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Magnetic Resonance Imaging Study of Lisdexamfetamine for Bipolar Depression

Primary Purpose

Bipolar Depression

Status
Terminated
Phase
Phase 4
Locations
United States
Study Type
Interventional
Intervention
Lisdexamfetamine
Placebo
Sponsored by
Steward St. Elizabeth's Medical Center of Boston, Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Bipolar Depression focused on measuring lisdexamfetamine, vyvanse, bipolar disorder, depression, stimulant, magnetic resonance spectroscopy, functional magnetic resonance imaging, neuropsychological testing

Eligibility Criteria

21 Years - 50 Years (Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Aged 21 to 50 years.
  • Diagnosed with Bipolar Disorder I or II disorder.
  • Currently in the depressive phase of the illness.
  • Montgomery Asberg Depression Rating Scale (MADRS) score greater than 15.
  • Medication regimen (Lamotrigine, Valproate, Lithium, either alone or in combination with atypical antipsychotics, or typical antipsychotics) at stable doses for at least one month.
  • Has an established residence and phone.
  • Capable of providing informed consent.

Exclusion Criteria:

  • Met Diagnostic and Statistical Manual 4th edition (DSM-IV-TR) criteria for rapid cycling within the 6 months prior to enrolling in the study.
  • Meets DSM-IV-TR criteria for Schizophrenia, Schizoaffective disorder, Post-Traumatic Stress disorder, Obsessive-Compulsive disorder, or Eating disorder. Co-morbid anxiety disorders are not a reason for exclusion.
  • History of psychotic symptoms at any point during the subject's illness.
  • Met DSM-IV-TR criteria for alcohol or substance (except for nicotine) dependence or abuse within the past 6 months.
  • Lifetime history of amphetamine abuse or dependence.
  • Subject has a lifetime history of stimulant-induced mania
  • History of seizures, including febrile seizures in childhood.
  • Young Mania Rating Scale (YMRS) greater than 8.
  • History of significant coronary artery disease, angina, untreated or inadequately treated thyroid disease (less than 1 month chemically euthyroid), type I diabetes, autoimmune disease, glaucoma, hypertension, seizures, or other medical condition(s) which in the opinion of the principal investigator is likely to significantly impact the subject's mood or potential response to the study medication.
  • Electrocardiogram (ECG) with significant arrhythmias or conduction abnormalities, which in the opinion of the physician investigator preclude study participation; uncontrolled hypertension (>160/100) or tachycardia (heart rate >110).
  • Female subjects who are peri or post-menopausal.
  • Subjects taking Ritalin or other stimulants, theophylline, steroids, atomoxetine, cholinesterase inhibitors, memantine, modafinil, warfarin, anticonvulsants, clonidine, theophylline, monoamine oxidase inhibitors, and pseudoephedrine, or other medications that are likely to significantly interact (either pharmacokinetically or pharmacodynamically) with the subject's mood or Lisdexamfetamine.
  • Subject regularly (more than 4 days per week) ingests more than four caffeine containing drinks per day.
  • Pregnancy.
  • In women of childbearing potential, an unwillingness to avoid pregnancy for the duration of the study.
  • Active suicidal ideation.
  • History of homicidal ideation.
  • Allergy or other clinical condition which prohibits the use of all of the approved mood stabilizers or Lisdexamfetamine.
  • Metal in the body (e.g. history of working as a sheet metal worker) or pacemaker which is a contra-indication to magnetic resonance imaging (MRI).
  • Significant claustrophobia.

Sites / Locations

  • Steward St. Elizabeth's Medical Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Placebo Comparator

Active Comparator

Arm Label

Placebo

Lisdexamfetamine

Arm Description

Subjects will receive placebo for lisdexamfetamine.

Subjects will start with 20 mg per day of lisdexamfetamine and may increase to a maximum of 40 mg.

