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Major Depressive DisorderPhase 4NCT04975100

Evaluation of Efficacy and Safety of add-on Sarcosine in Patients With Major Depressive Disorder

A Phase 4 study testing Sarcosine and SSRI in people with Major Depressive Disorder, run by All India Institute of Medical Sciences, Bhubaneswar at 1 site in India.

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

One-third of the patients with major depressive disorder do not respond to conventional antidepressants that act through the mono-aminergic system. The available treatment modalities, including SSRIs, are slow to act and have a lag time before showing improvement in symptoms of patients. Read more about this study

Who is it for?
Ages 18 to 65 years
Conditions the study is for
Major Depressive Disorder
What is being tested?
Sarcosine and SSRI
Type of treatment
Pill or oral medicine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
60 participants
Where
1 siteIndia
Study dates
26 Aug 2021to 30 Apr 2023
Phase
Phase 4
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 18 to 65 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patients aged 18-65 years, of either gender with the clinical diagnosis of major depressive disorder (DSM 5).
  • Patients with MADRS score ≥ 7 and ≤ 34 (Mild to moderate severity).
  • Patients who are on a stable dose of Sertraline 50 mg or any other SSRI (selective serotonin reuptake inhibitor) therapy in equivalent dose.
  • Patients who have given informed written consent.

Who cannot join

  • Major depressive patient treated with Electro Convulsive Therapy recently.
  • History of epilepsy, head trauma, or other major neurological or medical disorders.
  • Patients with a history of bipolar depression.
  • Patients with schizophrenia or other psychotic disorder.
  • Patients with suicidal risk.
  • Patients with cognitive impairment.
Show all 10Show fewer
  • Initiating or stopping formal psychotherapy within six weeks before enrolment.
  • Patients with comorbidities like any malignancies, hepatic, renal, cardiovascular, neurological or endocrinal, respiratory dysfunction.
  • Substance abuse history of psychoactive agents.
  • Pregnant and lactating mothers.

Trial locations and contacts

1 site in 1 country.

India1 site
  • AIIMS

    Bhubaneswar, Odisha, 751019

Other trials in India

About this study

Official title: Evaluation of Efficacy and Safety of add-on Sarcosine in Patients With Major Depressive Disorder: A Randomized Controlled Trial

One-third of the patients with major depressive disorder do not respond to conventional antidepressants that act through the mono-aminergic system. The available treatment modalities, including SSRIs, are slow to act and have a lag time before showing improvement in symptoms of patients. To overcome these treatment hurdles, add-on therapy to standard antidepressant drugs may lead to better therapeutic outcomes. Sarcosine, which is a nutraceutical, modulates glutamate neurotransmission has an ameliorative effect on the disease symptoms of depression and negative symptoms of schizophrenia. The only clinical study done on depressive patients by Huang et al. cannot be generalized due to certain inherent limitations. To date, there is no randomized controlled trial with add-on sarcosine to current antidepressant therapy to the best of our knowledge. So, we considered sarcosine can be the candidate drug for add-on therapy due to its multiple mechanisms on the glutaminergic system. Adding sarcosine to ongoing antidepressant therapy may either increase their response rate or decrease adverse drug reactions by decreasing the dose requirement or may show a quicker therapeutic effect. Hence, the present randomized controlled trial has been planned to evaluate the efficacy and safety of sarcosine as add-on therapy in major depressive disorder.

Read the detailed description

Major depressive disorder or unipolar depression is a commonly encountered psychiatric disorder, with reported lifetime and one-year prevalence rates of 16.6% and 6.6%, respectively, and is associated with an increased risk of suicide. It is estimated that more than 264 million of the global population have suffered from depression. Major depressive disorder causes significant disabilities, thus adversely affects the quality of life of patients and their caregivers. Despite the clinical significance of depression, its underlying pathophysiology is still not understood comprehensibly, and different potential targets have been explored. One of the most well-researched theories of previous decades has been the monoamine hypothesis; however, it appears that simple monoamine depletion is insufficient to account for the development of the disorder. Drugs acting through enhancing the monoaminergic pathway, i.e., increasing the synaptic concentration of serotonin, noradrenaline, or dopamine, are the most commonly prescribed antidepressant medication in the last five decades. Among them, second-generation antidepressant drugs like selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs) are the most effective and most widely used nowadays.

N-Methyl D-Aspartate receptor (NMDAR) modulation is one of the leading novel mechanisms in the pathophysiology of depression that has been postulated for the treatment of depression. The NMDA hypothesis originated from an unexpected observation that D-cycloserine, a partial agonist of the NMDAR, has antidepressant activity. Also, NMDA-enhancing treatment results in a significant reduction in depressive symptoms in patients with schizophrenia. It has also been observed that major depression is associated with decreased expression and release of brain-derived neurotrophic factors (BDNF).

