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Specialized Pro-resolving Lipid Mediators and Treatment Resistant Depression

Primary Purpose

Treatment Resistant Depression, Inflammation, Overweight

Status
Not yet recruiting
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Omega 3
Placebo
Sponsored by
Massachusetts General Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Treatment Resistant Depression focused on measuring omega-3, fatty acid, major depressive disorder

Eligibility Criteria

18 Years - 85 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Age: 18 and above Patients with MDD who have not responded to at least 2 and no more than 5 antidepressant trials during the current episode and have been on a current stable antidepressant regiment for at least 4 weeks. The diagnosis of MDD will be confirmed using the MINI and the historical failure to respond to antidepressant therapy will be documented using the Antidepressant Treatment Response Questionnaire (ATRQ), with failure to respond defined as less than 50% improvement by subject history. hs-CRP ≥ 3 mg/L and ≤ 10 mg/L BMI >25 kg/m2 17-item Hamilton Depression Rating Scale (HAM-D) score ≥15, and <25% decrease in score between screen and baseline Able to clearly understand English Exclusion Criteria: Diagnostic Exclusions: Meeting lifetime DSM-5 criteria for: a neurocognitive disorder, psychotic disorder, bipolar disorder, or anorexia nervosa in the 3 months prior to the screening; any substance use disorder (except for nicotine or caffeine use disorder); obsessive compulsive disorder or bulimia nervosa. Patients who, in the investigator's judgment, pose a current, serious suicidal or homicidal risk Presence of a serious or unstable medical illness, including insulin-dependent diabetes mellitus or bleeding disorder which, in the investigator's opinion, could compromise response to treatment, participant safety, or interpretation of study results Currently breastfeeding or pregnant women Currently participating in another clinical trial Treatment and Concomitant Medication Exclusions: Failure to respond during the course of the current major depressive episode to >5 adequate antidepressant trials Current use of antipsychotic medications or lithium Having received ketamine therapy within 90 days of the screening visit Patients who have initiated psychotherapy ≤ 90 days prior to screening.Having received electroconvulsive therapy during the current depressive episode or within 6 months of the screening visit Concomitant use of any psychotropic agents within 2 weeks of the baseline visit, except for the ongoing antidepressant, prescription hypnotics, diphenhydramine, or a stable daily dose of a benzodiazepine. Concomitant medications that might confound the biomarker findings within 1 week of the baseline visit and during the trial, including: regular (i.e. more than three times per week) ingestion of non-steroidal anti-inflammatory drugs (NSAIDs) or cyclooxygenase (COX)-2 inhibitors; any use of oral steroids, immunosuppressants, interferon, chemotherapy, or anticoagulants. Omega-3 Exclusions: A history of severe sensitivity to soy products, fish products, or PUFA supplements Patients who had taken supplements enriched with n-3 fatty acids within 60 days of the screening visit or who, at baseline, were consuming a diet containing > 3 g/day of n-3 fatty acids, or who consume > 2 meals of fatty fish per week. Having taken a supplement of ≥1 g/day of n-3 fatty acids for ≥6 weeks during the current major depressive episode Patients who have had either a poor response or intolerable side effects from n-3s in the past. Patients with the following conditions: Crohn's disease, Irritable Bowel Syndrome-diarrhea type, history of gastric bypass surgery, history of cholecystectomy, recent/current history of bulimia with purging, use of prokinetic medications that affect GI transit time, and small intestinal bacterial overgrowth (SIBO)

Sites / Locations

  • Emory University School of Medicine
  • Depression Clinical and Research Program at Massachusetts General Hospital
  • University of Utah

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Omega-3

Placebo

Arm Description

Omega-3 fatty acid (ProEPA Xtra) capsules containing 4 g/day of eicosapentaenoic acid (EPA), administered for 12 weeks.

Placebo capsules containing soybean oil (about 54% omega-6 and 6% omega-3, but no EPA or docosahexaenoic acid (DHA)), and matched to the ProEPA Xtra capsules in terms of appearance, odor, and taste.

