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Treatment Study of Bipolar Depression

Primary Purpose

Bipolar Disorder

Status
Terminated
Phase
Phase 4
Locations
United States
Study Type
Interventional
Intervention
ketamine
midazolam
Sponsored by
Icahn School of Medicine at Mount Sinai
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Bipolar Disorder focused on measuring Bipolar Disorder, Depression, Treatment-Resistant, ketamine, antidepressant, glutamate

Eligibility Criteria

21 Years - 70 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Male or female patients, 21-70 years;
  2. Primary diagnosis of bipolar I or II disorder as assessed by the SCID-P and confirmed by a study psychiatrist;
  3. Current depressive episode ≥ 8 weeks duration;
  4. History of a failure to respond to at least three (3) adequate pharmacotherapy trials in the current depressive episode (see above for definition for adequate trials);
  5. Subjects must be on a stable dose of divalproex ER with serum levels greater than 55 mcg/ml prior to enrollment;
  6. Subjects must be free of psychotropic medication for at least 2 weeks (4 weeks for fluoxetine) prior to enrollment (with the exception of divalproex ER as above);
  7. Subjects must have scored ≥ 32 on the IDS-C30 at both Screening and Infusion Day #1 and #2;

Exclusion Criteria:

  1. Women who plan to become pregnant, are pregnant or are breast-feeding;
  2. Any unstable medical illness including hepatic, renal, gastroenterologic, respiratory, cardiovascular, endocrinologic, neurologic, immunologic, or hematologic disease;
  3. Clinically significant abnormal findings of laboratory parameters, physical examination, or ECG;
  4. Lifetime history of schizophrenia, schizoaffective disorder, OCD, mental retardation, pervasive developmental disorders, or Tourette's syndrome;
  5. Current presence of psychotic, mixed or manic symptoms;
  6. Lifetime history of antidepressant-induced switch to a manic episode;
  7. History of rapid cycling bipolar subtype;
  8. Drug or alcohol abuse within the preceding 3 months or dependence within the preceding 5 years;
  9. Lifetime exposure to ketamine or phencyclidine;
  10. Patients judged by study investigator to be at high risk for suicide.

Sites / Locations

  • Mount Sinai School of Medicine

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Ketamine/Midazolam

Midazolam/Ketamine

Arm Description

Patients receive both treatment conditions (ketamine and midazolam) in a single arm, crossover design. Patients are randomized to ketamine-midazolam. Each treatment occurs as a single intravenous infusion on one treatment day. The two treatment conditions occur 2 weeks apart.

Patients receive both treatment conditions (ketamine and midazolam) in a single arm, crossover design. Patients are randomized to midazolam-ketamine. Each treatment occurs as a single intravenous infusion on one treatment day. The two treatment conditions occur 2 weeks apart.

Outcomes

Primary Outcome Measures

Montgomery-Asberg Depression Rating Scale (MADRS)

Secondary Outcome Measures

Quick Inventory of Depressive Symptomatology, Self Report (QIDS-SR)
Young Mania Rating Scale (YMRS)
Brief Psychiatric Rating Scale (BPRS)
Clinician-Administered Dissociative States Scale (CADSS)
Systematic Assessment for Treatment Emergent Effects (SAFTEE)

Full Information

First Posted
July 27, 2009
Last Updated
April 11, 2017
Sponsor
Icahn School of Medicine at Mount Sinai
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1. Study Identification

Unique Protocol Identification Number
NCT00947791
Brief Title
Treatment Study of Bipolar Depression
Official Title
Intravenous Ketamine in Treatment-Resistant Bipolar Depression
Study Type
Interventional

2. Study Status

Record Verification Date
April 2017
Overall Recruitment Status
Terminated
Why Stopped
Change in available resources for study procedures
Study Start Date
July 2009 (undefined)
Primary Completion Date
October 2009 (Actual)
Study Completion Date
October 2009 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Icahn School of Medicine at Mount Sinai

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to determine whether a single intravenous administration of an N-methyl-D-aspartate antagonist is safe and effective for the acute treatment of bipolar depression.
Detailed Description
Bipolar disorder (BPD) is a common, recurrent, and disabling medical condition. Although mania is the defining feature of BPD, depression represents the majority of illness burden in patients with this devastating condition. Despite the high degree of morbidity and mortality associated with bipolar depression, currently available treatments are few and often inadequate. Recently, a single intravenous (IV) dose of the N-methyl-D-aspartate (NMDA) glutamate receptor antagonist ketamine has demonstrated rapid antidepressant effects in severe unipolar depression. Therefore, the objective of the current study is to investigate the safety and efficacy of a single IV dose of ketamine in treatment-resistant bipolar depression (TRBD).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Bipolar Disorder
Keywords
Bipolar Disorder, Depression, Treatment-Resistant, ketamine, antidepressant, glutamate

