Efficacy and Tolerability of Riluzole in Treatment Resistant Depression
Condition: Depression
MeSH terms: Depression; Depressive Disorder; Depressive Disorder, Treatment-Resistant
Intervention: Riluzole; placebo
Intervention description: Riluzole 100mg PO; placebo
Intervention MeSH terms: Riluzole
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Enrollment: 104.0
Sex: All
Minimum age: 18 Years
Maximum age: 65 Years
Healthy volunteers: No
Keywords: MDD; Depression; Treatment refractory; Glutamate; Riluzole; Major depressive disorder; psychopharmacology; rilutek

Summary:

      This study aims to examine the antidepressant efficacy of riluzole, employing a randomized,
      double-blind, placebo-controlled, adjunctive trial in treatment-resistant major depressive
      disorder (TRD).
    

Eligibility criteria:

        Group A inclusion/exclusion

        Inclusion Criteria:

          1. Age 18-65

          2. Written informed consent

          3. Meets DSM-IV criteria (by Structured Clinical Interview for DSM-IV - SCID-I/P) for
             MDD, current

          4. Inventory of Depressive Symptomatology - Self-Rated (IDS-SR30) score of > 20 at
             screening, baseline and start of double-blind phase (Phase 2)

          5. May have a history of failure to respond to up to two FDA-approved antidepressants at
             adequate doses during the current episode for at least 8 weeks, and for inclusion into
             the Phase 2 subjects must have failed the 8-week prospective citalopram treatment.

          6. Montgomery Asberg Depression Rating Scale (MADRS) score of 18 or higher at baseline
             and start of Phase 2.

        Exclusion Criteria:

          1. Pregnant women or women of child bearing potential who are not using a medically
             accepted means of contraception (to include oral contraceptive or implant, condom,
             diaphragm, spermicide, intrauterine device, tubal ligation, or partner with vasectomy)

          2. Patients who no longer meet DSM-IV criteria for MDD during the baseline visit

          3. Patients who demonstrate > 50% decrease in depressive symptoms as reflected by the
             IDS-SR total score from screen to baseline

          4. Serious suicide or homicide risk, as assessed by evaluating clinician A serious
             suicide risk will be considered an inability to control suicide attempts, imminent
             risk of suicide in the investigator's judgment, or a history of serious suicidal
             behavior, which is defined using the Columbia-Suicide Severity Rating Scale (C-SSRS)
             as either (1) one or more actual suicide attempts in the 3 years before study entry
             with the lethality rated at 3 or higher, or (2) one or more interrupted suicide
             attempts with a potential lethality judged to result in serious injury or death.

          5. Unstable medical illness including cardiovascular, hepatic, renal, respiratory,
             endocrine, neurological, or hematological disease

          6. The following DSM-IV diagnoses: substance use disorders active within the last six
             months, any bipolar disorder (current or past), any psychotic disorder (current or
             past)

          7. History of a seizure disorder or clinical evidence of untreated hypothyroidism

          8. Patients requiring excluded medications (see Table 3 for details)

          9. Psychotic features in the current episode or a history of psychotic features, as
             assessed by SCID

         10. Any investigational psychotropic drug within the last 3 months

         11. Have failed 3 or more adequate antidepressant trials during the current Major
             Depressive Episode by MGH-ATRQ criteria.

         12. Patients with a history of antidepressant-induced hypomania.

         13. Patients with any evidence of clinically significant liver abnormalities, or any liver
             transaminase level >1.5 X ULN at initial screening, or >5 x ULN during Phase 2
             treatment.

         14. Axis II personality disorders that are the primary purpose of treatment, or would
             interfere with a patient's safety or compliance.

         15. Patients currently being treated for a respiratory disorder (including asthma or COPD)

         16. Any subject who scores a 5 or higher on item #10 of the MADRS

        Group B inclusion/exclusion

        Inclusion criteria:

          1. Age 18-65

          2. Written informed consent

          3. Meets DSM-IV criteria (by Structured Clinical Interview for DSM-IV - SCID-I/P) for
             MDD, current

          4. Inventory of Depressive Symptomatology - Self-Rated (IDS-SR30) score of > 20 at
             screening and baseline visits, that is at the start of Phase 2

          5. Has a history of failure to respond to 1, 2, or 3 FDA-approved antidepressants at
             adequate doses during the current episode for at least 8 weeks, as defined by the MGH
             Antidepressant Treatment Response Questionnaire (MGH-ATRQ), and must be currently on
             the failed SSRI for at least 8 weeks and on a stable dose for at least 4 weeks.

          6. Montgomery Asberg Depression Rating Scale (MADRS) score of 18 or higher at baseline
             and start of Phase 2.

        Exclusion Criteria

          1. Pregnant women or women of child bearing potential who are not using a medically
             accepted means of contraception (to include oral contraceptive or implant, condom,
             diaphragm, spermicide, intrauterine device, tubal ligation, or partner with vasectomy)

          2. Patients who no longer meet DSM-IV criteria for MDD during the baseline visit

          3. Serious suicide or homicide risk, as assessed by evaluating clinician A serious
             suicide risk will be considered an inability to control suicide attempts, imminent
             risk of suicide in the investigator's judgment, or a history of serious suicidal
             behavior, which is defined using the Columbia-Suicide Severity Rating Scale (C-SSRS)
             as either (1) one or more actual suicide attempts in the 3 years before study entry
             with the lethality rated at 3 or higher, or (2) one or more interrupted suicide
             attempts with a potential lethality judged to result in serious injury or death.

          4. Unstable medical illness including cardiovascular, hepatic, renal, respiratory,
             endocrine, neurological, or hematological disease

          5. The following DSM-IV diagnoses: substance use disorders active within the last six
             months, any bipolar disorder (current or past), any psychotic disorder (current or
             past)

          6. History of a seizure disorder or clinical evidence of untreated hypothyroidism;

          7. Patients requiring excluded medications (see Table 3 for details)

          8. Psychotic features in the current episode or a history of psychotic features, as
             assessed by SCID

          9. Any investigational psychotropic drug within the last 3 months

         10. Have failed 3 or more adequate antidepressant trials during the current Major
             Depressive Episode by MGH-ATRQ criteria.

         11. Patients with a history of antidepressant-induced hypomania.

         12. Patients with any evidence of clinically significant liver abnormalities, or any liver
             transaminase level >2 X ULN at initial screening, or >5 x ULN during Phase 2
             treatment.

         13. Axis II personality disorders that are the primary purpose of treatment, or would
             interfere with a patients safety or compliance.

         14. Patients currently being treated for a respiratory disorder (including asthma or COPD)

         15. Any subject who scores a 5 or higher on item #10 of the MADRS