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Cannabidiol for Bipolar Depression (CBD-BD) (CBD-BD)

Primary Purpose

Bipolar Disorder

Status
Not yet recruiting
Phase
Phase 3
Locations
Canada
Study Type
Interventional
Intervention
Cannabidiol
Placebo
Sponsored by
University of British Columbia
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Bipolar Disorder focused on measuring Cannabidiol, Bipolar Disorder, Bipolar Depression

Eligibility Criteria

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

Inclusion Criteria: Males or females aged 19 to 70 years (inclusive). Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) diagnosis of Bipolar Disorder Type I or Type II, AND a current major depressive episode. All patients must be taking either a mood stabilizer (i.e. lithium or valproate; lamotrigine monotherapy as a mood stabilizer is acceptable for BD II patients only and not for BD I) OR an atypical antipsychotic OR a combination of these (two mood stabilizers or a mood stabilizer plus an atypical antipsychotic), at therapeutic doses. Combinations of these medications as outlined above, or the combination of any of them with lamotrigine 100-400 mg daily, or the combination of a mood stabilizer plus asenapine 5-20 mg/day are also permitted. Have received a minimum of 6-weeks treatment at adequate doses for treatment of current depressive episode with at least one CANMAT recommended first-line treatment for bipolar I disorder (i.e. lithium, lamotrigine, lurasidone, or quetiapine either as monotherapy or adjunctive therapy), or at least one first or second-line treatment for bipolar II depression (i.e. quetiapine, lithium, lamotrigine, sertraline, or venlafaxine as monotherapy or adjunctive therapy, or bupropion adjunctive therapy). A MADRS score of ≥ 20 and a YMRS score of ≤ 12. Inpatient or outpatient status. Females of childbearing potential are required to take contraceptive pills OR agree to practice effective double barrier methods of contraception OR agree to completely abstain from heterosexual intercourse. Females who do not have childbearing potential are required to be postmenopausal for at least 1 year before the screening visit (confirmed by an FSH test) OR surgically sterile. The capability of understanding, consenting to and complying with study requirements. All concomitant medication must be at a stable dose for two weeks prior to the randomization visit. Exclusion Criteria: Current depressive episode greater than 6 months. A history of rapid cycling, defined as ≥ 4 mood episodes in the preceding 12 months. Current unstable or inadequately treated medical illness with the exception of current depression. A history of non-response or intolerance to CBD. Current or past month daily use of CBD, or any product or drug that contains CBD. Occasional users will be included if they agree to refrain from using during the trial. A history of non-response to electroconvulsive therapy. A current diagnosis of other primary psychiatric disorders as assessed by a study investigator to be primary and causing greater impairment than BD. A lifetime history of a primary psychotic disorder (e.g. schizoaffective disorder, bipolar subtype) according to DSM-5 criteria. Patients who have met the DSM-5 criteria for a substance use disorder (except for nicotine or caffeine) within the past 6 months. Significant active suicidal ideation (as evidenced by MADRS suicide item ≥ 4). Pregnancy or lactation. Liver function tests (AST and ALT) three times the upper limit of normal.

Sites / Locations

  • UBC Mood Disorders Centre
  • Dalhousie University
  • St. Joseph's Healthcare
  • Providence Care Hospital
  • Sunnybrook Health Sciences Centre
  • Centre for Addiction and Mental Health (CAMH)
  • Douglas Mental Health University Institute

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Cannabidiol

Placebo

Arm Description

Cannabidiol 200 - 600 mg / day added to current treatment for 6 weeks.

Placebo added to current treatment for 6 weeks.

Outcomes

Primary Outcome Measures

Improvement in depressive symptoms in bipolar patients treated with Cannabidiol vs Placebo adjunctive therapy
The Montgomery Asberg Depression Rating Scale (MADRS) will be used to measure change in depressive symptoms from baseline to endpoint. Scores range from 0 to 60, and lower scores reflect better clinical outcomes.

