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Psilocybin vs Escitalopram for Major Depressive Disorder: Comparative Mechanisms (Psilodep-RCT)

Primary Purpose

Depressive Disorder, Major

Status
Unknown status
Phase
Phase 2
Locations
United Kingdom
Study Type
Interventional
Intervention
Psilocybin + Placebo
Psilocybin + Escitalopram
Sponsored by
Imperial College London
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Depressive Disorder, Major focused on measuring depression, mdd, major depression, major depressive disorder, unipolar depression, psilocybin, psychedelics, psychedelic, escitalopram, ssri

Eligibility Criteria

18 Years - 80 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Major depressive disorder (DSM-IV)
  2. Depression of moderate to severe degree (17+ on the 21-item HAM-D).
  3. No MRI contraindications
  4. No SSRI contraindications
  5. Has a GP (general practitioner) or other mental healthcare professional who can confirm diagnosis
  6. 18-80 years of age
  7. Males and females
  8. Sufficiently competent with English language

Key exclusion criteria:

  1. Current or previously diagnosed psychotic disorder
  2. Immediate family member with a diagnosed psychotic disorder
  3. Medically significant condition rendering unsuitability for the study (e.g., diabetes, epilepsy, severe cardiovascular disease, hepatic or renal failure e.g. CLRC < 30 ml/min etc.)
  4. History of serious suicide attempts requiring hospitalisation.
  5. Significant history of mania (determined by study psychiatrist and medical records)
  6. Psychiatric condition judged to be incompatible with establishment of rapport with therapy team and/or safe exposure to psilocybin, e.g. borderline personality disorder
  7. Blood or needle phobia
  8. Positive pregnancy test at screening or during the study, women who are planning a pregnancy and/or women who are nursing/breastfeeding.
  9. Participants who do not agree to use an acceptable contraceptive method throughout their participation in study.
  10. Current drug or alcohol dependence
  11. No email access
  12. Use of contraindicated medication
  13. Patients presenting with abnormal QT interval prolongation at screening or with a history of this (QTc at screening above 440ms for men and above 470ms for women)

Sites / Locations

  • Imperial College Hammersmith campus

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Psilocybin

Escitalopram

Arm Description

Patients receive Psilocybin

Patients receive Escitalopram

Outcomes

Primary Outcome Measures

functional magnetic resonance imaging (fMRI)
Change in blood oxygen level dependent (BOLD) signal during fMRI in response to emotional faces during an emotional faces paradigm done inside the fMRI scanner.

Secondary Outcome Measures

Quick Inventory of Depressive Symptomatology (QIDS-SR16)
Change in QIDS-SR16 (self-rated measure of depressive symptoms). Scale is composed of 16 items that correlate with the 9 DSM-IV symptom criteria for depression. Each response is graded 0-4 (none-severe symptoms). Questions 1-4 concern sleep disturbances, Question 5 addresses sad mood, Questions 6-9 appetite/weight, Question 10 concentration, Question 11 self-criticism, Question 12 suicidal ideation, Question 13 interest, Q14 energy/fatigue and Questions 15-16 psychomotor agitation/retardation. All questions that address the same topic are grouped and only the highest score from each group is summed up together with the other questions in order to produce a total score. Scores can range from 0-27 and depression severity is graded based on the total score in the following way: 1-5 = No depression 6-10 = Mild depression 11-15 = Moderate depression 16-20 = Severe depression 21-27 = Very severe depression

Full Information

First Posted
December 6, 2017
Last Updated
July 30, 2020
Sponsor
Imperial College London
Collaborators
Alexander Mosely Charitable Trust
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1. Study Identification

Unique Protocol Identification Number
NCT03429075
Brief Title
Psilocybin vs Escitalopram for Major Depressive Disorder: Comparative Mechanisms
Acronym
Psilodep-RCT
Official Title
Psilocybin vs Escitalopram for Major Depressive Disorder: Comparative Mechanisms
Study Type
Interventional

2. Study Status

Record Verification Date
July 2020
Overall Recruitment Status
Unknown status
Study Start Date
January 7, 2019 (Actual)
Primary Completion Date
April 17, 2020 (Actual)
Study Completion Date
October 2020 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Imperial College London
Collaborators
Alexander Mosely Charitable Trust

4. Oversight

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

5. Study Description

Brief Summary
This is a randomised double-blind clinical trial. The aim is to compare the efficacy and mechanisms of action of psilocybin, the primary psychoactive substance in 'magic mushrooms', with the SSRI (selective serotonin reuptake inhibitor) escitalopram for major depressive disorder (MDD).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Depressive Disorder, Major
Keywords
depression, mdd, major depression, major depressive disorder, unipolar depression, psilocybin, psychedelics, psychedelic, escitalopram, ssri

