Predicting SSRI Efficacy in Veterans With PTSD

NCT ID: NCT04183205

Last Updated: 2025-04-10

Basic Information

• Recruitment Status: TERMINATED
• Clinical Phase: PHASE4
• Total Enrollment: 26 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2019-09-11
• Study Completion Date: 2025-03-31

Brief Summary

This is a research study to examine the effectiveness of a brief screening method that may predict which people with posttraumatic stress disorder (PTSD) or depression are most likely to show a positive response to selective serotonin reuptake inhibitor (SSRI) medications. Participants will be recruited over approximately 5.25 years, until at least 94 participants complete the 17 week study.

Detailed Description

Selective serotonin reuptake inhibitors (SSRIs) are prescribed to approximately 60% of Veterans with PTSD treated within the Veterans Health Administration (VHA). However, many patients are not responsive to SSRIs. Currently, there is no way to determine whether a particular patient will benefit from an SSRI; treatment is primarily accomplished through 'trial and error' over several weeks or months. The overarching goal of this study is to investigate the pre-treatment usefulness of a simple electrophysiological test for predicting the likelihood of a favorable response to an SSRI. This study will investigate whether a brief pre-treatment auditory event-related potentials procedure [referred to going forward as "Loudness Dependence of Auditory Evoked Potentials" (LDAEP)] offers a means for predicting treatment response to an SSRI for men and women diagnosed with PTSD or depression.

This study has four aims: 1) To determine the strength of the relationship between LDAEP and clinical response to SSRI treatment. 2) To determine LDAEP cut-off values that would enable clinicians to make individualized SSRI treatment recommendations. 3) To assess the usefulness of change in LDAEP as an objective measure of SSRI response. 4) Exploratory: To determine whether the relationship between LDAEP and clinical response to sertraline differs between men and women.

Means to Protect Subjects' Identities:

To ensure confidentiality, questionnaire and interview data will be stored in locked filing cabinets within locked offices. Each participant will have his or her own participant number and these numbers will be the only means by which participant information can be identified. Electronic data will be stored on a secure private, password-protected drive that can only be accessed by members of the study team and labeled only with the participant number. One list of names and participant numbers will be kept on a private, password-protected computer account on a separate drive from the de-identified data and accessible only to the study team.

ADMINISTRATION OF DRUGS IN RESEARCH NOT FUNDED BY NIH Description Of Identification Of Drug: SERTRALINE. Because the goal of this study is to identify pre-treatment predictors of SSRI response that ultimately could be used in routine clinical care, the investigators designed the study with ecological validity in mind. Specifically, the investigators chose sertraline as the study medication because it is: a) the most commonly prescribed SSRI in the US, b) one of only two FDA-approved drugs for treating PTSD, and c) one of the two most effective SSRIs for major depression, a common comorbidity with PTSD. Dosing will follow clinical practice guidelines, i.e., doses will be chosen based on clinical response and tolerability.

Description Of Administration Of Drug: The investigators are using an approach , which represents enhanced clinical care in that participants discuss medication levels, side effects, and symptoms with a psychiatrist every two weeks. Study medication and placebo will be stored and distributed by VA Boston Pharmacy service.

Conditions

Posttraumatic Stress Disorder; Major Depressive Disorder

Study Design

• Allocation Method: NON_RANDOMIZED
• Intervention Model: SEQUENTIAL
• Primary Study Purpose: SCREENING
• Blinding Strategy: DOUBLE

Study Groups

Placebo only arm

For individuals who are placebo responders during the 2 week placebo lead in phase, they will remain on placebo for the duration of the study (i.e., the 12 weeks where the placebo non-responders are taking sertraline).

Group Type: PLACEBO_COMPARATOR

LDAEP

Intervention Type: DIAGNOSTIC_TEST

This is an ERP task in which participants hear a series of tones ranging from 74dB to 104dB and electrophysiological activity is measured throughout. For each participant average P2 scores are derived for the 74dB tones, 84dB tones, 94dB tones, and 104dB tones. Then, LDAEP is defined as the slope of these average P2 scores.