Outcomes

Primary Outcome Measures

18-HEPE (18-hydroxy eicosapentaeoic acid)
Evaluate plasma 18-HEPE (18-hydroxy eicosapentaeoic acid) concentrations in 4 g/day EPA-enriched n-3 treatment vs placebo.
18-HEPE (18-hydroxy eicosapentaeoic acid) in Responders
Evaluate 18-HEPE (18-hydroxy eicosapentaeoic acid) levels in sustained responders (≥ 50% Montgomery-Asberg Depression Rating Scale [MADRS] score decrease from baseline at both week 8 and 12) to 4 g/day EPA-enriched n-3 treatment versus a) unsustained/non-responders to 4 g/day EPA-enriched n-3 treatment and b) placebo-supplemented sustained responders. The Montgomery-Asberg Depression Rating Scale [MADRS] measures depressive symptom severity. It contains 10 items, each one graded from 0-6 for a total score range of 0-60, with higher scores indicating greater depressive severity.

Secondary Outcome Measures

Full Information

First Posted
March 6, 2023
Last Updated
October 17, 2023
Sponsor
Massachusetts General Hospital
Collaborators
University of Utah, Emory University
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1. Study Identification

Unique Protocol Identification Number
NCT05774665
Brief Title
Specialized Pro-resolving Lipid Mediators and Treatment Resistant Depression
Official Title
Specialized Pro-resolving Lipid Mediators and Treatment Resistant Depression
Study Type
Interventional

2. Study Status

Record Verification Date
October 2023
Overall Recruitment Status
Not yet recruiting
Study Start Date
January 1, 2024 (Anticipated)
Primary Completion Date
January 1, 2026 (Anticipated)
Study Completion Date
April 30, 2026 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Massachusetts General Hospital
Collaborators
University of Utah, Emory University

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 goal of this clinical trial is to determine the impact of omega-3 fatty acids on the production of anti-inflammatory effects and clinical improvement in people with depression who have not responded well to standard antidepressant treatment. The main questions it seeks to answer are: Do omega-3 fatty acids added to ineffective antidepressant treatment increase production of compounds that reduce inflammation? Is the increase in these anti-inflammatory compounds associated with a stronger antidepressant effect? Participants taking antidepressants that have not worked completely will be assigned at random for a 12-week period to one of the following: an omega-3 preparation an inactive placebo During the course of the study, blood tests will be obtained for compounds associated with inflammation, and questionnaires to measure clinical improvement in depressive symptoms will be administered.
Detailed Description
This R33 application builds directly on a previous collaborative R01 (NCT00517036) and UG3 (NCT02553915) grants. The investigators will carry out a 12-week, randomized placebo-controlled, double-masked, augmentation trial of 4 g/day eicosapentaenoic acid (EPA)-enriched omega-3 treatment in adults with major depressive disorder (MDD), an inadequate response to antidepressants (treatment-resistant depression [TRD]), body mass index (BMI) >25 kg/m2 and inflammation (high sensitivity C reactive protein [hs-CRP] ≥ 3 mg/L). It is hypothesized that 4 g/day of EPA-enriched omega-3 will: 1) Significantly increase plasma 18-hydroxy eicosapentaeoic acid [18-HEPE] concentrations compared to placebo (primary biological endpoint) 2) Produce significantly more subjects with ≥ 50% sustained (at both week 8 and 12) decrease from baseline in Montgomery-Asberg Depression Rating Scale (MADRS) scores than placebo 3) Demonstrate that sustained responders (≥ 50% MADRS score decrease from baseline at both week 8 and 12) to 4 g/day of EPA omega-3 have significantly greater increases in 18-HEPE levels than unsustained/nonresponders to EPA-enriched omega-3 as well as placebo-supplemented sustained responders.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Treatment Resistant Depression, Inflammation, Overweight
Keywords
omega-3, fatty acid, major depressive disorder

