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Depressive Disorder, MajorPhase 2NCT03185819

Study to Evaluate the Efficacy and Safety of 3 Fixed Doses of Intranasal Esketamine in Addition to Comprehensive Standard of Care for the Rapid Reduction of the Symptoms of Major Depressive Disorder, Including Suicidal Ideation, in Pediatric Participants Assessed to be at Imminent Risk for Suicide

A Phase 2 study testing Midazolam and Esketamine in people with Depressive Disorder, Major, run by Janssen Research & Development, LLC at 51 sites in 9 countries.

Completed

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

Official record
Search all trials

Trial summary

The purpose of this study is to assess the efficacy of a single (first) dose of 3 fixed doses of intranasal esketamine {28 milligram (mg), 56 mg, and 84 mg} compared with psychoactive placebo (oral midazolam) in rapidly reducing the symptoms of major depressive disorder (MDD) including suicidal ideation in… Read more about this study

Who is it for?
Ages 9 to 17 years
Conditions the study is for
Depressive Disorder, Major
What is being tested?
Midazolam and Esketamine
Type of treatment
Pill or oral medicine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
147 participants
Where
51 sitesin 9 countries
Study dates
5 Oct 2017to 31 Mar 2023
Phase
Phase 2
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 9 to 17 years
  • All sexes
  • No healthy volunteers
  • Child

Who may be able to join

  • Participants must meet diagnostic and statistical manual of mental disorders (5th edition) {DSM-5} diagnostic criteria for major depressive disorder (MDD), without psychotic features, based upon clinical assessment and confirmed by the mini international neuropsychiatric interview for children and adolescents (MINI KID)
  • Participant must have a children's depression rating scale-revised (CDRS-R) total score of equal or more than (>=) 58 predose on Day 1
  • As part of standard of care treatment, participant must agree to be hospitalized voluntarily for a recommended period of 5 days after randomization (may be shorter or longer if clinically warranted in the investigator's opinion)
  • As part of the newly initiated or optimized standard of care treatment, participant must agree to take one of the prescribed non-investigational antidepressant medications (fluoxetine, escitalopram, sertraline; and 9-11 years old participants at US-sites only: fluoxetin [preferred], sertraline) at least during the double-blind treatment phase (Day 25)
  • As part of standard of care treatment, participant must agree to participate in a specific psychological intervention (individual cognitive behavioral therapy [CBT], interpersonal therapy, family therapy or psychodynamic psychotherapy) at least through the initial 8-week post-treatment follow-up period (Day 81)

Who cannot join

  • Participants has a current DSM-5 diagnosis of bipolar (or related disorders), intellectual disability, autism spectrum disorder, conduct disorder, anorexia nervosa, oppositional defiant disorder, or obsessive compulsive disorder
  • Participants currently meets DSM-5 criteria for borderline personality disorder. Participants not meeting full DSM-5 criteria for borderline personality disorder but exhibiting recurrent suicidal gestures, threats, or self-mutilating behaviors should also be excluded
  • Participant has a current or prior DSM-5 diagnosis of a psychotic disorder or MDD with psychosis
  • Participant meets the DSM-5 severity criteria for moderate or severe substance or alcohol use disorder (except for nicotine or caffeine) within the 6 months before screening. A history (lifetime) of ketamine, phencyclidine (PCP), lysergic acid diethylamide (LSD), or 3, 4-methylenedioxy-methamphetamine (MDMA) hallucinogen-related use disorder is exclusionary
  • Participant has a history of seizure disorder

Trial locations and contacts

51 sites in 9 countries.