Secondary Outcome Measures

Response rates
Response rates are defined as patients showing ≥50% reduction in MADRS scores.
Remission rates
Remission rates are defined as MADRS ≤ 10 and YMRS ≤ 8 at endpoint.
Treatment-emergent manic/hypomanic events
The Young Mania Rating Scale (YMRS) will be used to determine the presence of any treatment-emergent manic or hypomanic events from baseline to endpoint. Scores range from 0 to 60, and lower scores reflect better clinical outcomes.
Objective depressive symptoms
The 21-item Hamilton Depression Rating Scale (HAM-D 21) will be used to measure change in objective depressive symptoms from baseline to endpoint. Scores range from 0 to 62, and lower scores reflect better clinical outcomes.
Subjective depressive symptoms
The Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR) and the Dimensional Anhedonia Rating Scale (DARS) will be used to measure change in subjective depressive symptoms from baseline to endpoint. Lower scores on the QIDS-SR reflect better clinical outcomes; higher scores on the DARS reflect better clinical outcomes.
Objective anxiety symptoms
The Hamilton Anxiety Rating Scale (HAM-A) will be used to measure change in objective anxiety symptoms from baseline to endpoint. Scores range from 0 to 56 and lower scores reflect better clinical outcomes.
Subjective anxiety symptoms assessed by STAI
The State-Trait Anxiety Inventory (STAI) will be used to measure change in subjective anxiety symptoms. Lower scores on the STAI reflect better clinical outcomes.
Subjective anxiety symptoms assessed by GAD-7
The Generalized Anxiety Disorder 7-item (GAD-7) will be used to measure change in subjective anxiety symptoms. Lower scores on the GAD-7 reflect better clinical outcomes.
Overall psychiatric status
The Clinical Global Impression - severity & change scales will be used to measure change in global severity and global improvement in symptoms from baseline to endpoint. Scores range from 3 to 42, and higher scores reflect worsening in overall psychiatric status.
Psychotic symptoms
The Positive and Negative Syndrome Scale (PANSS) will be used to measure change in psychotic symptoms from baseline to endpoint. Scores range from 7 to 49, and lower scores reflect better clinical outcomes.
Subjective cognitive functioning
The Cognitive Complaints in Bipolar Disorder Risk Assessment (COBRA) and the Patient-Reported Outcomes Measurement Information System (PROMIS) Cognitive Function scale will be used to measure change in subjective cognitive functioning from baseline to endpoint. COBRA scores range from 0 to 48, and lower scores reflect better outcomes; PROMIS cognitive function scale scores range from 8 to 40, and higher scores reflect better outcomes.
Objective cognitive functioning
The Screen for Cognitive Impairment in Psychiatry (SCIP) will be used to measure change in objective cognitive functioning from baseline to endpoint. Higher scores reflect better outcomes.
Sleep quality
The Pittsburgh Sleep Quality Index (PSQI) will be used to measure changes in sleep quality and disturbance from baseline to endpoint. Lower scores reflect better sleep quality.
Suicidal thoughts and behaviours
The Columbia-Suicide Severity Rating Scale (C-SSRS) will be used to measure change in suicidal thoughts and behaviours from baseline to endpoint. Scores range from 0 to 37, and lower scores reflect better clinical outcomes.
Quality of Life assessed by QoL.BD
The Brief Quality of Life in Bipolar Disorder (QoL.BD) will be used to measure change in quality of life from baseline to endpoint. Higher scores reflect higher quality of life.
Daily functioning
The Functioning Assessment Short Test (FAST) will be used to measure change in daily functioning from baseline to endpoint. Lower scores reflect better daily functioning.
Health services utilization
A healthcare utilization diary will be used to measure improvement in health services utilization from baseline to endpoint.
Adverse events
Adverse events will be measured objectively using an open-ended form and subjectively using the Frequency, Intensity, and Burden of Side Effects Rating (FIBSER). FIBSER scores range from 0 to 18, and lower scores reflect better outcomes.

Full Information

First Posted
May 9, 2023
Last Updated
September 27, 2023
Sponsor
University of British Columbia
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1. Study Identification

Unique Protocol Identification Number
NCT05867849
Brief Title
Cannabidiol for Bipolar Depression (CBD-BD)
Acronym
CBD-BD
Official Title
Cannabidiol Adjunctive Therapy for Acute Bipolar Depression: A Randomized Double-Blind, Placebo Controlled Trial
Study Type
Interventional

2. Study Status

Record Verification Date
September 2023
Overall Recruitment Status
Not yet recruiting
Study Start Date
October 15, 2023 (Anticipated)
Primary Completion Date
December 2029 (Anticipated)
Study Completion Date
December 2030 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of British Columbia