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Model Description
Double blind randomized placebo controlled clinical trial
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Masking Description
Study will be placebo controlled. Participants will receive identical capsules with omega-3 fatty acids or placebo. Randomization will be set by our research pharmacy and no participants or study personnel will know treatment assignment.
Allocation
Randomized
Enrollment
90 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Omega-3
Arm Type
Experimental
Arm Description
Omega-3 fatty acid (ProEPA Xtra) capsules containing 4 g/day of eicosapentaenoic acid (EPA), administered for 12 weeks.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Placebo capsules containing soybean oil (about 54% omega-6 and 6% omega-3, but no EPA or docosahexaenoic acid (DHA)), and matched to the ProEPA Xtra capsules in terms of appearance, odor, and taste.
Intervention Type
Drug
Intervention Name(s)
Omega 3
Other Intervention Name(s)
EPA
Intervention Description
Omega-3 fatty acid enriched for eicosapentaenoic acid (EPA)
Intervention Type
Other
Intervention Name(s)
Placebo
Intervention Description
Placebo consisting of soybean oil (about 54% omega-6 and 6% omega-3, but no EPA or docosahexaenoic acid (DHA)).
Primary Outcome Measure Information:
Title
18-HEPE (18-hydroxy eicosapentaeoic acid)
Description
Evaluate plasma 18-HEPE (18-hydroxy eicosapentaeoic acid) concentrations in 4 g/day EPA-enriched n-3 treatment vs placebo.
Time Frame
12 weeks
Title
18-HEPE (18-hydroxy eicosapentaeoic acid) in Responders
Description
Evaluate 18-HEPE (18-hydroxy eicosapentaeoic acid) levels in sustained responders (≥ 50% Montgomery-Asberg Depression Rating Scale [MADRS] score decrease from baseline at both week 8 and 12) to 4 g/day EPA-enriched n-3 treatment versus a) unsustained/non-responders to 4 g/day EPA-enriched n-3 treatment and b) placebo-supplemented sustained responders. The Montgomery-Asberg Depression Rating Scale [MADRS] measures depressive symptom severity. It contains 10 items, each one graded from 0-6 for a total score range of 0-60, with higher scores indicating greater depressive severity.
Time Frame
12 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
85 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Age: 18 and above Patients with MDD who have not responded to at least 2 and no more than 5 antidepressant trials during the current episode and have been on a current stable antidepressant regiment for at least 4 weeks. The diagnosis of MDD will be confirmed using the MINI and the historical failure to respond to antidepressant therapy will be documented using the Antidepressant Treatment Response Questionnaire (ATRQ), with failure to respond defined as less than 50% improvement by subject history. hs-CRP ≥ 3 mg/L and ≤ 10 mg/L BMI >25 kg/m2 17-item Hamilton Depression Rating Scale (HAM-D) score ≥15, and <25% decrease in score between screen and baseline Able to clearly understand English Exclusion Criteria: Diagnostic Exclusions: Meeting lifetime DSM-5 criteria for: a neurocognitive disorder, psychotic disorder, bipolar disorder, or anorexia nervosa in the 3 months prior to the screening; any substance use disorder (except for nicotine or caffeine use disorder); obsessive compulsive disorder or bulimia nervosa. Patients who, in the investigator's judgment, pose a current, serious suicidal or homicidal risk Presence of a serious or unstable medical illness, including insulin-dependent diabetes mellitus or bleeding disorder which, in the investigator's opinion, could compromise response to treatment, participant safety, or interpretation of study results Currently breastfeeding or pregnant women Currently participating in another clinical trial Treatment and Concomitant Medication Exclusions: Failure to respond during the course of the current major depressive episode to >5 adequate antidepressant trials Current use of antipsychotic medications or lithium Having received ketamine therapy within 90 days of the screening visit Patients who have initiated psychotherapy ≤ 90 days prior to screening.Having received electroconvulsive therapy during the current depressive episode or within 6 months of the screening visit Concomitant use of any psychotropic agents within 2 weeks of the baseline visit, except for the ongoing antidepressant, prescription hypnotics, diphenhydramine, or a stable daily dose of a benzodiazepine. Concomitant medications that might confound the biomarker findings within 1 week of the baseline visit and during the trial, including: regular (i.e. more than three times per week) ingestion of non-steroidal anti-inflammatory drugs (NSAIDs) or cyclooxygenase (COX)-2 inhibitors; any use of oral steroids, immunosuppressants, interferon, chemotherapy, or anticoagulants. Omega-3 Exclusions: A history of severe sensitivity to soy products, fish products, or PUFA supplements Patients who had taken supplements enriched with n-3 fatty acids within 60 days of the screening visit or who, at baseline, were consuming a diet containing > 3 g/day of n-3 fatty acids, or who consume > 2 meals of fatty fish per week. Having taken a supplement of ≥1 g/day of n-3 fatty acids for ≥6 weeks during the current major depressive episode Patients who have had either a poor response or intolerable side effects from n-3s in the past. Patients with the following conditions: Crohn's disease, Irritable Bowel Syndrome-diarrhea type, history of gastric bypass surgery, history of cholecystectomy, recent/current history of bulimia with purging, use of prokinetic medications that affect GI transit time, and small intestinal bacterial overgrowth (SIBO)
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
David Mischoulon, MD, PhD
Phone
617-724-5198
Email
dmischoulon@mgh.harvard.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Mark H Rapaport, MD
Organizational Affiliation
University of Utah
Official's Role
Principal Investigator
Facility Information:
Facility Name
Emory University School of Medicine
City
Atlanta
State/Province
Georgia
ZIP/Postal Code
30322
Country
United States
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Boadie H Dunlop, MD
Phone
404-727-8474
Email
Bdunlop@emory.edu
Facility Name
Depression Clinical and Research Program at Massachusetts General Hospital
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02114
Country
United States
Facility Name
University of Utah
City
Salt Lake City
State/Province
Utah
ZIP/Postal Code
84108
Country
United States
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Mark H Rapaport, MD
Phone
801-587-8626
Email
mark.rapaport@hsc.utah.edu
First Name & Middle Initial & Last Name & Degree
Becky Kinkead, PhD
Phone
801-587-0689
Email
becky.kinkead@hsc.utah.edu

