Improving Therapeutic Learning in Depression: Proof of Concept
Primary Purpose
Major Depressive Disorder
Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
250 mg DCS
100 mg Modafinil
Placebo
Sponsored by
About this trial
This is an interventional treatment trial for Major Depressive Disorder focused on measuring Cognitive behavior therapy (CBT), d-cycloserine (DCS), Modafinil
Eligibility Criteria
Inclusion Criteria:
- Must have a DSM diagnosis of major depression as determined by structured diagnostic interview
- Must be free of psychotropic medications other than serotonin selective reuptake inhibitors (SSRIs) for at least 2 weeks
- No current suicidal ideation
- Able to speak and understand English
- Must be between the ages of 18 and 65, inclusive
- Must be a male, or a female who is not of childbearing potential (i.e., surgically sterile, postmenopausal for at least 1 year) or who is non-pregnant, non-lactating and using a medically accepted method of contraception. Acceptable methods of contraception include condoms (male or female) with or without a spermicidal agent, diaphragm or cervical cap with spermicide, medically prescribed IUD, hormonal contraceptives. A woman of childbearing potential who is not currently sexually active must agree to use a medically accepted method of contraception should she become sexually active while participating in the trial
Exclusion Criteria:
- A DSM diagnosis of dementia, neurodegenerative disease, or other organic mental disorder; substance use disorder other than nicotine or caffeine in the last 3 months; bulimia or anorexia within the last 3 months; lifetime history of psychotic disorder or, bipolar disorder, or developmental disorder;
- A diagnosis of organic brain syndrome, mental retardation, or other cognitive dysfunction that could interfere with a participants capacity to participate in CBT or to complete safety and efficacy assessments
- A history of seizures (apart from childhood febrile seizures) or head trauma causing ongoing cognitive impairment
- An uncontrolled, unstable clinically significant medical condition (e.g., renal, endocrine, hepatic, respiratory, cardiovascular, hematologic, immunologic or cerebrovascular disease, or malignancy, or poorly controlled hypertension (> 150/90mmHg) that may interfere with the interpretation of safety and efficacy evaluations in the opinion of the study physician or investigator
- Medical illness including hypertension, cardiac disease, liver disease, pulmonary diseases, central nervous system disease, and epilepsy;
- Recent (1 year) suicidal attempts or current suicidal ideation
- For women, currently pregnant, plans to be pregnant in the next 2 months, or currently breastfeeding
- Treatment with phenytoin, isoniazid, or propranolol or known sensitivity to modafinil or cycloserine
- A history of head trauma causing loss of consciousness, seizure or ongoing cognitive impairment
- Use of psychotropic medication (including stimulants) other than SSRIs
- Current daily use of alcohol or regular binge alcohol use as determined on the medical screen
- Insufficient command of the English language (i.e., cannot carry on a conversation with an interviewer in the English language or read associated text)
- Receipt of CBT in the previous five years
Sites / Locations
- Boston University
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm Type
Active Comparator
Active Comparator
Placebo Comparator
Arm Label
250 mg DCS
100 mg modafinil
Placebo
Arm Description
Baseline assessment (week 1), two weekly sessions when 250mg DCS is administered, and final week (week 4) when retention is assessed.
Baseline assessment (week 1), two weekly sessions when 100 mg modafinil is administered, and final week (week 4) when retention is assessed.
Baseline assessment (week 1), two weekly sessions when placebo is administered, and final week (week 4) when retention is assessed.
Outcomes
Primary Outcome Measures
Recall of Cognitive Therapy Content
A modified Cognitive Therapy Awareness Scale (CTAS) was used to assess delayed memory for cognitive therapy content from the computerized CBT. Higher scores indicate better memory for CBT skills. Scores range from 0 to 40.
1 Week Delayed Recall of Emotional Story Items
1 Week Delayed Recall of a Threat-Related Story. Scores can range from 0 to 74, with higher scores reflect greater memory for story items.
1 Week Delayed Recall Logical Memory
Higher scores reflect greater recall of Wechsler Memory Scale (WMS) Story B content assessed one week after last rehearsal. Possible scores range from 0 to 25.
Secondary Outcome Measures
Logical Memory Immediate Recall
Immediate Story Recall from the Wechsler Memory Scale Story B. Higher scores reflect greater recall of the story material from the previous week. Possible scores range from 0 to 25.
Immediate Memory Measured by the Hopkins Verbal Learning Task
The Hopkins Verbal Learning Test (HVLT) consists of a 12-item word list, composed of four words from each of the three semantic categories. The patient's free recall of the list is recorded. The same procedure is repeated for two more trials. The total recall score for the third trial was used as the recorded score and ranged from a minimum of zero to a maximum of 12 correct answers.