4. Oversight

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

5. Study Description

Brief Summary
Bipolar disorder (BD) is a lifelong condition characterized by recurrent episodes of depression and (hypo) mania. Periods of chronic and recurring depressive episodes are more common and can be severely disabling. Effective treatments exist; however, a significant portion of bipolar depressed patients do not respond to or have difficulty tolerating many of these interventions and thus look beyond established treatments to achieve symptom relief. Cannabidiol (CBD), a chemical from the Cannabis sativa plant has shown to have some beneficial effects on mood symptoms in a few small studies which assessed its effects in other mental and physical health conditions, but no large studies have been conducted to assess the safety and efficacy in bipolar depression. Additionally, several clinical studies have shown CBD to be safe and tolerable. The primary objective of this study is to assess the effectiveness, safety and tolerability of Cannabidiol in patients with bipolar depression (BD I or BD II) who have not responded to adequate trials with at least one first-line treatment for bipolar depression in comparison to those who will be treated with placebo. Placebo is an inactive substance that looks identical to the study medication but contains no therapeutic ingredient. This study is a randomized (like the flip of a coin), double-blind (you and the study team will not know which treatment arm you receive) study in which participants will receive either CBD or placebo added to their current treatment. Participants will have 5 clinical appointments and a phone appointment over a period of 10 weeks.
Detailed Description
This is a Phase 3, 6-week, double-blind, parallel group randomized controlled trial to assess the efficacy, safety and tolerability of adjunctive CBD vs placebo in patients with acute bipolar depression (BD I or BD II) who have not responded to adequate trials with at least one first-line treatment for bipolar I disorder (i.e. lithium, lamotrigine, lurasidone, or quetiapine either as monotherapy or adjunctive therapy), or at least one first or second-line treatment for bipolar II depression (i.e. quetiapine, lithium, lamotrigine, sertraline, or venlafaxine as monotherapy or adjunctive therapy, or bupropion adjunctive therapy). After the baseline visit, patients who meet the eligibility criteria will enter a 6-week double-blind treatment phase during which participants will be randomized to adjunctive CBD or identical placebo. Participants will be assessed at the screening visit, baseline visit, weeks 2, 4, and 6, or endpoint visit. All participants will receive a follow-up telephone call 2 weeks after the 6-week study endpoint or early termination visit to assess well-being. All participants will continue treatment with their mood stabilizer and/or atypical antipsychotic as prescribed by their treating physicians.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Bipolar Disorder
Keywords
Cannabidiol, Bipolar Disorder, Bipolar Depression