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
Data will be stored password-protected in REDCap. Following publication, data will be available to external researchers upon request for replication or secondary analysis. Subject confidentiality will be protected per HIPAA policies. Internal and external requests will be handled by the PI to ensure equitable access, fairness and safeguards. After reviewing a proposal from an external investigator, PI will approve requests with appropriate experimental design, scientific merit and IRB approval and recommend revisions if necessary. Database searches are completed by the study statistician following PI approval, and reports will be provided to investigators. Information can be printed directly from database or exported in spreadsheets in various formats. Format will be controlled by the study statistician. Distribution of data is controlled and de-identified as much as possible.
IPD Sharing Time Frame
Following publication of main study findings.
IPD Sharing Access Criteria
Interested investigators should contact the study team to inquire about data availability.
Citations:
PubMed Identifier
36005883
Citation
Mischoulon D, Dunlop BW, Kinkead B, Schettler PJ, Lamon-Fava S, Rakofsky JJ, Nierenberg AA, Clain AJ, Mletzko Crowe T, Wong A, Felger JC, Sangermano L, Ziegler TR, Cusin C, Fisher LB, Fava M, Rapaport MH. Omega-3 Fatty Acids for Major Depressive Disorder With High Inflammation: A Randomized Dose-Finding Clinical Trial. J Clin Psychiatry. 2022 Aug 22;83(5):21m14074. doi: 10.4088/JCP.21m14074.
Results Reference
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Specialized Pro-resolving Lipid Mediators and Treatment Resistant Depression

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