Placebo

Intervention Type: DRUG

placebo pills of the same size, color and taste as the active drug will be administered

Sertraline arm

After the 2-week placebo lead-in phase, placebo-non responders will receive sertraline 25 mg daily for 2 weeks. Thereafter, sertraline will be increased flexibly by 25 to 50 mg per day (at a rate no higher than 50 mg per week) to achieve a total daily dose of 50 to 200 mg, based on clinical response and tolerability, with a maximum dose of 200 mg/d. Subjects unable to tolerate higher doses may be dropped back to the previous dose and remain at that dose for the remainder of the study.

Group Type: ACTIVE_COMPARATOR

LDAEP

Intervention Type: DIAGNOSTIC_TEST

This is an ERP task in which participants hear a series of tones ranging from 74dB to 104dB and electrophysiological activity is measured throughout. For each participant average P2 scores are derived for the 74dB tones, 84dB tones, 94dB tones, and 104dB tones. Then, LDAEP is defined as the slope of these average P2 scores.

Placebo

Intervention Type: DRUG

placebo pills of the same size, color and taste as the active drug will be administered

sertraline

Intervention Type: DRUG

Sertraline is an FDA approved SSRI for treatment of PTSD.

Interventions

LDAEP

This is an ERP task in which participants hear a series of tones ranging from 74dB to 104dB and electrophysiological activity is measured throughout. For each participant average P2 scores are derived for the 74dB tones, 84dB tones, 94dB tones, and 104dB tones. Then, LDAEP is defined as the slope of these average P2 scores.

Intervention Type: DIAGNOSTIC_TEST

Placebo

placebo pills of the same size, color and taste as the active drug will be administered

Intervention Type: DRUG

sertraline

Sertraline is an FDA approved SSRI for treatment of PTSD.

Intervention Type: DRUG

Other Intervention Names

zoloft

Eligibility Criteria

Inclusion Criteria

1. has a history of trauma exposure as defined by criterion A of PTSD in the DSM-5

2. meets diagnostic criteria for PTSD, subthreshold PTSD, or MDD as defined by DSM-5

3. study psychiatrist's judgment that SSRIs are an acceptable treatment option for the participant's presenting concerns, and

4. interest in starting a trial of an SSRI

Exclusion Criteria

• current or past history of bipolar I disorder, schizophrenic or other psychotic disorders
• current organic brain disorder including severe traumatic brain injury, factitious disorder, or malingering
• pregnancy
• major neurological problems
• current moderate or severe substance use disorder
• active risk to self or others
• evidence of clinically significant hepatic or renal disease or any other acute or unstable medical condition that might interfere with safe conduct of the study
• intolerance or hypersensitivity to sertraline
• failed past trial of sertraline (confirmed by medical record review)
• use of drugs that directly affect the serotonin system (e.g., SNRIs, antipsychotics) within 3 months of the study
• use of an SSRI within 3 months of the study. Use of other psychotropic medications must have been stable for 3 months prior to enrollment and remain stable throughout participation
• hearing impairment for 780 Hz tones
• current enrollment in trauma-focused psychotherapy
• for those participants who currently have a non-VA or VA psychiatrist or primary care provider who is willing to prescribe medications, they must be willing to sign a release of information (ROI) for study staff to communicate with their providers and the provider believes that including the participant in the study is potentially appropriate.

• As discussed above, the investigators will inform the participant that the investigators will share the following information with their current relevant care provider:

• If the participant doesn't sign a release of release of information (ROI) to contact the provider, the participant will not be entered into the active study.

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 75 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Middlebury College

UNKNOWN

Sponsor Role: collaborator

Massachusetts General Hospital

OTHER

Sponsor Role: collaborator

Ralph H. Johnson VA Medical Center

FED

Sponsor Role: collaborator

VA Office of Research and Development

FED

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Suzanne Pineles, PhD

Role: PRINCIPAL_INVESTIGATOR

VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA

Locations

VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA

Boston, Massachusetts, United States

Ralph H. Johnson VA Medical Center, Charleston, SC

Charleston, South Carolina, United States

Countries

United States

Other Identifiers

MHBB-028-17F

Identifier Type: -

Identifier Source: org_study_id