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Major Depressive Disorder (MDD)Phase 3NCT00958204

Light, Ion, and Fluoxetine Efficacy (LIFE) in Depression

A Phase 3 study testing Light treatment, Negative ion therapy and Fluoxetine in people with Major Depressive Disorder (MDD), run by University of British Columbia at 1 site in Canada.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This study will investigate the additional benefits of light and ion therapy as added treatments to an antidepressant (fluoxetine) in subjects with major depressive disorder (MDD), versus treatment with fluoxetine alone. Read more about this study

Who is it for?
Ages 19 to 60 years
Conditions the study is for
Major Depressive Disorder (MDD)
What is being tested?
Light treatment, Negative ion therapy and Fluoxetine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
134 participants
Where
1 siteCanada
Study dates
Oct 2009to May 2014
Phase
Phase 3
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 19 to 60 years
  • All sexes
  • No healthy volunteers
  • Adult

Who may be able to join

  • Male and female outpatients aged 19-60 years.
  • Patients will meet DSM-IV criteria for major depressive disorder as determined by the mood disorders section of the Mini International Neuropsychiatric Interview (MINI, Sheehan et al, 1998).
  • A score of 20 or greater on the Hamilton Depression Rating Scale (Ham-D), indicating at least moderately severe depression.
  • Competency to give informed consent.

Who cannot join

  • Pregnant women, lactating women and sexually active women of childbearing potential who are not using medically accepted means of contraception.
  • Serious suicidal risks as judged by the clinician and the MINI.
  • The following DSM-IV diagnoses (to ensure a homogeneous diagnostic group): organic mental disorders; substance abuse/dependence, including alcohol, active within the last year; schizophrenia, paranoid, or delusional disorders; other psychotic disorders; panic disorder or generalized anxiety disorder, if a primary diagnosis; obsessive-compulsive disorder or post-traumatic stress disorder; bipolar disorder; bulimia nervosa or anorexia nervosa.
  • Serious illness including cardiac, hepatic, renal, respiratory, endocrinologic, neurologic and hematologic disease that is not stabilized, or a past history of convulsions.
  • Any retinal disease or systemic illness with active retinal involvement (e.g. diabetes) that precludes the use of bright light.
  • Patients who have a history of severe allergies and multiple drug adverse reactions.
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  • Regular or current use of other psychotropic drugs, including lithium and tryptophan.
  • Patients treated with beta blocking drugs.
  • Hypertensive patients being treated with guanethidine, reserpine, clonidine or methyldopa (because of possible mood-altering effects of those drugs).
  • Use of monoamine oxidase inhibitors within 14 days of Visit 1 (to ensure no drug interactions between fluoxetine and MAOIs), or use of heterocyclic antidepressants within 7 days of Visit 1 (to ensure adequate washout period of two weeks between stopping previous drug and start of treatment at Visit 2).
  • Previous use of fluoxetine or light therapy.
  • Treatment resistance in the current episode, as defined by failure (lack of clinically significant response) of two or more antidepressants given at therapeutic doses for at least 6 weeks.
  • Patients who start formal psychotherapy (e.g. cognitive-behavioural or interpersonal psychotherapy) within 3 months of Visit 1, or who plan to initiate such psychotherapy during this study.
  • Patients involved in any other form of treatment for depression.

Trial locations and contacts

1 site in 1 country.

Canada1 site
  • UBC Hospital Mood Disorders Centre

    Vancouver, British Columbia, V6T 2A1

Other trials in Canada

About this study

Official title: Light and Ion Treatment to Enhance Medication Efficacy in Depression

This study will investigate the additional benefits of light and ion therapy as added treatments to an antidepressant (fluoxetine) in subjects with major depressive disorder (MDD), versus treatment with fluoxetine alone. Outcomes will include depressive symptom rating scales and measures of quality of life, work absence and productivity, and use of health care services. The primary hypotheses are that, in patients with nonseasonal major depressive disorder (MDD) of at least moderate severity: 1) bright light therapy or negative ion therapy will be superior to a placebo condition in reducing symptoms of depression, and 2) the combination of fluoxetine and either bright light or negative ion therapy is more effective than either monotherapy condition.

