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DepressionPhase 4NCT02989727

Melancholic Symptoms in Bipolar Depression and Responsiveness to Lamotrigine

A Phase 4 study testing Lamotrigine in people with Depression and Bipolar Disorder, run by University of Saskatchewan 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

The purpose of this study is to determine if patients with melancholic bipolar II depression are more responsive to lamotrigine than patients with non-melancholic bipolar II depression. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Depression, Bipolar Disorder, Bipolar Depression
What is being tested?
Lamotrigine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
150 participants
Where
1 siteCanada
Study dates
Nov 2003to Dec 2017
Phase
Phase 4
Are there results?
Yes, posted in the registrySummary in the doctors' view

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 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patients must provide written and informed consent.
  • Diagnosis of Bipolar II Disorder and currently depressed for minimum of the last 8 weeks, with a HAMD-17 score of at least 18 with scores of 3 or more on Items 1 or 7.
  • For females, be of non-childbearing potential, or of childbearing potential with a negative pregnancy test at screening and agrees to one of (a) abstinence from sex two weeks prior and five days after drug continuation/discontinuation, (b) personal or partner sterilization, (c) one method of hormonal contraception, or (d) two barrier methods of contraception.
  • Acceptable results (within two times the normal limit) on laboratory screening tests (e.g., thyroid function).

Who cannot join

  • Active suicidality.
  • History of non-response to antidepressant treatment, or any previous treatment with lamotrigine.
  • History of substance dependence in the past year, or abuse within the 4 weeks prior to study entry.
  • Rapid cycling bipolar disorder.
  • Receiving additional psychoactive medication (not including lorazepam for agitation), or has started a new course of psychotherapy within the last month.
  • Received treatment for an anxiety or eating disorder within the last 12 months.
  • Investigational drug use within the last month.
  • History of epilepsy.

Trial locations and contacts

1 site in 1 country.

Canada1 site
  • Department of Psychiatry, Royal University Hospital

    Saskatoon, Saskatchewan, S7N0W8

Other trials in Canada

About this study

Official title: Melancholic Symptoms in Bipolar Depression and Responsiveness to Lamotrigine: Results From an 8-week, Multicenter, Double-blind, Placebo-controlled Trial

The purpose of this study is to determine if patients with melancholic bipolar II depression are more responsive to lamotrigine than patients with non-melancholic bipolar II depression. To do this, the investigators will re-analyze a previous clinical trial that evaluated lamotrigine as a treatment for bipolar II depression (GSK-SCA100223; NCT00274677).

Read the detailed description

Patients suffering from depression with melancholic symptoms (i.e., anhedonia, flat affect, diurnal mood variation, terminal insomnia, psychomotor disturbances, decreased weight/appetite, and excessive guilt) respond better to certain antidepressants. Melancholic symptoms also occur in bipolar depression, although they have received less research. Lamotrigine has been shown to alter some of the biological processes that are known to occur in melancholic depression. The purpose of this study is to determine if patients with melancholic bipolar II depression are more responsive to lamotrigine than patients with non-melancholic bipolar II depression.

This study will re-analyze data from a previous 8-week, randomized, placebo-controlled trial that evaluated lamotrigine as a treatment for bipolar II depression (GSK-SCA100223; NCT00274677). The original study data was made available by GlaxoSmithKline as part of an initiative to make clinical trials data available for research use. Access was applied for via https://www.clinicalstudydatarequest.com.

The analysis strategy will be comparable to the original study, although the investigators will first classify participants as suffering from either melancholic or non-melancholic depression. The diagnosis of melancholic depression was established according to baseline responses to the Hamilton Depression Rating Scale (HAMD-17) and the Montgomery-Åsberg Depression Rating Scale (MADRS), according to the DSM-IV-TR diagnostic criteria. HAMD-17 and MADRS change scores will be compared between the treatment and placebo groups using Analysis of Variance (ANOVA). Both ANOVA models will include a test for an interaction between treatment group (lamotrigine vs. placebo) and melancholic depression (melancholic depression vs. non-melancholic depression). To handle missing data, each ANOVA model will be computed with only complete-case data first and subsequently using inverse probability weights that account for the probability of drop out. Inverse probability weights will be created based on covariates that predict missing responses. HAMD-17 and MADRS response rates between the treatment and placebo groups will be evaluated with a Cox proportional hazard regression analysis. There will be two separate analyses, one including participants with melancholic depression, and one including participants with non-melancholic depression. Statistical models will also adjust for baseline depression severity, if participants with melancholic depression are found to have more severe depressive symptoms at baseline.

Given the delay between antidepressant initiation and response, trial-and-error prescribing is an inevitably lengthy process. The investigators hope the results of this study will enable more timely and effective treatment for patients with bipolar depression.

Being tested
Lamotrigine, Placebos
Medical subject headings
Depression, Bipolar Disorder, Depressive Disorder

What participants receive

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

  • LamotrigineDrug

    Also called Lamictal

    Lamotrigine tablets at dosages of 25mg/day for Week 1 and Week 2, 50mg/day for Week 3 and Week 4, 100mg/day for Week 5, and 200mg/day for Week 6, Week 7, and Week 8.

