PET Synaptogenesis After Psilocybin In DEpression Recovery

Study Overview
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Brief Summary
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Participants with depression will be given a single dose of psilocybin and supportive psychotherapy before, during, and after drug administration. Participants will undergo positron emission tomography (PET) imaging before and one week after psilocybin using a marker of synaptic density. This design allows us to assess the relationship between neurotrophic, and antidepressant effects produced by psilocybin.

Detailed Description
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The investigators are studying the neurotrophic effects of psilocybin using 11C-UCB-J, a PET marker for synaptogenesis. Psilocybin is a naturally occurring psychedelic and exerts perceptual effects via 5-HT2A receptor agonism. Psilocybin has gained a great deal of attention as a tool for psychiatric treatment, with clinical trials demonstrating symptom relief after a single dose that is immediate and persists for months. Recognizing the therapeutic potential of psilocybin, the US Food and Drug Administration granted breakthrough therapy status to the Usona Institute for Phase 2 testing of psilocybin in depression. Animal models suggest that psychedelics exert antidepressant effects by producing a rapid and powerful neurotrophic response in the brain. The investigators will enroll patients with major depressive disorder and anhedonia. Participants will be given a single dose of psilocybin and supportive psychotherapy before, during, and after drug administration. Participants will undergo PET imaging before and one week after drug using 11C-UCB-J, a radiotracer that binds to SV2A - a marker of synaptic density and synaptogenesis. This design allows the investigators to assess the relationship between neurotrophic, and antidepressant effects produced by psilocybin.

Official Title
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SV2A Marker of Synaptogenesis in a Clinical Trial of Psilocybin for Depression

Conditions
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Major Depressive Disorder, Anhedonia

Intervention / Treatment
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* Drug: Psilocybin


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Men and women between 18 and 65 years of age; Able to provide informed consent Women of childbearing age must agree to be on two forms of contraception and men are required to utilize at least one form of contraception Willingness to comply and be available for all study requirements, including psychological, cognitive, and imaging for the duration of the study Meeting DSM-5 criteria for major depressive disorder and current depressive episode Snaith-Hamilton Anhedonia Pleasure Scale (SHAPS) ≥ 6 points Willing and able to taper and/or discontinue current psychotropic medications Exclusion Criteria: Women who are pregnant or who intend to become pregnant or nurse during the study duration. Presence of psychiatric conditions that are contraindications to psilocybin exposure (e.g., personal or first degree relative with history of schizophrenia spectrum or bipolar disorder); Use of psychotropic medication that may interact with psilocybin (TCA, MAOi, antipsychotic/neuroleptics, anti-epileptic/mood stabilizer, lithium, SSRI, SNRI, Mirtazapine, Buproprion, Vortioxetine). Recent use of psychedelics (psilocybin, LSD, ayahuasca, mescaline; past 5 years); or prior severe adverse reactions to psychedelics Active suicidal ideation or history of a suicide attempt. Presence of medical conditions that are contraindications to psilocybin exposure (e.g., neurological conditions or severe hypertension, severe and/or unstable metabolic or cardiovascular conditions); Current medical conditions that are known to increase risk of severe coronavirus infection or deemed by a study physician to put an individual at high risk (i.e., cancer, COPD, obesity, immunosuppression, type 2 diabetes, serious heart conditions, sickle cell disease, asthma); Presence of contraindications to PET or MRI scanning (renal disease, implantable devices, bone hardware, some IUDs); Body mass index >30 (due to MRI confounds).

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Interventional Model Description: Open label treatment study, no placebo.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Psilocybin<br>Eligible adults to undergo a single drug session with psilocybin (25mg tablet) plus supportive psychotherapy | Drug: Psilocybin<br>* Psilocybin (25mg tablet) plus supportive psychotherapy<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Synaptogenesis in hippocampus | Change in 11C-UCB-J signal in the hippocampus from baseline to post-treatment PET scans. | 7 days after psilocybin | 
| Synaptogenesis in medial prefrontal cortex | Change in 11C-UCB-J signal in the medial prefrontal cortex from baseline to post-treatment PET scans. | 7 days after psilocybin | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in major depressive disorder symptoms | Change in Montgomery-Asberg Depression Rating Scale (MADRS) - score range 0-60 (higher score equals greater severity of depressive symptoms). | 7 days after psilocybin | 
| Change in anhedonia symptoms | Change in Snaith-Hamilton Anhedonia Pleasure Scale (SHAPS) - is a 14 item self-report measure assessing pleasure response/hedonic experience across domains. The SHAPS measures both anticipation and experience of pleasure. A score is obtained by making binary (disagree/strongly disagree =1) and summing the 14 items - range 0-14, greater than 3 is considered abnormal. | 7 days after psilocybin | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Psilocybin, 11C-UCB-J, SV2A