Rapid Antidepressant Effects of Yohimbine in Major Depression
Condition: Depression, Involutional; Major Depresssion
MeSH terms: Depression; Depressive Disorder; Depressive Disorder, Major
Intervention: Yohimbine hydrochloride; Placebo
Intervention description: Participants receive yohimbine 0.125 mg/kg administered over 3 minutes during REM sleep.; Participants receive an inactive equivalent of yohimbine 0.125 mg/kg administered over 3 minutes during REM sleep.
Intervention MeSH terms: Yohimbine
Phase: Phase 2
Study type: Interventional
Primary purpose: Other
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Enrollment: 11.0
Sex: All
Minimum age: 18 Years
Maximum age: 65 Years
Healthy volunteers: No
Keywords: Yohimbine; Sleep Deprivation; Depression; Mood Disorder; Fast; Affective Disorder; Rapid Onset; Major Depression; MDD

Summary:

      This study examines if Yohimbine, when given during the sleep cycle, will improve symptoms of
      depression within a matter of hours.

      Purpose: This study will examine whether the drug yohimbine, given at a specific time during
      the sleep cycle, produces chemical changes in the brain similar to those that occur with
      sleep deprivation. It will also see if yohimbine can induce rapid (next day) antidepressant
      effects in patients with major depression. Total sleep deprivation for 36 hours improves mood
      in most patients with major depression in a matter of hours, but the response is usually
      short-lived. Understanding the chemical changes that occur in the body during sleep
      deprivation may help in the development of a rapidly acting antidepressant.Patients with
      major depressive disorder between 18 and 65 years of age may be eligible for this study.
      Candidates are screened with a medical and psychiatric history, physical examination,
      electrocardiogram, and blood and urine tests. Participants are hospitalized at the NIH
      Clinical Center for the study, as follows: Drug-free period: Patients are tapered off their
      anti-depression medications and remain drug-free for 1 week before beginning study phase 1.
      Study phase 1: Patients undergo sleep deprivation for 36 hours. Those whose depression
      improves with sleep deprivation initially and then worsens continue to phase 2. The day after
      sleep deprivation, patients undergo a lumbar puncture (spinal tap). For this test, a local
      anesthetic is given and a needle is inserted in the space between the bones in the lower back
      where the cerebrospinal fluid circulates below the spinal cord. A small amount of fluid is
      collected through the needle. Study phase 2: Patients spend 1 night in the sleep lab. A
      catheter (plastic tube) is placed in a vein in each arm-one to give yohimbine and the other
      to draw blood samples. A small monitor cuff is placed on a finger to measure the patient's
      blood pressure and blood oxygen levels during the night. While asleep, the patient receives a
      dose of yohimbine or placebo, given over 3 minutes. A lumbar puncture is done the following
      morning. Patients receive no medications for 6 days, and then the sleep lab procedure is
      repeated. Patients who received yohimbine in the previous experiment are switched to placebo,
      and those who were given placebo are switched to yohimbine.
    

Eligibility criteria:

        -  INCLUSION CRITERIA:

        Male or female subjects, 18 to 65 years of age.

        Female subjects of childbearing potential must be using a medically accepted means of
        contraception.

        Each subject must have a level of understanding sufficient to agree to all required tests
        and examinations and sign an informed consent document.

        Subjects must fulfill DSM-IV criteria for Major Depression, based on clinical assessment
        and confirmed by a structured diagnostic interview, SCID-P.

        Subjects must have an initial score of at least 18 on the 21-item HDRS at screen and at
        baseline of TSD and Study Phase II.

        Subjects with a greater than 25% decrease in the 21-item HDRS total scores between screen
        and baseline of TSD will be dropped from the study.

        EXCLUSION CRITERIA:

        Subjects with documented uncontrolled hypertension in the 30 days prior to Study Period I,
        or have a systolic blood pressure greater than or equal to 140 and/or diastolic blood
        pressure greater than or equal to 90 on 3 or more readings during the drug-free period.

        Apnea/hypopnea index is greater than 15 episodes per minute.

        Presence of psychotic features or a diagnosis of Schizophrenia or any other psychotic
        disorder as defined in the DSM-IV.

        Subjects with current DSM-IV diagnosis of generalized anxiety disorder, panic disorder, or
        posttraumatic stress disorder.

        Subjects with a history of DSM-IV drug or alcohol dependency or abuse (including for
        nicotine) within the preceding 3 months.

        Female subjects who are either pregnant or nursing.

        Serious, unstable illnesses including hepatic, renal gastroenterologic, respiratory,
        cardiovascular (including ischemic heart disease), endocrinologic, neurologic, immunologic,
        or hematologic disease.

        DSM-IV diagnosis of primary sleep disorder.

        Subjects with uncorrected hypothyroidism or hyperthyroidism.

        Subjects with one or more seizures without a clear and resolved etiology.

        Documented history of hypersensitivity or intolerance to yohimbine.

        Treatment with a reversible MAOI within 4 weeks prior to Study Phase II.

        Treatment with fluoxetine within 3 weeks prior to Study Phase II.

        Treatment with any other concomitant medication not allowed 7 days prior to Study Phase II.

        Treatment with clozapine or ECT within 3 months prior to Study Phase I.

        Judged clinically to be at serious suicide risk.

        Previous nonresponse to total sleep deprivation treatment.

        STUDY PHASE II:

        INCLUSION CRITERIA

        Same as above plus:

        Response to total sleep deprivation (40% decrease in the HAM-D6) followed by:

        Depressive relapse (score of at least 18 on the 21-item HDRS and no longer meets response
        criteria) prior to Study Period II.

        EXCLUSION CRITERIA:

        YMRS total score of greater than or equal to 12 within 24 hours of yohimbine
        administration.