Read the detailed description

Rationale

Many effective treatments exist for depression, including psychotherapies and antidepressant medications. However, antidepressants are not always effective, and they can produce significant side effects and pose a risk of overdose. Medication can also be expensive, thereby limiting accessibility. Furthermore, many people with MDD prefer to use non-pharmacological treatments. Some studies have found that combination antidepressant and psychotherapy is more effective than either monotherapy in people with chronic forms of MDD. However, evidence-based psychotherapies such as cognitive-behavioural therapy are not widely available within the Canadian health care system.

For these reasons, there is great interest in finding alternative treatments to antidepressants and psychotherapy. Bright light therapy, which is well established as an effective treatment for seasonal affective disorder (SAD), has many attributes that make it highly attractive to use for nonseasonal MDD: it is a safe, well-tolerated, inexpensive, easy to use, non-pharmacological treatment that can be used as monotherapy or combined with medications without the worry of drug-drug interactions. The "gold standard" method for applying light therapy is via a 10,000 lux white fluorescent light box for 30 minutes a day, usually in the early morning upon arising from bed. The mechanism of action of light therapy is still unknown, but major hypotheses involve resynchronizing circadian rhythms and/or restoring neurotransmitter dysfunction. Bright light has predictable phase-shifting effects on circadian rhythms in humans, but studies of light therapy have not consistently demonstrated correlations of phase shift with antidepressant response. Although most of these studies have been done in patients with SAD, there is considerable evidence that nonseasonal MDD is also associated with disturbances in circadian rhythms. Other studies have shown that rapidly depleting serotonin and catecholamines can reverse the antidepressant effects of light therapy in SAD, thereby demonstrating monoaminergic effects of bright light similar to those seen with antidepressants. These chronobiologic and monoaminergic effects of bright light provide a rationale for the use of light therapy in nonseasonal MDD. As well, initial studies have shown that negative ion generators may be an effective treatment for neurovegetative symptoms of SAD, specifically oversleeping, overeating, and fatigability. However, relatively few studies have been conducted of light and ion therapy in nonseasonal MDD. Several systematic reviews of light and ion therapy for nonseasonal MDD have shown some support for efficacy, but these are based on a limited number of small-sample, poorly controlled RCTs.

Research Method

This study is an 8-week, multi-centre, double-blind (subject and rater), randomized, parallel-design trial to assess the efficacy of light and ion therapy when combined with fluoxetine in the treatment of subjects with MDD, compared to treatment with fluoxetine alone. A total of 216 depressed patients meeting entry criteria will be enrolled over a three-year period.

Eligible patients will be randomized to one of four treatment conditions for the entire treatment period (8 weeks):

  1. light treatment using a fluorescent light box (30 minutes daily) plus a placebo pill every day; or
  2. negative ion generator (30 minutes daily) plus 20 mg of fluoxetine per day; or
  3. negative ion generator (30 minutes daily) plus placebo pill every day; or
  4. light treatment using a fluorescent light box (30 minutes daily) plus 20 mg of fluoxetine per day.

Half of all devices (light boxes and negative ions) will be deactivated to test placebo conditions.

Outcomes (HAM-D) will be primarily assessed over the telephone by raters blind to treatment assignment. Other outcome measures will be assessed by patient-rated questionnaires administered over the Internet using a secure web site, and by ratings from the treating physician (CGI and Health Economics Assessment).

Statistical Analysis All randomized subjects who have at least one follow-up visit will be included in the analysis based on intent-to-treat. Ineligible subjects who are inappropriately randomized will be excluded from the analysis. Missing data will be imputed using last observation carried forward (LOCF). For the analyses the treatment variables will remain coded and the analysts and investigators will remain blinded to variable identity during analysis and interpretation.