Immediate Recall of Emotional Story Items
Immediate recall score of items from the Emotional Story presentation. Scores can range from 0 to 74, with higher scores reflect greater memory for story items.
Skills of Cognitive Therapy
This measure assesses the self-reported use of skills from cognitive therapy. Scores can range from 8 to 40, and higher scores indicate greater use.
Digits Backward
The examiner reads a list of digits and asks that each digit be read backwards. The score is the total number of trials completed correctly; scores range from 0 to 16. Higher scores indicate better performance.
Full Information
NCT ID
NCT02376257
First Posted
July 11, 2014
Last Updated
August 22, 2018
Sponsor
Boston University Charles River Campus
1. Study Identification
Unique Protocol Identification Number
NCT02376257
Brief Title
Improving Therapeutic Learning in Depression: Proof of Concept
Official Title
Improving Therapeutic Learning in Depression: Proof of Concept
Study Type
Interventional
2. Study Status
Record Verification Date
August 2018
Overall Recruitment Status
Completed
Study Start Date
September 16, 2014 (Actual)
Primary Completion Date
April 21, 2017 (Actual)
Study Completion Date
May 2017 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Boston University Charles River Campus
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
Despite advances in both pharmacotherapy and psychotherapy for major depression, non-response and partial-response remain relatively common outcomes, motivating the search for new treatments. This study is concerned with the development of one such novel treatment, the augmentation of exposure-based cognitive-behavior therapy (CBT) with d-cycloserine (DCS).
Detailed Description
Investigators will study the efficacy of DCS for augmenting therapeutic learning relevant for the treatment of depression (i.e., outside the extinction learning where DCS has been shown to have success). Specifically, the study investigates the role of DCS in enhancing declarative memory in depressed individuals, as evaluated by standardized tests and the retention of cognitive therapy session material. Investigators will also study an active comparison agent, modafinil, which appears to offer cognitive enhancing effects among both sleep-deprived and non-sleep-deprived individuals, but also appears to have drug-state (e.g., mood and side) effects that are not characteristic of DCS augmentation. Therefore, drug-context effects may affect memory retention over time. Hence, the study will evaluate memory enhancement effects both during the period of drug action as well as one week later when no drug is taken. Overall, investigators will examine cognitive function and memory performance over 4 study sessions in 96 men and women with major depression, who, in a double-blind fashion, will be randomly assigned to either: (1) 250mg DCS, (2) 100mg modafinil, or (3) placebo administered on Study Weeks 2 and 3. The memory tests include both items unique to a given study week and memory tasks that are repeated over time that allow assessment of memory and retention effects across one-week periods.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Major Depressive Disorder
Keywords
Cognitive behavior therapy (CBT), d-cycloserine (DCS), Modafinil
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
36 (Actual)
8. Arms, Groups, and Interventions
Arm Title
250 mg DCS
Arm Type
Active Comparator
Arm Description
Baseline assessment (week 1), two weekly sessions when 250mg DCS is administered, and final week (week 4) when retention is assessed.
Arm Title
100 mg modafinil
Arm Type
Active Comparator
Arm Description
Baseline assessment (week 1), two weekly sessions when 100 mg modafinil is administered, and final week (week 4) when retention is assessed.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Baseline assessment (week 1), two weekly sessions when placebo is administered, and final week (week 4) when retention is assessed.
Intervention Type
Drug
Intervention Name(s)
250 mg DCS
Other Intervention Name(s)
d-cycloserine
Intervention Description
Drug
Intervention Type
Drug
Intervention Name(s)
100 mg Modafinil
Intervention Description
Drug
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Drug
Primary Outcome Measure Information:
Title
Recall of Cognitive Therapy Content
Description
A modified Cognitive Therapy Awareness Scale (CTAS) was used to assess delayed memory for cognitive therapy content from the computerized CBT. Higher scores indicate better memory for CBT skills. Scores range from 0 to 40.
Time Frame
Week 2 and Week 3
Title
1 Week Delayed Recall of Emotional Story Items
Description
1 Week Delayed Recall of a Threat-Related Story. Scores can range from 0 to 74, with higher scores reflect greater memory for story items.
Time Frame
Week 2 and Week 3
Title
1 Week Delayed Recall Logical Memory
Description
Higher scores reflect greater recall of Wechsler Memory Scale (WMS) Story B content assessed one week after last rehearsal. Possible scores range from 0 to 25.