Outcomes

Primary Outcome Measures

Change in Montgomery Asberg Depression Rating Scale (MADRS) Score Over Time.
The change in MADRS score from the baseline visit to the week 8 visit is reported. The MADRS is a clinician-rated scale that consists of 10 items rated on a from 0 to 6 (maximum score of 60), with higher scores indicating greater symptom severity. An increase in score indicates a worsening of symptoms whereas a decrease indicates an improvement in symptoms.

Secondary Outcome Measures

Change in Clinical Global Impressions Severity (CGI-S) Score.
The CGI-S score reflects the clinician's overall impression of the patient's functional status. The scoring for the single item ranges from 1 with an anchor of "normal, not at all ill" to 7 with an anchor of "among the most extremely ill patients". Thus, higher scores indicate greater severity of symptoms.
Change in Clinical Global Impressions Improvement (CGI-I) Score.
The CGI-I score indicates the clinician's overall assessment of improvement in function from one visit to the next. The single item is scored from 1 to 7 with anchor points ranging from very much improved (1) to very much worse (7). A decrease in score reflects an improvement in functional status.

Full Information

First Posted
January 14, 2010
Last Updated
December 19, 2012
Sponsor
Steward St. Elizabeth's Medical Center of Boston, Inc.
Collaborators
Shire
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1. Study Identification

Unique Protocol Identification Number
NCT01051440
Brief Title
Magnetic Resonance Imaging Study of Lisdexamfetamine for Bipolar Depression
Official Title
A Magnetic Resonance Spectroscopy and fMRI Study of the Effects of Lisdexamfetamine on Bipolar Depression
Study Type
Interventional

2. Study Status

Record Verification Date
December 2012
Overall Recruitment Status
Terminated
Why Stopped
Slow enrollment
Study Start Date
February 2010 (undefined)
Primary Completion Date
June 2011 (Actual)
Study Completion Date
June 2011 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Steward St. Elizabeth's Medical Center of Boston, Inc.
Collaborators
Shire

4. Oversight

5. Study Description

Brief Summary
There have been reports that stimulants may be effective for bipolar depression without triggering mania. This study will examine whether lisdexamfetamine can improve depressive symptoms over the course of eight weeks. Lisdexamfetamine is a prodrug stimulant that is currently approved for attention deficit hyperactivity disorder (ADHD). Participants take the study drug or placebo in addition to a mood stabilizer. The study includes functional magnetic resonance imaging and magnetic resonance spectroscopy to determine whether the medication alters the response to affective stimuli or glutamate, glutamine, or gamma aminobutyric acid (GABA) levels. Neuropsychological testing is also included to determine whether the study drug improves memory and attention in this population. The primary hypothesis is that lisdexamfetamine is clinically effective in this population. The secondary hypothesis is that it will result in an increased response to affective stimuli and altered neurotransmitter levels in the anterior cingulate cortex.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Bipolar Depression
Keywords
lisdexamfetamine, vyvanse, bipolar disorder, depression, stimulant, magnetic resonance spectroscopy, functional magnetic resonance imaging, neuropsychological testing

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
2 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Subjects will receive placebo for lisdexamfetamine.
Arm Title
Lisdexamfetamine
Arm Type
Active Comparator
Arm Description
Subjects will start with 20 mg per day of lisdexamfetamine and may increase to a maximum of 40 mg.
Intervention Type
Drug
Intervention Name(s)
Lisdexamfetamine
Other Intervention Name(s)
Vyvanse
Intervention Description
Start at 20 mg daily. Increased to a maximum of 40 mg daily. Can be decreased in 10 mg increments.
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Subjects will receive placebo matched to lisdexamfetamine.
Primary Outcome Measure Information:
Title
Change in Montgomery Asberg Depression Rating Scale (MADRS) Score Over Time.
Description
The change in MADRS score from the baseline visit to the week 8 visit is reported. The MADRS is a clinician-rated scale that consists of 10 items rated on a from 0 to 6 (maximum score of 60), with higher scores indicating greater symptom severity. An increase in score indicates a worsening of symptoms whereas a decrease indicates an improvement in symptoms.
Time Frame
baseline and 8 weeks
Secondary Outcome Measure Information:
Title
Change in Clinical Global Impressions Severity (CGI-S) Score.
Description
The CGI-S score reflects the clinician's overall impression of the patient's functional status. The scoring for the single item ranges from 1 with an anchor of "normal, not at all ill" to 7 with an anchor of "among the most extremely ill patients". Thus, higher scores indicate greater severity of symptoms.
Time Frame
baseline and week 8
Title
Change in Clinical Global Impressions Improvement (CGI-I) Score.
Description
The CGI-I score indicates the clinician's overall assessment of improvement in function from one visit to the next. The single item is scored from 1 to 7 with anchor points ranging from very much improved (1) to very much worse (7). A decrease in score reflects an improvement in functional status.
Time Frame
week 1 and week 9

