Assessing Treatment Emergent Suicidal Ideation in Patients With Major Depression

NCT ID: NCT00532103

Last Updated: 2008-09-22

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

300 participants

Study Classification

OBSERVATIONAL

Study Start Date

2007-07-31

Study Completion Date

2008-02-29

Brief Summary

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This study will develop a new methodology to evaluate any treatment-emergent suicidal ideation that might occur when an antidepressant treatment has been started and/or during times when doses are increased in patients with major depressive disorder.

Detailed Description

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This is a pilot study to begin to develop a measurement procedure to help guide the clinical management of suicide risk in people beginning a type of antidepressant medication called a selective serotonin reuptake inhibitor (SSRI). The goals of the study are: 1) to identify the best method and assessment measures to evaluate the severity of suicidal ideation, 2) to determine the appropriate frequency and duration of assessment required to adequately evaluate this suicidal ideation, 3) to evaluate the presence of symptoms that are associated with suicidal ideation (such as anxiety, panic attacks, difficulty in sleeping) and 4) to identify the most critical time periods during which suicidal ideation appears or worsens (such as how long after initiation of treatment or dosage increase).

In all, 300 adult participants with major depressive disorder (MDD), between the ages of 18 and 75, may be enrolled at primary and psychiatric care sites across the US. All patients will be treated with an SSRI for eight weeks. The choice of SSRI used in treatment will be chosen by the study physician at each site. For this study, physicians will choose from the following six SSRIs: citalopram, escitalopram, sertraline, paroxetine, paroxetine-CR, and fluoxetine.

Patients beginning an SSRI for MDD in "real world" psychiatric and primary care settings, will have clinic visits and receive evaluations of their symptoms of depression, side effects, suicidal thinking and symptoms that are thought to be associated with suicidal risk, every other week for eight weeks. They will be evaluated by phone for symptoms and side effects each week they do not come to the clinic. They will also receive phone calls three times a week for the first two weeks of the study, after beginning the antidepressant, and after a dose increase to evaluate suicide risk.

Conditions

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Depression

Keywords

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Suicidal Ideation Major Depressive Disorder Suicide Risk Antidepressant Medication

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Eligibility Criteria

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Inclusion Criteria

ONLY PATIENTS BEING TREATED AT THE PARTICIPATING CLINICS ARE ELIGIBLE FOR THIS STUDY

* Patients must be enrolled at the primary or specialty care site, and be planning to continue living in the area of that clinic throughout the study
* Patients must be 18-75 years old
* Patients must meet clinical criteria for MDD, based on clinical interview and DSM IV MDD checklist
* Screening HAM-D17 score greater than or equal to 14
* Patients must give written informed consent
* Patients with and without current suicidal ideation may be included in the study
* Patients must not have taken antidepressant medication for at least 2 weeks prior to screen (or 4 weeks in the case of fluoxetine).

Exclusion Criteria

* Current substance abuse or dependence
* Two past SSRI treatment failures within the current episode, or last 2 years if chronic.
* Patients with a current Axis I diagnosis of Bipolar disorder or Schizophrenia
* Patients with a current Primary Axis I diagnosis of Obsessive-Compulsive disorder, Anorexia Nervosa or Bulimia.
* Women who are sexually active and who are not using adequate contraception, or who are pregnant, trying to become pregnant, or breast feeding.
* Patients with general medical conditions that contraindicate antidepressant medications
* Patients whose clinical status requires inpatient treatment at the time of baseline interview.
* Patients who cannot read and understand English since all research instruments are not yet translated and validated in Spanish or other languages.
* Some reports of SSRI-induced akathisia-like states have found them to be more highly correlated with either concurrent or previous treatment with a neuroleptic, even in patients with no history of movement disorders therefore, patients who have taken an anti-psychotic medication within 4 months of the screening visit will be excluded from the study.
Minimum Eligible Age

18 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Institute of Mental Health (NIMH)

NIH

Sponsor Role lead

Responsible Party

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The University of Texas Southwestern Medical Center

Principal Investigators

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Madhukar Trivedi, MD

Role: PRINCIPAL_INVESTIGATOR

University of Texas Southwestern Medical Center

Stephen R. Wisniewski, PhD

Role: STUDY_DIRECTOR

University of Pittsburgh

Diane Warden, PhD, MBA

Role: STUDY_DIRECTOR

University of Texas Southwestern Medical Center

Kathy Shores-Wilson, PhD

Role: STUDY_DIRECTOR

University of Texas Southwestern Medical Center

David W. Morris, PhD

Role: STUDY_DIRECTOR

University of Texas Southwestern Medical Center

Locations

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Tuscalossa VA Mental Health Clinic