Sarcosine (N-Methyl Glycine), an endogenous amino acid with NMDA receptor function enhancing property, is usually used as a dietary supplement or nutraceutical. Sarcosine increases the availability of glycine for the glycine binding site of the NMDA receptor by inhibiting its reuptake from the synaptic cleft. It also possesses glycine binding site co-agonistic activity. In various animal studies, it has been found that long-term sarcosine treatment significantly ameliorated the induced depression, confirming the potential role of sarcosine as an antidepressant agent. Huang et al. and Chen et al. have demonstrated antidepressant effects of sarcosine in animal behavior models of depression. The only clinical trial of sarcosine done on depressive patients by Huang et al. has shown better and quicker response with superior tolerability as compared to citalopram.

Therapeutic latency, lack of efficacy in a significant proportion of patients, and adverse drug reactions are the primary concerns in current antidepressant therapies. To overcome these treatment challenges, add-on therapy to standard antidepressant drugs may lead to better therapeutic outcomes. Our literature search found that to date, there is no randomized controlled trial on sarcosine as an add-on therapy to first-line antidepressants like SSRIs. The result of the previous study by Huang et al. cannot be generalized because of the inherent limitations in study design. So, the present randomized controlled trial has been planned to evaluate the efficacy and safety of add-on sarcosine to SSRIs in major depressive disorder.

Being tested
Sarcosine and SSRI, Placebo and SSRI
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.

  • Sarcosine and SSRIDrug

    Patients in the test group will get Sarcosine 500 mg capsules once daily as an add-on to ongoing SSRI treatment

  • Placebo and SSRIDrug

    Patients in the control group will get identical-looking capsules containing placebo in addition to SSRI at an once daily dose

Study groups in NCT04975100
Study groupRoleWhat they receive
TestExperimentalPatients in the test group will get Sarcosine 500 mg capsules once daily as an add-on to ongoing SSRI treatment.
Receives: Drug: Sarcosine and SSRI
ControlActive comparatorPatients in the control group will get identical-looking capsules containing placebo in addition to SSRI at an once daily dose
Receives: Drug: Placebo and SSRI

What is being measured

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

  1. Change in severity of depressive symptoms from baseline.

    The change in symptoms of depression will be evaluated using Montgomery Asberg Depression Rating Scale score. Each item of the questionnaire yields a score of 0 to 6. The overall score ranges from 0 to 60. A higher score indicates more severe depression.

    Measured: 8 weeks

Secondary outcomes (7)
  1. Response rate

    Response rate is defined by percentage of patients showing 50% decrease in MADRS scores from baseline.

    Measured: 8 weeks

  2. Remission rate

    Remission rate is defined by percentage of patients achieving MADRS scores <7 at 8-week follow-up.

    Measured: 8 weeks

  3. Severity of symptoms

    Severity of symptoms at baseline will be assessed by Clinical Global Impression severity scale. The Clinical Global Impression Severity scale is a 7-point scale that requires the clinician to rate the severity of the patient's illness. A higher score reflects more severe illness.

    Measured: Baseline

  4. Change in severity of symptoms

    Change in severity of symptoms will be assessed by Clinical Global Impression Improvement scale. The Clinical Global Impression Improvement scale is a 7 point scale that requires the clinician to assess how much the patient's illness has improved or worsened relative to a baseline state at the beginning of the intervention. A lower value reflects better improvement of symptoms.

    Measured: 8 weeks

  5. Change in serum Brain Derived Neurotrophic Factor (BDNF) from baseline

    Serum BDNF levels will be measured using a commercially available human enzyme-linked immunosorbent assay (ELISA) kit.

    Measured: 8 weeks

  6. Change in serum Glycine from baseline

    Serum Glycine levels will be measured using a commercially available human enzyme-linked immunosorbent assay (ELISA) kit.

    Measured: 8 weeks

  7. Incidence of adverse drug reactions

    During the follow-up visit, occurrence of adverse events will be assessed by the nondirective questioning to the patient.

    Measured: 8 weeks

Timeline

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

  1. First posted23 Jul 2021
  2. Study start26 Aug 2021
  3. Primary completion30 Apr 2023
  4. Study completion30 Apr 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 4
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Double blind
Who is masked
Participant, Investigator
Enrolment
60 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04975100
Sponsor's protocol ID
IEC/AIIMSBBSR/PGThesis/21/07
Status last verified
Jul 2023
First submitted
14 Jul 2021
Last updated
25 Jul 2023
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided: It will be decided later.

Publications

  • Kessler RC, Berglund P, Demler O, Jin R, Koretz D, Merikangas KR, Rush AJ, Walters EE, Wang PS; National Comorbidity Survey Replication. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA. 2003 Jun 18;289(23):3095-105. doi: 10.1001/jama.289.23.3095.

    PubMed 12813115
  • Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005 Jun;62(6):593-602. doi: 10.1001/archpsyc.62.6.593.