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Crossover Assignment
Masking
ParticipantInvestigator
Masking Description
Patient, doctor and rater are masked (triple masked). Only the research pharmacist is unblinded.
Allocation
Randomized
Enrollment
1 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Ketamine/Midazolam
Arm Type
Experimental
Arm Description
Patients receive both treatment conditions (ketamine and midazolam) in a single arm, crossover design. Patients are randomized to ketamine-midazolam. Each treatment occurs as a single intravenous infusion on one treatment day. The two treatment conditions occur 2 weeks apart.
Arm Title
Midazolam/Ketamine
Arm Type
Experimental
Arm Description
Patients receive both treatment conditions (ketamine and midazolam) in a single arm, crossover design. Patients are randomized to midazolam-ketamine. Each treatment occurs as a single intravenous infusion on one treatment day. The two treatment conditions occur 2 weeks apart.
Intervention Type
Drug
Intervention Name(s)
ketamine
Intervention Description
a single IV infusion of ketamine, IV 0.5 mg/kg
Intervention Type
Drug
Intervention Name(s)
midazolam
Intervention Description
a single IV infusion of midazolam, 0.045 mg/kg
Primary Outcome Measure Information:
Title
Montgomery-Asberg Depression Rating Scale (MADRS)
Time Frame
24 hrs post-infusion compared to baseline
Secondary Outcome Measure Information:
Title
Quick Inventory of Depressive Symptomatology, Self Report (QIDS-SR)
Time Frame
24 hrs post-infusion compared to baseline
Title
Young Mania Rating Scale (YMRS)
Time Frame
24 hrs post-infusion compared to baseline
Title
Brief Psychiatric Rating Scale (BPRS)
Time Frame
4 hrs post-infusion compared to baseline
Title
Clinician-Administered Dissociative States Scale (CADSS)
Time Frame
4 hrs post-infusion compared to baseline
Title
Systematic Assessment for Treatment Emergent Effects (SAFTEE)
Time Frame
4 hrs post-infusion compared to baseline

10. Eligibility

Sex
All
Minimum Age & Unit of Time
21 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male or female patients, 21-70 years; Primary diagnosis of bipolar I or II disorder as assessed by the SCID-P and confirmed by a study psychiatrist; Current depressive episode ≥ 8 weeks duration; History of a failure to respond to at least three (3) adequate pharmacotherapy trials in the current depressive episode (see above for definition for adequate trials); Subjects must be on a stable dose of divalproex ER with serum levels greater than 55 mcg/ml prior to enrollment; Subjects must be free of psychotropic medication for at least 2 weeks (4 weeks for fluoxetine) prior to enrollment (with the exception of divalproex ER as above); Subjects must have scored ≥ 32 on the IDS-C30 at both Screening and Infusion Day #1 and #2; Exclusion Criteria: Women who plan to become pregnant, are pregnant or are breast-feeding; Any unstable medical illness including hepatic, renal, gastroenterologic, respiratory, cardiovascular, endocrinologic, neurologic, immunologic, or hematologic disease; Clinically significant abnormal findings of laboratory parameters, physical examination, or ECG; Lifetime history of schizophrenia, schizoaffective disorder, OCD, mental retardation, pervasive developmental disorders, or Tourette's syndrome; Current presence of psychotic, mixed or manic symptoms; Lifetime history of antidepressant-induced switch to a manic episode; History of rapid cycling bipolar subtype; Drug or alcohol abuse within the preceding 3 months or dependence within the preceding 5 years; Lifetime exposure to ketamine or phencyclidine; Patients judged by study investigator to be at high risk for suicide.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
James W Murrough, MD
Organizational Affiliation
Icahn School of Medicine at Mount Sinai
Official's Role
Principal Investigator
Facility Information:
Facility Name
Mount Sinai School of Medicine
City
New York
State/Province
New York
ZIP/Postal Code
10029
Country
United States

12. IPD Sharing Statement

Learn more about this trial

Treatment Study of Bipolar Depression

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