10. Eligibility

Sex
All
Minimum Age & Unit of Time
21 Years
Maximum Age & Unit of Time
50 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Aged 21 to 50 years. Diagnosed with Bipolar Disorder I or II disorder. Currently in the depressive phase of the illness. Montgomery Asberg Depression Rating Scale (MADRS) score greater than 15. Medication regimen (Lamotrigine, Valproate, Lithium, either alone or in combination with atypical antipsychotics, or typical antipsychotics) at stable doses for at least one month. Has an established residence and phone. Capable of providing informed consent. Exclusion Criteria: Met Diagnostic and Statistical Manual 4th edition (DSM-IV-TR) criteria for rapid cycling within the 6 months prior to enrolling in the study. Meets DSM-IV-TR criteria for Schizophrenia, Schizoaffective disorder, Post-Traumatic Stress disorder, Obsessive-Compulsive disorder, or Eating disorder. Co-morbid anxiety disorders are not a reason for exclusion. History of psychotic symptoms at any point during the subject's illness. Met DSM-IV-TR criteria for alcohol or substance (except for nicotine) dependence or abuse within the past 6 months. Lifetime history of amphetamine abuse or dependence. Subject has a lifetime history of stimulant-induced mania History of seizures, including febrile seizures in childhood. Young Mania Rating Scale (YMRS) greater than 8. History of significant coronary artery disease, angina, untreated or inadequately treated thyroid disease (less than 1 month chemically euthyroid), type I diabetes, autoimmune disease, glaucoma, hypertension, seizures, or other medical condition(s) which in the opinion of the principal investigator is likely to significantly impact the subject's mood or potential response to the study medication. Electrocardiogram (ECG) with significant arrhythmias or conduction abnormalities, which in the opinion of the physician investigator preclude study participation; uncontrolled hypertension (>160/100) or tachycardia (heart rate >110). Female subjects who are peri or post-menopausal. Subjects taking Ritalin or other stimulants, theophylline, steroids, atomoxetine, cholinesterase inhibitors, memantine, modafinil, warfarin, anticonvulsants, clonidine, theophylline, monoamine oxidase inhibitors, and pseudoephedrine, or other medications that are likely to significantly interact (either pharmacokinetically or pharmacodynamically) with the subject's mood or Lisdexamfetamine. Subject regularly (more than 4 days per week) ingests more than four caffeine containing drinks per day. Pregnancy. In women of childbearing potential, an unwillingness to avoid pregnancy for the duration of the study. Active suicidal ideation. History of homicidal ideation. Allergy or other clinical condition which prohibits the use of all of the approved mood stabilizers or Lisdexamfetamine. Metal in the body (e.g. history of working as a sheet metal worker) or pacemaker which is a contra-indication to magnetic resonance imaging (MRI). Significant claustrophobia.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Michael E Henry, MD
Organizational Affiliation
Steward St. Elizabeth's Medical Center of Boston, Inc.
Official's Role
Principal Investigator
Facility Information:
Facility Name
Steward St. Elizabeth's Medical Center
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02135
Country
United States

12. IPD Sharing Statement

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Magnetic Resonance Imaging Study of Lisdexamfetamine for Bipolar Depression

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