

Full Information

NCT ID

NCT00602290

First Posted

January 23, 2008

Last Updated

December 12, 2017

Sponsor

University of California, Los Angeles

Collaborators

National Institute of Mental Health (NIMH)

1. Study Identification

Unique Protocol Identification Number

NCT00602290

Brief Title

Effectiveness of Methylphenidate in Improving Cognition and Function in Older Adults With Depression

Official Title

The Use of Methylphenidate to Improve Clinical Outcomes in Geriatric Depression: A Double-blind Placebo-Controlled Trial of Methylphenidate (Ritalin) Augmentation of Citalopram (Celexa) in Depressed Elderly Patients

Study Type

Interventional

2. Study Status

Record Verification Date

December 2017

Overall Recruitment Status

Completed

Study Start Date

February 2008 (undefined)

Primary Completion Date

January 2013 (Actual)

Study Completion Date

February 2013 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title

Principal Investigator

Name of the Sponsor

University of California, Los Angeles

Collaborators

National Institute of Mental Health (NIMH)

4. Oversight

Data Monitoring Committee

Yes

5. Study Description

Brief Summary

This study will evaluate the safety and effectiveness of methylphenidate in improving cognition and function in older adults with depression.

Detailed Description

Less than 50% of older adults with depression achieve remission and functional recovery in response to first-line antidepressant treatment. Most are left with significant residual symptoms, putting them at risk for illness relapse, frailty, and suicide. Improved understanding of the neurobiology of depression in older adults and mechanisms of treatment response may lead to better clinical management of depression. Methylphenidate (MPH) has long been used in the elderly and the medically ill to provide rapid improvement in depression, apathy, and fatigue. However, its potential beneficial effects on cognitive and functional outcomes in older adults with depression have not been studied. Combining MPH with the serotonergic antidepressant citalopram may result in better clinical outcomes than would using citalopram alone. This study will compare the safety and effectiveness of MPH combined with citalopram, MPH combined with placebo, and citalopram combined with placebo in improving thinking, memory, and speed of recovery in older adults with depression. The study will also evaluate selected dopamine- and serotonin-related gene relationships with mood, cognitive symptoms, and treatment response to MPH and citalopram. Participation in this double-blind study will last 16 weeks. All potential participants will initially undergo comprehensive medical, neuropsychiatric, and cognitive assessments and genetic testing. These initial assessments will include questionnaires about depressive symptoms, a medical history, an electrocardiogram (ECG), and a blood draw for the genetic testing. Eligible participants will then be randomly assigned to one of three groups: MPH and citalopram, MPH and placebo, or citalopram and placebo. All participants will receive 16 weeks of treatment with their assigned medications. Study visits will occur weekly for the first 6 weeks of treatment and bi-weekly for the remainder of the study. During study visits, participants will undergo vital sign and weight measurements, answer questionnaires, and report any medication side effects. Blood will again be drawn at Visits 4 and 10, and the ECG will be repeated at Visit 10 if any cardiac symptoms occur. Most initial assessments will be repeated on Visit 13, the last study visit. Participants will also be contacted weekly by phone throughout the study to answer questions on how they are feeling and any possible side effects.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study

Depression

Keywords

Major Depression, Geriatric Major Unipolar Depression, Executive Cognitive Dysfunction, Elderly, Geriatric, Executive Cognitive Impairment, Quality of Life, Disability, Comorbidity, Medical Burden, Safety, Candidate Genes

7. Study Design

Primary Purpose

Treatment

Study Phase

Phase 4

Interventional Study Model

Parallel Assignment

Masking

ParticipantCare ProviderInvestigatorOutcomes Assessor

Allocation

Randomized

Enrollment

181 (Actual)

8. Arms, Groups, and Interventions

Arm Title

1 - Citalopram and placebo

Arm Type

Active Comparator

Arm Description

Participants will take a combination of citalopram and placebo for 16 weeks

Arm Title

2 - Methylphenidate and placebo

Arm Type

Active Comparator

Arm Description

Participants will take a combination of methylphenidate and placebo for 16 weeks

Arm Title

3 - Methylphenidate and Citalopram

Arm Type

Active Comparator

Arm Description

Participants will take a combination of methylphenidate and citalopram for 16 weeks

Intervention Type

Drug

Intervention Name(s)

Citalopram

Other Intervention Name(s)

Celexa

Intervention Description

Citalopram dosage will be 20 to 60 mg a day prior to FDA warning limiting it to 20-40 mg in 2011. Participants will begin taking one 20-mg capsule once per day for 4 weeks, and this dosage may be increased or decreased depending on the participant's response to the medication or side-effect profile. Participants will continue on their assigned dosage of citalopram that will be titrated up after week 4 if clinical global impressions (CGI) scores were > 2 until treatment completion.