Tuscaloosa, Alabama, United States

Site Status

Harbor UCLA Family Health Care Center

Harbor City, California, United States

Site Status

UCLA Internal Medicine Clinic

Los Angeles, California, United States

Site Status

Veterans Affairs Medical Center/FIRM Primary Care Clinic

San Diego, California, United States

Site Status

Northwestern Psychiatric Outpatient Treatment Care Center

Chicago, Illinois, United States

Site Status

Clinical Research Institute

Wichita, Kansas, United States

Site Status

MGH/Northshore Medical Center (Salem Psychiatric Facility)

Salem, Massachusetts, United States

Site Status

General Psychiatric Ambulatory Clinic

Ann Arbor, Michigan, United States

Site Status

Irving Goldman Primary Care at North Shore Hospital

New York, New York, United States

Site Status

UNC Chapel Hill Adult Diagnostic & Treatment Clinic

Chapel Hill, North Carolina, United States

Site Status

Laureate Psychiatric Clinic and Hospital

Tulsa, Oklahoma, United States

Site Status

Bellefield Clinic of WPIC

Pittsburgh, Pennsylvania, United States

Site Status

Vine Hill Community Clinic

Nashville, Tennessee, United States

Site Status

UT Southwestern Family Medicine Clinic

Dallas, Texas, United States

Site Status

VCU Outpatient Psychiatry Clinic

Richmond, Virginia, United States

Site Status

Countries

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United States

References

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Jha MK, Minhajuddin A, South C, Rush AJ, Trivedi MH. Irritability and Its Clinical Utility in Major Depressive Disorder: Prediction of Individual-Level Acute-Phase Outcomes Using Early Changes in Irritability and Depression Severity. Am J Psychiatry. 2019 May 1;176(5):358-366. doi: 10.1176/appi.ajp.2018.18030355. Epub 2019 Mar 29.

Reference Type DERIVED
PMID: 30922100 (View on PubMed)

Gollan JK, Fava M, Kurian B, Wisniewski SR, Rush AJ, Daly E, Miyahara S, Trivedi MH. What are the clinical implications of new onset or worsening anxiety during the first two weeks of SSRI treatment for depression? Depress Anxiety. 2012 Feb;29(2):94-101. doi: 10.1002/da.20917. Epub 2011 Dec 6.

Reference Type DERIVED
PMID: 22147631 (View on PubMed)

Trivedi MH, Wisniewski SR, Morris DW, Fava M, Kurian BT, Gollan JK, Nierenberg AA, Warden D, Gaynes BN, Luther JF, Rush AJ. Concise Associated Symptoms Tracking scale: a brief self-report and clinician rating of symptoms associated with suicidality. J Clin Psychiatry. 2011 Jun;72(6):765-74. doi: 10.4088/JCP.11m06840.

Reference Type DERIVED
PMID: 21733477 (View on PubMed)

Trivedi MH, Wisniewski SR, Morris DW, Fava M, Gollan JK, Warden D, Nierenberg AA, Gaynes BN, Husain MM, Luther JF, Zisook S, Rush AJ. Concise Health Risk Tracking scale: a brief self-report and clinician rating of suicidal risk. J Clin Psychiatry. 2011 Jun;72(6):757-64. doi: 10.4088/JCP.11m06837.

Reference Type DERIVED
PMID: 21733476 (View on PubMed)

Warden D, Trivedi MH, Wisniewski SR, Kurian B, Zisook S, Kornstein SG, Friedman ES, Miyahara S, Leuchter AF, Fava M, Rush AJ. Early adverse events and attrition in selective serotonin reuptake inhibitor treatment: a suicide assessment methodology study report. J Clin Psychopharmacol. 2010 Jun;30(3):259-66. doi: 10.1097/JCP.0b013e3181dbfd04.

Reference Type DERIVED
PMID: 20473060 (View on PubMed)

Other Identifiers

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DSIR AT

Identifier Type: -

Identifier Source: secondary_id

N01MH90003

Identifier Type: NIH

Identifier Source: secondary_id

View Link

N01 MH90003-01

Identifier Type: -

Identifier Source: org_study_id