Drug Therapy to Treat Minor Depression

Study Overview
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Brief Summary
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This 6-month study will compare the effectiveness of citalopram (Celexa®), hypericum (St. John's Wort), and placebo for the treatment of minor depression.

Detailed Description
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Minor depression is highly prevalent, causes substantial morbidity and disability, presents a serious risk factor for the development of major depressive disorder, yet is under recognized and under treated. Researchers have determined that patients with minor depression frequently seek treatment from general practitioners and are often treated with prescription antidepressants. There is a need to evaluate the effectiveness of St. John's Wort in the management of minor depression. If the proposed study demonstrates the efficacy of St. John's Wort and/or citalopram, it will suggest treatment paradigms that can be tested and applied in primary care settings. Subjects participated in a 12-week double-blind randomized study comparing St. John's Wort, citalopram, and placebo. Subjects were recruited through clinical referrals and community advertising. Data were obtained at the baseline visit (just prior to randomization) and at postrandomization visits conducted at 2-week intervals for the next 12 weeks, for a modified intent-to-treat sample consisting of all 73 subjects with at least 1 post-randomization visit (evaluable sample).

Official Title
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Pharmacotherapy for Minor Depression

Conditions
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Depression

Intervention / Treatment
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* Drug: Citalopram
* Drug: St. John's Wort
* Drug: Placebos


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Minor Depression symptoms for at least 6 months Endorse one of the DSM-IV A criteria for MDD and at least one other symptom of MDD or endorse both of the A criteria for MDD Global Assessment of Functioning (GAF) score < 70 Short form health survey (SF-36) social functioning score <= 75% or an emotional role functioning score <= 67% HAM-D-17 score 10-17, inclusive Minor depression symptoms for at least 6 months Exclusion Criteria: Major depressive disorder (MDD) or dysthymia within the past year or in partial remission of MDD At least a 12-week course of either citalopram at a minimum or 40 mg/day or St. John's Wort at a minimum of 900 mg/day during the current episode of depression Previous intolerance to either citalopram or St. John's Wort or history of nonresponse to either citalopram at a minimum of 40 mg/day or St. John's Wort at a minimum of 900 mg/day for at least 12 weeks Unstable medical illness, including cardiovascular, hepatic, renal, respiratory, endocrine, neurologic, or hematologic disease Uncontrolled seizure disorder The following DSM-IV diagnoses: organic mental disorders; substance use disorders, including alcohol, active within the last year or patients with a positive urine drug screen; schizophrenia; delusional disorder; psychotic disorders not elsewhere classified; bipolar disorder; bereavement; adjustment disorder; antisocial personality disorder; panic disorder, social phobia, generalized anxiety disorder (GAD), or obsessive compulsive disorder (OCD). Patients may have a lifetime diagnosis of an anxiety disorder as long as it is not current. Mood-congruent or mood-incongruent psychotic features Psychotropic drugs Hypothyroidism Investigational psychotropic drugs within the last year Positive toxicology screen Medications metabolized by the CYP3A4 system, where induction of this system poses a risk to the medical stability of the patient Pregnancy or refusal to use a medically accepted method of contraception Serious suicide or homicide risk Psychotherapy beginning less than 3 months ago

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 85 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
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: citalopram<br>Subjects in this arm received 20mg/day of citalopram taken orally for 12 weeks. | Drug: Citalopram<br>* Established Selective Serotonin Reuptake Inhibitor antidepressant<br>* Other names: Celexa, Cipramil;|
| Experimental: St. John's Wort<br>Subjects in this arm received 810 mg/day of St. John's Wort taken orally (in three tablets of 270mg each) for 12 weeks. | Drug: St. John's Wort<br>* Natural extract from the St. John's Wort plant.<br>* Other names: Hypericum;|
| Placebo Comparator: Placebo<br>Subjects in this arm received double-dummy (look-alike) placebo for 12 weeks. | Drug: Placebos<br>* Placebo pill<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Efficacy Assessed Using the Inventory of Depressive Symptomatology - Clinician Rated (IDS-C) | We expect that subjects with minor depression treated for 12 weeks with St. John's Wort or citalopram will have significantly greater reduction in depressive symptom severity than those treated with placebo. This will be measured by blind ratings on the Inventory of Depressive Symptomatology - Clinician Rated (IDS-C) which has a total score range from 0 to 84 with 0 being not depressed at all and 84 being the most depressed. The change will be calculated by subtracting the Week 12 score from the Baseline score. | Change from Baseline to Week 12 | 
| Number of Adverse Events (Physical Symptoms) Emerging or Worsening During 12 Weeks of Treatment | We expect that subjects treated for Minor Depression for 12 weeks with either St. John's Wort or citalopram will have similar safety profiles to subjects treated with placebo, and will not differ by more than 20% in rates of adverse side effects (e.g., nausea, headache, insomnia, hypersomnia, diarrhea) from subjects treated with placebo. This was measured by the number of adverse events (physical symptoms) emerging or worsening during 12 weeks of treatment. | Change from Baseline to Week 12 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Minor Depression, St. John's Wart