    PubMed 15939837
  • Hawton K, van Heeringen K. Suicide. Lancet. 2009 Apr 18;373(9672):1372-81. doi: 10.1016/S0140-6736(09)60372-X.

    PubMed 19376453
  • Hasler G. Pathophysiology of depression: do we have any solid evidence of interest to clinicians? World Psychiatry. 2010 Oct;9(3):155-61. doi: 10.1002/j.2051-5545.2010.tb00298.x.

    PubMed 20975857
  • Ruhe HG, Mason NS, Schene AH. Mood is indirectly related to serotonin, norepinephrine and dopamine levels in humans: a meta-analysis of monoamine depletion studies. Mol Psychiatry. 2007 Apr;12(4):331-59. doi: 10.1038/sj.mp.4001949. Epub 2007 Jan 16.

    PubMed 17389902
  • Perez-Caballero L, Torres-Sanchez S, Romero-Lopez-Alberca C, Gonzalez-Saiz F, Mico JA, Berrocoso E. Monoaminergic system and depression. Cell Tissue Res. 2019 Jul;377(1):107-113. doi: 10.1007/s00441-018-2978-8. Epub 2019 Jan 10.

    PubMed 30627806
  • Pochwat B, Nowak G, Szewczyk B. An update on NMDA antagonists in depression. Expert Rev Neurother. 2019 Nov;19(11):1055-1067. doi: 10.1080/14737175.2019.1643237. Epub 2019 Jul 22.

    PubMed 31328587
  • Phillips C. Brain-Derived Neurotrophic Factor, Depression, and Physical Activity: Making the Neuroplastic Connection. Neural Plast. 2017;2017:7260130. doi: 10.1155/2017/7260130. Epub 2017 Aug 8.

    PubMed 28928987
  • Lee MY, Lin YR, Tu YS, Tseng YJ, Chan MH, Chen HH. Effects of sarcosine and N, N-dimethylglycine on NMDA receptor-mediated excitatory field potentials. J Biomed Sci. 2017 Feb 28;24(1):18. doi: 10.1186/s12929-016-0314-8.

    PubMed 28245819
  • Peyrovian B, Rosenblat JD, Pan Z, Iacobucci M, Brietzke E, McIntyre RS. The glycine site of NMDA receptors: A target for cognitive enhancement in psychiatric disorders. Prog Neuropsychopharmacol Biol Psychiatry. 2019 Jun 8;92:387-404. doi: 10.1016/j.pnpbp.2019.02.001. Epub 2019 Feb 6.

    PubMed 30738126
  • Chen KT, Wu CH, Tsai MH, Wu YC, Jou MJ, Huang CC, Wei IH. Antidepressant-like effects of long-term sarcosine treatment in rats with or without chronic unpredictable stress. Behav Brain Res. 2017 Jan 1;316:1-10. doi: 10.1016/j.bbr.2016.06.004. Epub 2016 Aug 21.

    PubMed 27555541
  • Huang CC, Wei IH, Huang CL, Chen KT, Tsai MH, Tsai P, Tun R, Huang KH, Chang YC, Lane HY, Tsai GE. Inhibition of glycine transporter-I as a novel mechanism for the treatment of depression. Biol Psychiatry. 2013 Nov 15;74(10):734-41. doi: 10.1016/j.biopsych.2013.02.020. Epub 2013 Apr 3.

    PubMed 23562005
  • Commons KG, Linnros SE. Delayed Antidepressant Efficacy and the Desensitization Hypothesis. ACS Chem Neurosci. 2019 Jul 17;10(7):3048-3052. doi: 10.1021/acschemneuro.8b00698. Epub 2019 Mar 11.

    PubMed 30807103
  • Chen KT, Tsai MH, Wu CH, Jou MJ, Wei IH, Huang CC. AMPA Receptor-mTOR Activation is Required for the Antidepressant-Like Effects of Sarcosine during the Forced Swim Test in Rats: Insertion of AMPA Receptor may Play a Role. Front Behav Neurosci. 2015 Jun 18;9:162. doi: 10.3389/fnbeh.2015.00162. eCollection 2015.

    PubMed 26150775
  • Padhan M, Mohapatra D, Mishra BR, Maiti R, Jena M. Efficacy and safety of add-on sarcosine in patients with major depressive disorder: A randomized controlled trial. J Psychiatr Res. 2024 Oct;178:298-304. doi: 10.1016/j.jpsychires.2024.08.026. Epub 2024 Aug 22.

    PubMed 39180989

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Sarcosine and SSRI in people with Major Depressive Disorder, run by All India Institute of Medical Sciences, Bhubaneswar at 1 site in India.

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 10 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 25 Jul 2023. 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 India. 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. 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?

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 severity of depressive symptoms from baseline. (time frame: 8 weeks). 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 NCT04975100, which also lists 15 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 25 Jul 2023.

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