Intervention Type

Drug

Intervention Name(s)

Methylphenidate (MPH)

Other Intervention Name(s)

Ritalin

Intervention Description

MPH dosage will be 5 to 40 mg a day. Participants will initially take 1 capsule (2.5 mg) twice per day, which will be increased to a maximum up to 8 x 2.5 mg capsules twice per day. After Visit 11, MPH dosage will be gradually reduced over 2 weeks until participants are no longer taking any capsules.

Intervention Type

Drug

Intervention Name(s)

Placebo

Intervention Description

Placebo pills will be taken in combination with the active pills. Participants will initially take 1 capsule twice per day, which will be increased to a maximum of 16 capsules twice per day matching methylphenidate, and 1-3 capsules matching citalopram. After Visit 11, placebo dosage will be gradually reduced over 2 weeks until participants are no longer taking any capsules.

Primary Outcome Measure Information:

Title

Hamilton Depression Rating Scale (HDRS) Maintained Scores at Week 16

Description

Time Frame

Maintained response measured at Week 16

Secondary Outcome Measure Information:

Title

Quality of Life Assessment

Description

Time Frame

Measured at Baseline and Week 16

10. Eligibility

Sex

All

Minimum Age & Unit of Time

60 Years

Accepts Healthy Volunteers

Eligibility Criteria

Inclusion Criteria: Meets Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) criteria for major depressive disorder (recurrent and nonrecurrent course will be identified) Score of 16 or higher on the 24-item Hamilton Depression Rating Scale (HDRS) at study entry Score of 26 or higher on the Mini-Mental State Exam (MMSE) Exclusion Criteria: History of psychiatric illness or a substance abuse disorder other than unipolar depression, diagnosed prior to the onset of the first depressive episode Presence of psychotic symptoms Severe or acute medical illness (e.g., major surgery, metastatic cancer, stroke, heart attack) 6 months prior to study entry Acute suicidal or violent behavior or history of suicide attempt within the year prior to study entry Presence of delirium, neurodegenerative dementia, Parkinson's disease, or any other central nervous system (CNS) diseases Toxic or metabolic abnormalities on laboratory examination Medications taken or medical illnesses present that could account for depression Active heart failure categorized as Class III or greater according to New York Heart Association criteria Heart attack or crescendo angina within the 3 months prior to study entry Symptomatic cardiac arrhythmias or symptomatic, hemodynamically significant mitral or aortic valvular disease Resting heart rate less than 50 beats per minute and a corrected QT (QTc) interval greater than 0.45 seconds Second or third degree atrioventricular block Systolic blood pressure greater than 180 mmHg or less than 90 mmHg and diastolic blood pressure greater than 105 mmHg or less than 50 mmHg at study entry Treated with depot neuroleptic therapy within 6 months prior to study entry Treated with any neuroleptic, antidepressant, anxiolytic medication (other than lorazepam), or over-the-counter CNS-active medications used for treatment of depression (e.g, St. John's Wort, kava-kava, melatonin) within 2 weeks (4 weeks for fluoxetine or monoamine-oxidase inhibitors (MAOIs)) prior to the first administration of study medication Known allergy to citalopram or MPH or history of ineffective treatment with citalopram or MPH for current depressive episode Requires concomitant therapy with any prescription or over-the-counter medications that have potentially dangerous interactions with either citalopram or MPH Requires electroconvulsive therapy (ECT) or received ECT within 3 months prior to study entry Initiated psychotherapy within 3 months prior to study entry or will be initiating or terminating psychotherapy during the study

Overall Study Officials:

First Name & Middle Initial & Last Name & Degree

Helen Lavretsky, MD

Organizational Affiliation

University of California, Los Angeles

Official's Role

Principal Investigator

Facility Information:

Facility Name

UCLA Semel Institute - Neuropsychiatric Institute (NPI)

City

Los Angeles

State/Province

California

ZIP/Postal Code

90095

Country

United States

12. IPD Sharing Statement

Citations:

PubMed Identifier

21857219

Citation

Schneider B, Ercoli L, Siddarth P, Lavretsky H. Vascular burden and cognitive functioning in depressed older adults. Am J Geriatr Psychiatry. 2012 Aug;20(8):673-81. doi: 10.1097/JGP.0b013e31822ccd64.

Results Reference

result

PubMed Identifier

26471432

Citation

Eyre HA, Eskin A, Nelson SF, St Cyr NM, Siddarth P, Baune BT, Lavretsky H. Genomic predictors of remission to antidepressant treatment in geriatric depression using genome-wide expression analyses: a pilot study. Int J Geriatr Psychiatry. 2016 May;31(5):510-7. doi: 10.1002/gps.4356. Epub 2015 Oct 15.

Results Reference

derived

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Effectiveness of Methylphenidate in Improving Cognition and Function in Older Adults With Depression

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