51 sites in 9 countries

United States18 sites
  • Atlanta Behavioral Research, LLC

    Atlanta, Georgia, 30338

  • Sheppard Pratt Health System

    Baltimore, Maryland, 21204

  • State University of New York at Buffalo

    Buffalo, New York, 14215

  • University North Carolina at Chapel Hill

    Chapel Hill, North Carolina, 27599

  • Rush University Medical Center

    Chicago, Illinois, 60612

  • University of Cincinnati Hospital

    Cincinnati, Ohio, 45219

  • University Hospital of Cleveland

    Cleveland, Ohio, 44106

  • Ohio State University

    Columbus, Ohio, 43210

  • University of Texas Southwestern Medical Center

    Dallas, Texas, 75390-9063

  • CBH Health

    Gaithersburg, Maryland, 20877

  • Institute of Living/ Hartford Hospital

    Hartford, Connecticut, 06106

  • University of Iowa, Carver College of Medicine

    Iowa City, Iowa, 52242

  • Lake Charles Clinical Trials

    Lake Charles, Louisiana, 70629

  • Vanderbilt University Medical Center

    Nashville, Tennessee, 37212

  • Yale University

    New Haven, Connecticut, 06520

  • Beacon Medical Group Clinical Research

    South Bend, Indiana, 46617

  • Neuroscience Research Institute

    Winfield, Illinois, 60190

  • Wake Forest Baptist Medical Center

    Winston-Salem, North Carolina, 27103

Other trials in United States

Spain8 sites
  • Hosp Clinic de Barcelona

    Barcelona, 08036

  • Hosp. Sant Joan de Deu

    Esplugues de Llobregat, 08950

  • Hosp. Gral. Univ. Gregorio Maranon

    Madrid, 28007

  • Hosp. Infantil Univ. Nino Jesus

    Madrid, 28009

  • Hosp. Univ. Pta. de Hierro Majadahonda

    Majadahonda, 28222

  • Hosp. Univ. Central de Asturias

    Oviedo, 33011

  • Clinica Univ. de Navarra

    Pamplona, 31008

  • Corporacio Sanitari Parc Tauli

    Sabadell, 08208

Other trials in Spain

Italy7 sites
  • Azienda Ospedaliera G. Brotzu

    Cagliari, 09134

  • OSP RIUNITI-DIP Donna- Bambino

    Foggia, 71122

  • Ospedale di Merano

    Merano, 39012

  • Azienda Ospedaliera Universitaria Policlinico G. Martino

    Messina, 98125

  • Azienda Ospedaliera Universitaria Federico II

    Naples, 80138

  • IRCCS C. Mondino, Istituto Neurologico Nazionale, Fondazione

    Pavia, 27100

  • Irccs Burlo-Garofalo

    Trieste, 34137

Other trials in Italy

France6 sites
  • Hospices Civils de Lyon HCL

    Bron, 69677

  • CHRU Lille - Hôpital Fontan 1

    Lille, 59000

  • CHU Nantes

    Nantes, 44093

  • Hôpital Universitaire Pitié-Salpêtrière

    Paris, 75013

  • Hopital Sainte Anne

    Paris, 75014

  • Hôpital Robert Debré

    Paris, 75019

Other trials in France

Brazil4 sites
  • Trial Tech Tecnologia em Pesquisas com Medicamentos

    Curitiba, 80240-280

  • Hospital Universitario Professor Edgar Santos

    Salvador, 40110-060

  • CEMEC - Centro Multidisciplinar de Estudos Clínicos

    São Bernardo do Campo, 09715-090

  • Hospital São Sebastião

    Turvo, 88930-000

Other trials in Brazil

Poland3 sites
  • Klinika Psychiatrii Dzieci i Mlodziezy, CM UJ

    Krakow, 31-501

  • Dzieciecy Szpital Kliniczny im Jozefa Polikarpa Brudzinskiego

    Warsaw, 02 091

  • Instytut Psychiatrii i Neurologii Klinika Psychiatrii Dzieci i Mlodziezy

    Warsaw, 02-957

Other trials in Poland

Bulgaria2 sites
  • Mental Health Center - Rousse

    Rousse, 7003

  • Multiprofile Hospital for Active Treatment - MHAT Sveta Marina EAD

    Varna

Other trials in Bulgaria

Hungary2 sites
  • Vadaskert Gyermek es Ifjusagpszichiatriai Korhaz es Szakambulancia

    Budapest

  • Szegedi Tudomanyegyetem

    Szeged

Other trials in Hungary

Belgium1 site
  • Hopital Erasme

    Brussels, 1070

Other trials in Belgium

About this study

Official title: A Double-blind, Randomized, Psychoactive Placebo-controlled, Study to Evaluate the Efficacy and Safety of 3 Fixed Doses (28 mg, 56 mg and 84 mg) of Intranasal Esketamine in Addition to Comprehensive Standard of Care for the Rapid Reduction of the Symptoms of Major Depressive Disorder, Including Suicidal Ideation, in Pediatric Subjects Assessed to be at Imminent Risk for Suicide

The purpose of this study is to assess the efficacy of a single (first) dose of 3 fixed doses of intranasal esketamine {28 milligram (mg), 56 mg, and 84 mg} compared with psychoactive placebo (oral midazolam) in rapidly reducing the symptoms of major depressive disorder (MDD) including suicidal ideation in participants 12 to less than 18 years of age who are assessed to be at imminent risk for suicide.

Read the detailed description

This study will enroll participants with major depressive disorder (MDD) presenting with suicidal ideation who are assessed to be at imminent risk for suicide. The study will be conducted in 4 phases: a screening evaluation performed within 48 hours prior to Day 1 intranasal dose; a 25-day double-blind treatment phase (Days 1-25); an 8-week initial post-treatment phase (Days 25-81); and a subsequent phase to complete a full 6-month post-treatment follow-up (Days 81-200). Efficacy, safety, pharmacokinetic, biomarker, and pharmacogenomic evaluations will be performed in the study at defined schedule. The duration of the participant's participation will be approximately 29 weeks. If you or a loved one are having thoughts of suicide, please seek immediate medical help. Go to the emergency room or call the National Suicide Prevention Lifeline at 1-800-273-8255.