Time Frame
Week 2 and Week 3
Secondary Outcome Measure Information:
Title
Logical Memory Immediate Recall
Description
Immediate Story Recall from the Wechsler Memory Scale Story B. Higher scores reflect greater recall of the story material from the previous week. Possible scores range from 0 to 25.
Time Frame
Week 1, Week 2, Week 3
Title
Immediate Memory Measured by the Hopkins Verbal Learning Task
Description
The Hopkins Verbal Learning Test (HVLT) consists of a 12-item word list, composed of four words from each of the three semantic categories. The patient's free recall of the list is recorded. The same procedure is repeated for two more trials. The total recall score for the third trial was used as the recorded score and ranged from a minimum of zero to a maximum of 12 correct answers.
Time Frame
Baseline, Week 1, Week 2, Week 3
Title
Immediate Recall of Emotional Story Items
Description
Immediate recall score of items from the Emotional Story presentation. Scores can range from 0 to 74, with higher scores reflect greater memory for story items.
Time Frame
Week 1, Week 2, Week 3
Title
Skills of Cognitive Therapy
Description
This measure assesses the self-reported use of skills from cognitive therapy. Scores can range from 8 to 40, and higher scores indicate greater use.
Time Frame
Week 2 and Week 3
Title
Digits Backward
Description
The examiner reads a list of digits and asks that each digit be read backwards. The score is the total number of trials completed correctly; scores range from 0 to 16. Higher scores indicate better performance.
Time Frame
Baseline, Week 1, Week 2, Week 3
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Must have a DSM diagnosis of major depression as determined by structured diagnostic interview
Must be free of psychotropic medications other than serotonin selective reuptake inhibitors (SSRIs) for at least 2 weeks
No current suicidal ideation
Able to speak and understand English
Must be between the ages of 18 and 65, inclusive
Must be a male, or a female who is not of childbearing potential (i.e., surgically sterile, postmenopausal for at least 1 year) or who is non-pregnant, non-lactating and using a medically accepted method of contraception. Acceptable methods of contraception include condoms (male or female) with or without a spermicidal agent, diaphragm or cervical cap with spermicide, medically prescribed IUD, hormonal contraceptives. A woman of childbearing potential who is not currently sexually active must agree to use a medically accepted method of contraception should she become sexually active while participating in the trial
Exclusion Criteria:
A DSM diagnosis of dementia, neurodegenerative disease, or other organic mental disorder; substance use disorder other than nicotine or caffeine in the last 3 months; bulimia or anorexia within the last 3 months; lifetime history of psychotic disorder or, bipolar disorder, or developmental disorder;
A diagnosis of organic brain syndrome, mental retardation, or other cognitive dysfunction that could interfere with a participants capacity to participate in CBT or to complete safety and efficacy assessments
A history of seizures (apart from childhood febrile seizures) or head trauma causing ongoing cognitive impairment
An uncontrolled, unstable clinically significant medical condition (e.g., renal, endocrine, hepatic, respiratory, cardiovascular, hematologic, immunologic or cerebrovascular disease, or malignancy, or poorly controlled hypertension (> 150/90mmHg) that may interfere with the interpretation of safety and efficacy evaluations in the opinion of the study physician or investigator
Medical illness including hypertension, cardiac disease, liver disease, pulmonary diseases, central nervous system disease, and epilepsy;
Recent (1 year) suicidal attempts or current suicidal ideation
For women, currently pregnant, plans to be pregnant in the next 2 months, or currently breastfeeding
Treatment with phenytoin, isoniazid, or propranolol or known sensitivity to modafinil or cycloserine
A history of head trauma causing loss of consciousness, seizure or ongoing cognitive impairment
Use of psychotropic medication (including stimulants) other than SSRIs
Current daily use of alcohol or regular binge alcohol use as determined on the medical screen
Insufficient command of the English language (i.e., cannot carry on a conversation with an interviewer in the English language or read associated text)
Receipt of CBT in the previous five years
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Michael W Otto, Ph. D
Organizational Affiliation
Boston University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Boston University
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02215
Country
United States
12. IPD Sharing Statement
Citations:
PubMed Identifier
27094721
Citation
Otto MW, Lee J, Hofmann SG, Hearon BA, Smits JA, Rosenfield D, Fava M, Wright JH. Examining the efficacy of d-cycloserine to augment therapeutic learning in depression. Contemp Clin Trials. 2016 May;48:146-52. doi: 10.1016/j.cct.2016.03.009. Epub 2016 Apr 16.
Results Reference
background
Learn more about this trial
Improving Therapeutic Learning in Depression: Proof of Concept
We'll reach out to this number within 24 hrs