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
360 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Cannabidiol
Arm Type
Experimental
Arm Description
Cannabidiol 200 - 600 mg / day added to current treatment for 6 weeks.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Placebo added to current treatment for 6 weeks.
Intervention Type
Drug
Intervention Name(s)
Cannabidiol
Other Intervention Name(s)
CBD
Intervention Description
Cannabinoid
Intervention Type
Other
Intervention Name(s)
Placebo
Intervention Description
Inactive substance
Primary Outcome Measure Information:
Title
Improvement in depressive symptoms in bipolar patients treated with Cannabidiol vs Placebo adjunctive therapy
Description
The Montgomery Asberg Depression Rating Scale (MADRS) will be used to measure change in depressive symptoms from baseline to endpoint. Scores range from 0 to 60, and lower scores reflect better clinical outcomes.
Time Frame
6 weeks
Secondary Outcome Measure Information:
Title
Response rates
Description
Response rates are defined as patients showing ≥50% reduction in MADRS scores.
Time Frame
6 weeks
Title
Remission rates
Description
Remission rates are defined as MADRS ≤ 10 and YMRS ≤ 8 at endpoint.
Time Frame
6 weeks
Title
Treatment-emergent manic/hypomanic events
Description
The Young Mania Rating Scale (YMRS) will be used to determine the presence of any treatment-emergent manic or hypomanic events from baseline to endpoint. Scores range from 0 to 60, and lower scores reflect better clinical outcomes.
Time Frame
6 weeks
Title
Objective depressive symptoms
Description
The 21-item Hamilton Depression Rating Scale (HAM-D 21) will be used to measure change in objective depressive symptoms from baseline to endpoint. Scores range from 0 to 62, and lower scores reflect better clinical outcomes.
Time Frame
6 weeks
Title
Subjective depressive symptoms
Description
The Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR) and the Dimensional Anhedonia Rating Scale (DARS) will be used to measure change in subjective depressive symptoms from baseline to endpoint. Lower scores on the QIDS-SR reflect better clinical outcomes; higher scores on the DARS reflect better clinical outcomes.
Time Frame
6 weeks
Title
Objective anxiety symptoms
Description
The Hamilton Anxiety Rating Scale (HAM-A) will be used to measure change in objective anxiety symptoms from baseline to endpoint. Scores range from 0 to 56 and lower scores reflect better clinical outcomes.
Time Frame
6 weeks
Title
Subjective anxiety symptoms assessed by STAI
Description
The State-Trait Anxiety Inventory (STAI) will be used to measure change in subjective anxiety symptoms. Lower scores on the STAI reflect better clinical outcomes.
Time Frame
6 weeks
Title
Subjective anxiety symptoms assessed by GAD-7
Description
The Generalized Anxiety Disorder 7-item (GAD-7) will be used to measure change in subjective anxiety symptoms. Lower scores on the GAD-7 reflect better clinical outcomes.
Time Frame
6 weeks
Title
Overall psychiatric status
Description
The Clinical Global Impression - severity & change scales will be used to measure change in global severity and global improvement in symptoms from baseline to endpoint. Scores range from 3 to 42, and higher scores reflect worsening in overall psychiatric status.
Time Frame
6 weeks
Title
Psychotic symptoms
Description
The Positive and Negative Syndrome Scale (PANSS) will be used to measure change in psychotic symptoms from baseline to endpoint. Scores range from 7 to 49, and lower scores reflect better clinical outcomes.
Time Frame
6 weeks
Title
Subjective cognitive functioning
Description
The Cognitive Complaints in Bipolar Disorder Risk Assessment (COBRA) and the Patient-Reported Outcomes Measurement Information System (PROMIS) Cognitive Function scale will be used to measure change in subjective cognitive functioning from baseline to endpoint. COBRA scores range from 0 to 48, and lower scores reflect better outcomes; PROMIS cognitive function scale scores range from 8 to 40, and higher scores reflect better outcomes.
Time Frame
6 weeks
Title
Objective cognitive functioning
Description
The Screen for Cognitive Impairment in Psychiatry (SCIP) will be used to measure change in objective cognitive functioning from baseline to endpoint. Higher scores reflect better outcomes.
Time Frame
Week 6
Title
Sleep quality
Description
The Pittsburgh Sleep Quality Index (PSQI) will be used to measure changes in sleep quality and disturbance from baseline to endpoint. Lower scores reflect better sleep quality.
Time Frame
6 weeks
Title
Suicidal thoughts and behaviours
Description
The Columbia-Suicide Severity Rating Scale (C-SSRS) will be used to measure change in suicidal thoughts and behaviours from baseline to endpoint. Scores range from 0 to 37, and lower scores reflect better clinical outcomes.
Time Frame
6 weeks
Title
Quality of Life assessed by QoL.BD
Description
The Brief Quality of Life in Bipolar Disorder (QoL.BD) will be used to measure change in quality of life from baseline to endpoint. Higher scores reflect higher quality of life.
Time Frame
6 weeks
Title
Daily functioning
Description
The Functioning Assessment Short Test (FAST) will be used to measure change in daily functioning from baseline to endpoint. Lower scores reflect better daily functioning.
Time Frame
6 weeks
Title
Health services utilization
Description
A healthcare utilization diary will be used to measure improvement in health services utilization from baseline to endpoint.
Time Frame
6 weeks
Title
Adverse events
Description