  • PlacebosDrug

    Also called Placebo

    Placebo tablets

Study groups in NCT02989727
Study groupRoleWhat they receive
Lamotrigine - melancholic depressionExperimentalParticipants with melancholic depression who were randomly assigned to receive lamotrigine tablets escalated to a target dose of 200mg/day.
Receives: Drug: Lamotrigine
Placebo - melancholic depressionPlacebo comparatorParticipants with melancholic depression who were randomly assigned to receive a placebo comparator.
Receives: Drug: Placebos
Lamotrigine - nonmelancholic depressionExperimentalParticipants not meeting DSM-IV-TR diagnostic criteria for melancholic depression who were randomly assigned to receive lamotrigine tablets escalated to a target dose of 200mg/day.
Receives: Drug: Lamotrigine
Placebo - nonmelancholic depressionPlacebo comparatorParticipants not meeting DSM-IV-TR diagnostic criteria for melancholic depression who were randomly assigned to receive a placebo comparator.
Receives: Drug: Placebos

What is being measured

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

  1. Montgomery-Asberg Depression Rating Scale (MADRS) Change Scores

    Scale scores range from 0 to 60. This outcome is a change score calculated by subtracting Baseline from Week 8 scores.

    Lower scores indicate greater improvement of depressive symptoms.

    Measured: Eight weeks

  2. Hamilton Depression Rating Scale (HAMD-17) Change Scores

    Scale scores range from 0 to 52. This outcome is a change score calculated by subtracting Baseline from Week 8 scores.

    Lower scores indicate greater improvement of depressive symptoms.

    Measured: Eight weeks

  3. Number of Participants With 50% Reduction in the Montgomery-Asberg Depression Rating Scale (MADRS)

    Scale scores range from 0 to 60. A response is defined as a score reduction from baseline of at least 50%.

    Measured: Eight weeks

  4. Number of Participants With 50% Reduction in the Montgomery-Asberg Depression Rating Scale (MADRS)

    Scale scores range from 0 to 60. A response is defined as a score reduction from baseline of at least 50%.

    Measured: Seven weeks

  5. Number of Participants With 50% Reduction in the Montgomery-Asberg Depression Rating Scale (MADRS)

    Scale scores range from 0 to 60. A response is defined as a score reduction from baseline of at least 50%.

    Measured: Six weeks

  6. Number of Participants With 50% Reduction in the Montgomery-Asberg Depression Rating Scale (MADRS)

    Scale scores range from 0 to 60. A response is defined as a score reduction from baseline of at least 50%.

    Measured: Five weeks

  7. Number of Participants With 50% Reduction in the Montgomery-Asberg Depression Rating Scale (MADRS)

    Scale scores range from 0 to 60. A response is defined as a score reduction from baseline of at least 50%.

    Measured: Four weeks

  8. Number of Participants With 50% Reduction in the Montgomery-Asberg Depression Rating Scale (MADRS)

    Scale scores range from 0 to 60. A response is defined as a score reduction from baseline of at least 50%.

    Measured: Three weeks

  9. Number of Participants With 50% Reduction in the Montgomery-Asberg Depression Rating Scale (MADRS)

    Scale scores range from 0 to 60. A response is defined as a score reduction from baseline of at least 50%.

    Measured: Two weeks

  10. Number of Participants With 50% Reduction in the Montgomery-Asberg Depression Rating Scale (MADRS)

    Scale scores range from 0 to 60. A response is defined as a score reduction from baseline of at least 50%.

    Measured: One week

  11. Number of Participants With 50% Reduction in the Hamilton Depression Rating Scale (HAMD-17)

    Scale scores range from 0 to 52. A response is defined as a score reduction from baseline of at least 50%.

    Measured: Eight weeks

  12. Number of Participants With 50% Reduction in the Hamilton Depression Rating Scale (HAMD-17)

    Scale scores range from 0 to 52. A response is defined as a score reduction from baseline of at least 50%.

    Measured: Seven weeks

  13. Number of Participants With 50% Reduction in the Hamilton Depression Rating Scale (HAMD-17)

    Scale scores range from 0 to 52. A response is defined as a score reduction from baseline of at least 50%.

    Measured: Six weeks

  14. Number of Participants With 50% Reduction in the Hamilton Depression Rating Scale (HAMD-17)

    Scale scores range from 0 to 52. A response is defined as a score reduction from baseline of at least 50%.

    Measured: Five weeks

  15. Number of Participants With 50% Reduction in the Hamilton Depression Rating Scale (HAMD-17)

    Scale scores range from 0 to 52. A response is defined as a score reduction from baseline of at least 50%.

    Measured: Four weeks

  16. Number of Participants With 50% Reduction in the Hamilton Depression Rating Scale (HAMD-17)

    Scale scores range from 0 to 52. A response is defined as a score reduction from baseline of at least 50%.

    Measured: Three weeks

  17. Number of Participants With 50% Reduction in the Hamilton Depression Rating Scale (HAMD-17)

    Scale scores range from 0 to 52. A response is defined as a score reduction from baseline of at least 50%.

    Measured: Two weeks

  18. Number of Participants With 50% Reduction in the Hamilton Depression Rating Scale (HAMD-17)

    Scale scores range from 0 to 52. A response is defined as a score reduction from baseline of at least 50%.

    Measured: One week

Timeline

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

  1. First posted12 Dec 2016 (estimated)
  2. Study startNov 2003
  3. Primary completionAug 2005
  4. Study completionDec 2017

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 4
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Double blind
Who is masked
Participant, Investigator
Enrolment
150 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02989727
Sponsor's protocol ID
GSK-SCA100223
Status last verified
Sep 2018
First submitted
8 Dec 2016
Last updated
15 Feb 2019
Data monitoring committee
No
Individual data sharing
Yes: Patient-level data for the study (GSK-SCA100223; NCT00274677) is available through www.clinicalstudydatarequest.com.

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Lamotrigine in people with Depression and Bipolar Disorder, run by University of Saskatchewan 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 8 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 15 Feb 2019. 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 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

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

Are results available for this study?

Yes. Results are posted in the registry (first posted 15 Feb 2019). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

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?

Montgomery-Asberg Depression Rating Scale (MADRS) Change Scores (time frame: Eight weeks). The study lists 18 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
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 15 Feb 2019.

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