Being tested
Intranasal Placebo, Midazolam Placebo Solution, Midazolam, Esketamine
Medical subject headings
Depressive Disorder, Major

What participants receive

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

  • Intranasal PlaceboDrug

    Participants will receive placebo as intranasal dose to match intranasal esketamine.

  • Midazolam Placebo SolutionDrug

    Participants will receive placebo as oral dose to match midazolam drug.

  • MidazolamDrug

    Participants will receive midazolam solution 0.125 mg/kg as oral dose to match placebo.

  • EsketamineDrug

    Participants will receive esketamine at a dose of 28 mg as intranasal solution.

  • EsketamineDrug

    Participants will receive esketamine at a dose of 56 mg as intranasal solution.

  • EsketamineDrug

    Participants will receive esketamine at a dose of 84 mg as intranasal solution.

Study groups in NCT03185819
Study groupRoleWhat they receive
Oral Midazolam + Intranasal PlaceboPlacebo comparatorParticipants will receive midazolam solution 0.125 milligram per kilogram (mg/kg) orally 2 times per week for 4 weeks and 3 intranasal doses of matched placebo to esketamine.
Receives: Drug: Intranasal Placebo; Drug: Midazolam
Oral Placebo + Esketamine 84 mgExperimentalParticipants will receive intranasal esketamine 84 mg as 3 intranasal doses of esketamine in each nostril (each dose contains 14 mg of esketamine) along with oral placebo 2 times per week for 4 weeks.
Receives: Drug: Midazolam Placebo Solution; Drug: Esketamine
Oral Placebo + Esketamine 56 mgExperimentalParticipants will receive intranasal esketamine 56 mg as 2 intranasal doses of esketamine in each nostril (each dose contains 14 mg of esketamine) along with oral placebo 2 times per week for 4 weeks.
Receives: Drug: Midazolam Placebo Solution; Drug: Esketamine
Oral Placebo + Esketamine 28 mgExperimentalParticipants will receive intranasal esketamine 28 mg as 1 intranasal doses of esketamine in each nostril (each dose contains 14 mg of esketamine) along with oral placebo 2 times per week for 4 weeks.
Receives: Drug: Midazolam Placebo Solution; Drug: Esketamine

What is being measured

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

  1. Change From Baseline in Children's Depression Rating Scale-Revised (CDRS-R) Total Score at 24 Hours Post First Dose (Day 2)

    The CDRS-R is a validated 17- item, clinician-rated instrument developed to assess depressive symptomatology in children. Scores were based on interviews with both the child and their caregiver. Of the 17-item, 3 items were non-verbal behavior (listless speech, hypoactivity, and depressed affect) rated on a 5-point scale from 1 (no depression) to 5 (severe depression) and 14 items were rated on a 7-point scale from 1 (no depression) to 7 (severe depression), where higher score indicated more severe depression. The CDRS-R total score was the sum of the 17-tems score and it ranged from 17 (normal) to 113 (severe depression). Higher score indicated more severe depression and worse outcome.

    Measured: Baseline (predose on Day 1) and 24 hours post first dose on Day 1 (i.e., Day 2)

Timeline

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

  1. First posted14 Jun 2017
  2. Study start5 Oct 2017
  3. Primary completion31 Mar 2023
  4. Study completion31 Mar 2023

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 2
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Double blind
Who is masked
Participant, Investigator
Enrolment
147 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03185819
Sponsor's protocol ID
CR108323
Other IDs
2016-004422-42, ESKETINSUI2002, 2016
Status last verified
Apr 2025
First submitted
12 Jun 2017
Last updated
29 Apr 2025
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
Expanded access
Available

Publications

  • Kosik-Gonzalez C, Fu DJ, Chen LN, Lane R, Bloch MH, DelBello M, Moreno C, Drevets WC, Canuso CM. Effect of Esketamine on Depressive Symptoms in Adolescents With Major Depressive Disorder at Imminent Suicide Risk: A Randomized Psychoactive-Controlled Study. J Am Acad Child Adolesc Psychiatry. 2026 Jan;65(1):42-55. doi: 10.1016/j.jaac.2025.02.015. Epub 2025 Mar 7.

    PubMed 40058488

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Midazolam and Esketamine in people with Depressive Disorder, Major, run by Janssen Research & Development, LLC at 51 sites in 9 countries.

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 5 inclusion and 5 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 29 Apr 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 51 sites in United States, Spain, Italy, France, Brazil and 4 more countries. 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 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

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 17 Apr 2024). 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?

Change From Baseline in Children's Depression Rating Scale-Revised (CDRS-R) Total Score at 24 Hours Post First Dose (Day 2) (time frame: Baseline (predose on Day 1) and 24 hours post first dose on Day 1 (i.e., Day 2)). 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 NCT03185819, which also lists 1 linked publication.

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 29 Apr 2025.

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