Concomitant administration of quetiapine (Seroquel®) in cognitive-behavioural therapy for refractory depression: a 12-week placebo-controlled study

• Register: ISRCTN
• Last refreshed on: 13 January 2015
• Main ID: ISRCTN12638696
• Date of registration: 19/10/2007
• Prospective Registration: No
• Primary sponsor: Astra Zeneca Canada Inc.
• Public title: Concomitant administration of quetiapine (Seroquel®) in cognitive-behavioural therapy for refractory depression: a 12-week placebo-controlled study
• Date of first enrolment: 23/05/2002
• Target sample size: 32
• Recruitment status: Completed
• URL: http://isrctn.com/ISRCTN12638696
• Study type: Interventional
• Study design: Randomized, double-blind, placebo-controlled trial. (Treatment)

Countries of recruitment

Canada

Contacts

• Name: Yves Chaput

Key inclusion & exclusion criteria

Inclusion criteria: 1. Males and females between the ages of 18 and 70.
2. Signed an informed consent form and have the capacity to follow the course of the study.
3. Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV) criteria for depression (unipolar) as well as a Hamilton depression rating scale (HAMD, 21 items) score of 20 or greater at screen (day 0) and 18 or over at randomization (day 28).
4. A Clinical Global Impression (severity scale) score of 4 or greater.
5. Patients will be required to have a diagnosis of refractory major depression as determined by having had;
5.1. At least two sequential 8 week treatments with two different classes of antidepressants. For instance, an 8 week treatment with a Selective Serotonin Reuptake Inhibitor (SSRI) + an atypical antidepressant or alternatively, a SSRI + a TriCyclic Antidepressant (TCA) (this latter class would include venlafaxine) or alternatively, a SSRI + a monoamine oxidase inhibitor. All antidepressants would have had to be administered at the following doses:
a. Venlafaxine (regular venlafaxine 300 mg/day; venlafaxine 'Extended Release' (venlafaxine XR) 225 mg/day, for at least 3 of the 8 weeks)
b. A tricyclic antidepressant (minimum dose of 150 mg/day equivalent of imipramine for 3 of the 8 weeks)
c. A SSRI (at a minimum 40 mg/day for fluoxetine, 30 mg/day for paroxetine and citalopram, 150 mg/day of sertraline and 250 mg/day for fluvoxamine for 3 of the 8 weeks)
d. Moclobemide (600 mg/day for 3 of the 8 weeks)
e. Nefazodone (500 mg/day for 3 of the 8 weeks)
f. Bupropion (250 mg/day for 3 of the 8 weeks)
g. An irreversible monoamnie oxidase inhibitor (at maximum posology for 3 of the 8 weeks)
Exclusion criteria: 1. Patients who in the investigator's opinion pose a current risk of suicide.
2. Women of childbearing potential who are pregnant, planning pregnancy in the next 6 months, breast-feeding, or not using medically adequate means of birth control (abstinence, hormonal treatment, Intrauterine Device [IUD]).
3. Any of the following DSM-IV diagnoses: schizophrenia or any other chronic psychotic disorder, personality disorder, panic disorder, generalized anxiety disorder, obsessive-compulsive disorder, somatoform disorder, anorexia nervosa, bulimia, organic mental disorder.
4. Definite or suspected substance abuse in the past 12 months.
5. Serious or unstable medical illness or any co-existing disease or treatment that in the opinion of the investigator contraindicates the use of study drug.
6. Treatment with other psychotropic drugs (prescription or not) other than zopiclone 7.5 mg or temazepam, 15 to 30 mg on a prn ("when necessary") basis for insomnia.
7. Clinically significant laboratory abnormalities at screen.
8. Positive urine screen for drugs of abuse.
9. Known or suspected allergies to psychotropic drugs.
10. Use of any of the following potent cytochrome P450 inhibitors in the 14 days preceding randomization (Day 1) e.g. ketoconazole, itraconazole, fluconazole, erythromycin, clarithromycin, troleandomycin, indinavir, nelfinavir, tironavir, and saquinavir.
11. Use of potent P450 inducers (e.g. phenytoin, carbamazepine, barbiturates, rifampin, glucorticoids) in the 14 days preceding randomization (Day 1).
12. Thyroid-stimulating hormone concentration more than 10% above the upper limit of the normal range, regardless of treatment for hypothyroidism or hyhperthyroidism.

Age minimum:
Age maximum:
Gender: Both

Health Condition(s) or Problem(s) studied

Depression
Mental and Behavioural Disorders
Depression

Intervention(s)

The participants were recruited at the following two sites:
1. The Nore-Dame Hosptial, the University of Montreal, Quebec, Canada
2. The city of Saint-Jean-sur-Richelieu, Quebec, Canada

In order to confirm that patients are indeed refractory all candidates will undergo an initial open phase of antidepressant potentiation using lithium carbonate (at least 600 mg per day) for three weeks. The antidepressant dose of patients currently receiving either TCAs, venlafaxine or SSRIs will be set as close as possible to the maximum recommended therapeutic dose for the three week period. Primary assessment variables will be reassessed at day 21 (HAMD and the Clinical Global Impression of Severity [CGI-S]/ Clinical Global Impression of Improvement [CGI-I]). A reduction equal or greater than 40% of the initial HAMD score will classify the patient as a responder. Responders will be tapered off lithium and referred back to their attending physicians following this three week period. Treatment with lithium for three weeks should be sufficient to maintain response in these patients now taking their initial antidepressant only. As lithium potentiation has not been extensively investigated with the newer atypical antidepressants, patients currently receiving buproprion, nefazodone or moclobemide who nevertheless wish to participate in the study will be switched to venlafaxine XR for a period of five weeks prior to the three week lithium potentiation.

Following this initial phase, non-responders will be tapered of their medication (lithium and antidepressant) during a one week period and subsequently randomized to one of two treatment groups; CBT and placebo or CBT and quetiapine. CBT will be administered in 12 weekly two hour CBT sessions given in an individual setting. Individual, rather than group CBT treatment is chosen as there is evidence to suggest that group CBT may be less efficacious in alleviating depressive symptomatology than individually administered CBT. The CBT pa

Primary Outcome(s)

Primary efficacy variables will be reassessed (HAMD, the Montgomery-Asberg Depression Rating Scale [MADRS] and CGI-S/CGI-I) on day 21 and 28 as well as every two weeks thereafter by raters blind to the treatment.

Secondary Outcome(s)

Assessment of the secondary variables (Extrapyramidal Symptom Rating Scale [ESRS], the Barnes' Akathisia Rating scale and the Heinrich Quality of Life Scale [HQL]) will be performed again at day 112.

Secondary ID(s)

5077-9016

Source(s) of Monetary Support

Astra Zeneca Canada Inc. (Investigator initiated trial)