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
59 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Psilocybin
Arm Type
Experimental
Arm Description
Patients receive Psilocybin
Arm Title
Escitalopram
Arm Type
Active Comparator
Arm Description
Patients receive Escitalopram
Intervention Type
Drug
Intervention Name(s)
Psilocybin + Placebo
Intervention Description
Multiple dosing days psilocybin vs 6 weeks of daily placebo
Intervention Type
Drug
Intervention Name(s)
Psilocybin + Escitalopram
Intervention Description
Multiple dosing days psilocybin vs 6 weeks of daily escitalopram
Primary Outcome Measure Information:
Title
functional magnetic resonance imaging (fMRI)
Description
Change in blood oxygen level dependent (BOLD) signal during fMRI in response to emotional faces during an emotional faces paradigm done inside the fMRI scanner.
Time Frame
Baseline measure vs 6 weeks post 1st psilocybin dosing
Secondary Outcome Measure Information:
Title
Quick Inventory of Depressive Symptomatology (QIDS-SR16)
Description
Change in QIDS-SR16 (self-rated measure of depressive symptoms). Scale is composed of 16 items that correlate with the 9 DSM-IV symptom criteria for depression. Each response is graded 0-4 (none-severe symptoms). Questions 1-4 concern sleep disturbances, Question 5 addresses sad mood, Questions 6-9 appetite/weight, Question 10 concentration, Question 11 self-criticism, Question 12 suicidal ideation, Question 13 interest, Q14 energy/fatigue and Questions 15-16 psychomotor agitation/retardation. All questions that address the same topic are grouped and only the highest score from each group is summed up together with the other questions in order to produce a total score. Scores can range from 0-27 and depression severity is graded based on the total score in the following way: 1-5 = No depression 6-10 = Mild depression 11-15 = Moderate depression 16-20 = Severe depression 21-27 = Very severe depression
Time Frame
Baseline vs 6 weeks post 1st psilocybin dosing

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Major depressive disorder (DSM-IV) Depression of moderate to severe degree (17+ on the 21-item HAM-D). No MRI contraindications No SSRI contraindications Has a GP (general practitioner) or other mental healthcare professional who can confirm diagnosis 18-80 years of age Males and females Sufficiently competent with English language Key exclusion criteria: Current or previously diagnosed psychotic disorder Immediate family member with a diagnosed psychotic disorder Medically significant condition rendering unsuitability for the study (e.g., diabetes, epilepsy, severe cardiovascular disease, hepatic or renal failure e.g. CLRC < 30 ml/min etc.) History of serious suicide attempts requiring hospitalisation. Significant history of mania (determined by study psychiatrist and medical records) Psychiatric condition judged to be incompatible with establishment of rapport with therapy team and/or safe exposure to psilocybin, e.g. borderline personality disorder Blood or needle phobia Positive pregnancy test at screening or during the study, women who are planning a pregnancy and/or women who are nursing/breastfeeding. Participants who do not agree to use an acceptable contraceptive method throughout their participation in study. Current drug or alcohol dependence No email access Use of contraindicated medication Patients presenting with abnormal QT interval prolongation at screening or with a history of this (QTc at screening above 440ms for men and above 470ms for women)
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
David J Nutt, Medicine
Organizational Affiliation
Imperial College London
Official's Role
Principal Investigator
Facility Information:
Facility Name
Imperial College Hammersmith campus
City
London
ZIP/Postal Code
W12 0NN
Country
United Kingdom

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
29119217
Citation
Carhart-Harris RL, Bolstridge M, Day CMJ, Rucker J, Watts R, Erritzoe DE, Kaelen M, Giribaldi B, Bloomfield M, Pilling S, Rickard JA, Forbes B, Feilding A, Taylor D, Curran HV, Nutt DJ. Psilocybin with psychological support for treatment-resistant depression: six-month follow-up. Psychopharmacology (Berl). 2018 Feb;235(2):399-408. doi: 10.1007/s00213-017-4771-x. Epub 2017 Nov 8.
Results Reference
background
PubMed Identifier
35431912
Citation
Murphy R, Kettner H, Zeifman R, Giribaldi B, Kartner L, Martell J, Read T, Murphy-Beiner A, Baker-Jones M, Nutt D, Erritzoe D, Watts R, Carhart-Harris R. Therapeutic Alliance and Rapport Modulate Responses to Psilocybin Assisted Therapy for Depression. Front Pharmacol. 2022 Mar 31;12:788155. doi: 10.3389/fphar.2021.788155. eCollection 2021.
Results Reference
derived
PubMed Identifier
35411074
Citation
Daws RE, Timmermann C, Giribaldi B, Sexton JD, Wall MB, Erritzoe D, Roseman L, Nutt D, Carhart-Harris R. Increased global integration in the brain after psilocybin therapy for depression. Nat Med. 2022 Apr;28(4):844-851. doi: 10.1038/s41591-022-01744-z. Epub 2022 Apr 11.
Results Reference
derived
PubMed Identifier
33852780
Citation
Carhart-Harris R, Giribaldi B, Watts R, Baker-Jones M, Murphy-Beiner A, Murphy R, Martell J, Blemings A, Erritzoe D, Nutt DJ. Trial of Psilocybin versus Escitalopram for Depression. N Engl J Med. 2021 Apr 15;384(15):1402-1411. doi: 10.1056/NEJMoa2032994.
Results Reference
derived

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Psilocybin vs Escitalopram for Major Depressive Disorder: Comparative Mechanisms

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