The pre-specified primary efficacy endpoint is the adjusted mean change from baseline to endpoint (8 weeks) in the HAM-D score using LOCF. All comparisons will be analyzed using ANCOVA adjusting for baseline value and centre. The secondary outcomes will also be analyzed using a similar analysis, when appropriate. Post-hoc analyses will also examine observed case data. Categorical data (such as proportions of the sample with adverse events) will be analyzed using chi-square tests or Fisher's test where cell sizes warrant.

Being tested
Light treatment, Negative ion therapy, Placebo, Fluoxetine
Keywords
Depression, rating scales, RCT, combination treatment, light therapy, negative ion therapy, fluoxetine, antidepressants
Medical subject headings
Depressive Disorder, Major, Depression

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Light treatmentProcedure or surgery

    Light therapy: from a 10,000 lux fluorescent white light box, for 30 minutes per day upon waking in the morning, for 8 weeks.

  • Negative ion therapyProcedure or surgery

    Negative ion therapy: from a negative ion generator with an output of 200 trillion ions per second per cubic centimeter, for 30 minutes per day upon waking in the morning, for 8 weeks

  • PlaceboDrug

    Placebo Pill: one oral tablet each day, for 8 weeks.

  • FluoxetineDrug

    Fluoxetine: 20 mg oral tablet each day, for 8 weeks

Study groups in NCT00958204
Study groupRoleWhat they receive
1ExperimentalLight treatment using a fluorescent light box (30 minutes daily) plus a placebo pill every day
Receives: Procedure: Light treatment; Drug: Placebo
2ExperimentalNegative ion generator (30 minutes daily) plus 20 mg of fluoxetine per day
Receives: Procedure: Negative ion therapy; Drug: Fluoxetine
3Active comparatorLight treatment using a fluorescent light box (30 minutes daily) plus 20 mg of fluoxetine per day
Receives: Procedure: Light treatment; Drug: Fluoxetine
4Placebo comparatorNegative ion generator (30 minutes daily) plus placebo pill every day
Receives: Procedure: Negative ion therapy; Drug: Placebo

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change in adjusted HAM-D scores at 2-month follow-up.

    Measured: 2 months

Secondary outcomes (1)
  1. At 2-month follow-up: clinical response and remission rates, absenteeism and work productivity, adverse events, quality of life, and health services.

    Measured: 2 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted13 Aug 2009 (estimated)
  2. Study startOct 2009
  3. Primary completionFeb 2014
  4. Study completionMay 2014

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Double blind
Who is masked
Participant, Outcomes assessor
Enrolment
134 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT00958204
Sponsor's protocol ID
H09-01015
Status last verified
Jun 2014
First submitted
11 Aug 2009
Last updated
6 Jun 2014
Results posted
No
Data monitoring committee
Yes

Publications

  • Levitan RD, Levitt AJ, Michalak EE, Morehouse R, Ramasubbu R, Yatham LN, Tam EM, Lam RW. Appetitive Symptoms Differentially Predict Treatment Response to Fluoxetine, Light, and Placebo in Nonseasonal Major Depression. J Clin Psychiatry. 2018 Jul 24;79(4):17m11856. doi: 10.4088/JCP.17m11856.

    PubMed 30063303
  • Lam RW, Levitt AJ, Levitan RD, Michalak EE, Cheung AH, Morehouse R, Ramasubbu R, Yatham LN, Tam EM. Efficacy of Bright Light Treatment, Fluoxetine, and the Combination in Patients With Nonseasonal Major Depressive Disorder: A Randomized Clinical Trial. JAMA Psychiatry. 2016 Jan;73(1):56-63. doi: 10.1001/jamapsychiatry.2015.2235.

    PubMed 26580307

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Light treatment, Negative ion therapy and Fluoxetine in people with Major Depressive Disorder (MDD), run by University of British Columbia at 1 site in Canada.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 14 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 6 Jun 2014. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Canada. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change in adjusted HAM-D scores at 2-month follow-up. (time frame: 2 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT00958204, which also lists 2 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 6 Jun 2014.

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