Adverse events will be measured objectively using an open-ended form and subjectively using the Frequency, Intensity, and Burden of Side Effects Rating (FIBSER). FIBSER scores range from 0 to 18, and lower scores reflect better outcomes.
Time Frame
6 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
19 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Males or females aged 19 to 70 years (inclusive). Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) diagnosis of Bipolar Disorder Type I or Type II, AND a current major depressive episode. All patients must be taking either a mood stabilizer (i.e. lithium or valproate; lamotrigine monotherapy as a mood stabilizer is acceptable for BD II patients only and not for BD I) OR an atypical antipsychotic OR a combination of these (two mood stabilizers or a mood stabilizer plus an atypical antipsychotic), at therapeutic doses. Combinations of these medications as outlined above, or the combination of any of them with lamotrigine 100-400 mg daily, or the combination of a mood stabilizer plus asenapine 5-20 mg/day are also permitted. Have received a minimum of 6-weeks treatment at adequate doses for treatment of current depressive episode with at least one CANMAT recommended first-line treatment for bipolar I disorder (i.e. lithium, lamotrigine, lurasidone, or quetiapine either as monotherapy or adjunctive therapy), or at least one first or second-line treatment for bipolar II depression (i.e. quetiapine, lithium, lamotrigine, sertraline, or venlafaxine as monotherapy or adjunctive therapy, or bupropion adjunctive therapy). A MADRS score of ≥ 20 and a YMRS score of ≤ 12. Inpatient or outpatient status. Females of childbearing potential are required to take contraceptive pills OR agree to practice effective double barrier methods of contraception OR agree to completely abstain from heterosexual intercourse. Females who do not have childbearing potential are required to be postmenopausal for at least 1 year before the screening visit (confirmed by an FSH test) OR surgically sterile. The capability of understanding, consenting to and complying with study requirements. All concomitant medication must be at a stable dose for two weeks prior to the randomization visit. Exclusion Criteria: Current depressive episode greater than 6 months. A history of rapid cycling, defined as ≥ 4 mood episodes in the preceding 12 months. Current unstable or inadequately treated medical illness with the exception of current depression. A history of non-response or intolerance to CBD. Current or past month daily use of CBD, or any product or drug that contains CBD. Occasional users will be included if they agree to refrain from using during the trial. A history of non-response to electroconvulsive therapy. A current diagnosis of other primary psychiatric disorders as assessed by a study investigator to be primary and causing greater impairment than BD. A lifetime history of a primary psychotic disorder (e.g. schizoaffective disorder, bipolar subtype) according to DSM-5 criteria. Patients who have met the DSM-5 criteria for a substance use disorder (except for nicotine or caffeine) within the past 6 months. Significant active suicidal ideation (as evidenced by MADRS suicide item ≥ 4). Pregnancy or lactation. Liver function tests (AST and ALT) three times the upper limit of normal.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Nazlin Walji, BSc
Phone
604-822-7294
Email
nazlin.walji@ubc.ca
First Name & Middle Initial & Last Name or Official Title & Degree
Shannon Reid, BA
Phone
604-822-8045
Email
shannon.reid@ubc.ca
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Lakshmi N Yatham, MBBS, MRCPsy
Organizational Affiliation
University of British Columbia, Department of Psychiatry
Official's Role
Principal Investigator
Facility Information:
Facility Name
UBC Mood Disorders Centre
City
Vancouver
State/Province
British Columbia
ZIP/Postal Code
V6T 1Z3
Country
Canada
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Shannon Reid, BA
Phone
604-822-8045
Email
shannon.reid@ubc.ca
First Name & Middle Initial & Last Name & Degree
Nazlin Walji, BSc
Phone
604-822-7294
Email
nazlin.walji@ubc.ca
First Name & Middle Initial & Last Name & Degree
Lakshmi N Yatham, MBBS, MRCPsy
Facility Name
Dalhousie University
City
Halifax
State/Province
Nova Scotia
ZIP/Postal Code
B3H 2E2
Country
Canada
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Martin Alda, MD, FRCPC
Facility Name
St. Joseph's Healthcare
City
Hamilton
State/Province
Ontario
ZIP/Postal Code
L8N 3K7
Country
Canada
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Benicio Frey, MD
First Name & Middle Initial & Last Name & Degree
Flavio Kapczinski
Facility Name
Providence Care Hospital
City
Kingston
State/Province
Ontario
ZIP/Postal Code
K7L 4X3
Country
Canada
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Roumen Milev, MD
Facility Name
Sunnybrook Health Sciences Centre
City
Toronto
State/Province
Ontario
ZIP/Postal Code
M4N 3M5
Country
Canada
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Ayal Schaffer, MD
Facility Name
Centre for Addiction and Mental Health (CAMH)
City
Toronto
State/Province
Ontario
ZIP/Postal Code
M6J1H4
Country
Canada
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Arun Ravindran, MD
First Name & Middle Initial & Last Name & Degree
Nisha Ravindran, MD
Facility Name
Douglas Mental Health University Institute
City
Montreal
State/Province
Quebec
ZIP/Postal Code
H4H 1R3
Country
Canada
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Serge Beaulieu, MD

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Cannabidiol for Bipolar Depression (CBD-BD)

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