Pre-Treatment Positron Emission Topography Scanning for Increasing Success in Antidepressant Treatment
Condition: Depression
MeSH terms: Depression
Study type: Interventional

Summary: 
      This study will use pre-treatment positron emission topography and functional magnetic
      resonance imaging scans of the brain to predict the most effective antidepressant treatment
      for people with major depressive disorder.
    

Detailed description: 
      Major depressive disorder (MDD) is characterized by a combination of symptoms that can
      interfere with a person's ability to work, study, sleep, eat, and enjoy activities that were
      once pleasurable. Studies have shown that as little as 50% to 60% of individuals with MDD may
      respond to the first antidepressant medication prescribed. Currently psychiatrists lack tools
      that allow them to select the treatment plan that is most likely to benefit a particular
      individual. Some of the chemical abnormalities in the brains of people with MDD are
      detectable on positron emission topography (PET) scans. There are distinct differences in the
      PET scans of people with MDD who respond to treatment with a selective serotonin reuptake
      inhibitor (SSRI), people with MDD who do not respond to SSRI treatment, and people who do not
      have MDD. This study will use pretreatment PET and functional magnetic resonance imaging
      (fMRI) scans of the brain to predict which antidepressants will be most effective in people
      with MDD. This may help to reduce the trial and error currently associated with
      antidepressant treatment.

      We will perform pretreatment PET scans to quantify serotonin transporter (5-HTT) and
      serotonin 1A (5-HT1A) receptor in patients with major depressive disorder (MDD). All patients
      will then receive a standardized treatment protocol with a selective serotonin reuptake
      inhibitor (SSRI), escitalopram. If the patient does not remit, he or she will receive a
      selective norepinephrine reuptake inhibitor (NRI), desipramine. We hypothesize those patients
      with high pre and postsynaptic 5-HT1A BP and low 5-HTT BP in specific brain regions will not
      remit to a SSRI and will remit to a selective NRI. Finally, we will generate a predictive
      model of remission based on brain imaging outcome measures. Our overall goal is to reduce the
      trial and error associated with antidepressant treatment by using data from pre-treatment
      quantification of 5-HT1A receptors and 5-HTT to guide antidepressant treatment selection.
    

Intervention name(s): Escitalopram; Desipramine
Intervention type(s): Drug; Drug
Intervention description(s): Escitalopram will be administered at a dose of 10 mg daily for 4 weeks. If participants have not achieved response (greater than 50 % improvement in Hamilton Depression Rating Scale) by 4 weeks, the dose will be increased to 20 mg. Remission status is determined after an 8-week trial.; Subsequent to escitalopram trial, non-remitters will be offered pharmacotherapy with desipramine. Desipramine will be initiated at a dose of 50 mg and titrated according to a treatment manual, with monitoring of therapeutic blood levels. Remission status is determined after an 8-week trial.
Other intervention name(s): Lexapro; Norpramin
Intervention MeSH terms: Desipramine; Escitalopram
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Major Depression; Antidepressants