Rapid Antidepressant Effects of Leucine

Study Overview
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Brief Summary
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This randomized double-blind placebo-controlled crossover study seeks to evaluate the antidepressant effect of L-leucine, an essential amino acid, in patients with Major Depressive Disorder (MDD).

Detailed Description
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This is a pilot phase II clinical trial of L-leucine to test its efficacy in reducing depressive symptoms in MDD patients, especially those who exhibit increased inflammation. The determination of increased inflammation will be done post-hoc. During the screening visit, all study participants will provide demographic information and complete self-report assessments and clinician evaluations and examinations. Blood and urine tests will also be performed. All participants who meet eligibility criteria and are willing to proceed with the study will enter this 6-week study after being randomized to two-week course of either L-leucine or placebo. In this cross-over study, participants will be crossed over to the second treatment after 2 weeks of washout. The study period will last 42 days (6 weeks) from the baseline visit. Both L-leucine and placebo will be provided as an effervescent mixture powder. Investigators hypothesize that MDD subjects will have greater reduction in depression severity on leucine as compared to placebo.

Official Title
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A Pilot Double-Blind Randomized Placebo-Controlled Crossover Study to Investigate Rapid Antidepressant Effects of Leucine

Conditions
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Major Depressive Disorder

Intervention / Treatment
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* Drug: L-Leucine
* Other: Maltodextrin


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Current primary diagnosis of nonpsychotic major depressive disorder. Stable antidepressant dose of no more than one antidepressant medication for 4 weeks and no anticipated changes during the study period. Stable doses of all concomitant medications for over 6 weeks. No more than two failed antidepressant trials of adequate dose and duration, as defined by ATRQ, in the current episode. Exclusion Criteria: Psychiatric co-morbidity posing safety risk. Pregnant or breastfeeding or plan to become pregnant over the ensuing 2 months following study entry or are sexually active and not using adequate contraception Exclusionary psychiatric conditions (such as substance dependence in the last 6 months, substance abuse in the last 2 months, or lifetime history of psychotic disorders. Unstable or terminal general medical condition (GMC). Concomitant medications that interact with L-leucine (e.g. sildenafil). Vagus nerve stimulation, ECT, or rTMS, or other somatic antidepressant treatment during current episode Inadequately controlled hypothyroidism. Therapy that is depression specific, such as CBT or Interpersonal Psychotherapy of Depression. Hypersensitivity to L-leucine Have Maple Syrup Urine Disease.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 64 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: Crossover Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: L-leucine<br>4 gm L-leucine by mouth twice daily for two weeks | Drug: L-Leucine<br>* L-leucine is an essential amino acid which will be provided as an effervescent powder mixture to participants.<br>* Other names: Leucine;|
| Placebo Comparator: Maltodextrin<br>4 gm maltodextrin by mouth twice daily for two weeks | Other: Maltodextrin<br>* Maltodextrin is a nonsweet carbohydrate which will be provided as an effervescent powder mixture similar in taste and appearance to the L-leucine containing effervescent powder mixture<br>* Other names: Placebo;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in QIDS-SR From Baseline at 14 Days | The Quick Inventory of Depressive Symptomatology, self-report (QIDS-SR), self-report is a 16-item measure of depression severity that includes the 9 criterion symptoms for MDD. Items are scored on a 4-point Likert scale, ranging from 0 to 3 (total score range, 0-27). Totals scores of ≤ 5 indicate no depression; 6-10 indicates mild depression; 11-15 indicates moderate depression; 16-20 indicates severe depression; and ≥ 21 indicates very severe depression. For purposes of this report, severe and very severe categories were combined as severe to very severe depression (≥ 16). The QIDS-A self-report has demonstrated acceptable psychometric properties. | Baseline to 14 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percentage of MDD Patients With 50% or Greater Reduction in Depression Severity After 14 Days of LEU and PBO Treatments. | Response criteria defined based on QIDS-SR score at baseline and 14 days after treatment initiation. The Quick Inventory of Depressive Symptomatology, self-report (QIDS-SR), self-report is a 16-item measure of depression severity that includes the 9 criterion symptoms for MDD. Items are scored on a 4-point Likert scale, ranging from 0 to 3 (total score range, 0-27). Totals scores of ≤ 5 indicate no depression; 6-10 indicates mild depression; 11-15 indicates moderate depression; 16-20 indicates severe depression; and ≥ 21 indicates very severe depression. For purposes of this report, severe and very severe categories were combined as severe to very severe depression (≥ 16). The QIDS-A self-report has demonstrated acceptable psychometric properties. | Baseline to 14 days | 
| Percentage of MDD Patients With QIDS-SR Score Less Than or Equal to 5 at 14 Days of LEU and PBO Treatments. | Remission operationalized as QIDS-SR <=5. The Quick Inventory of Depressive Symptomatology, self-report (QIDS-SR), self-report is a 16-item measure of depression severity that includes the 9 criterion symptoms for MDD. Items are scored on a 4-point Likert scale, ranging from 0 to 3 (total score range, 0-27). Totals scores of ≤ 5 indicate no depression; 6-10 indicates mild depression; 11-15 indicates moderate depression; 16-20 indicates severe depression; and ≥ 21 indicates very severe depression. For purposes of this report, severe and very severe categories were combined as severe to very severe depression (≥ 16). The QIDS-A self-report has demonstrated acceptable psychometric properties. | 14 days | 
| Rates of Adverse Effects After 3 Days, 7 Days and 14 Days of LEU and PBO Treatments. | Adverse effect burden will be measured with Frequency Intensity and Burden of Side-effect rating scale (FIBSER). The Frequency, Intensity, Burden of Side Effects Rating (FIBSER) scale was designed by Dr. Stephen Wisniewski for use in the U.S. STAR*D effectiveness study. It is a 3-item scale to assess side effects from antidepressant treatment. To use the FIBSER in measurement-based care, clinicians should consider item 3 (Burden). If the score is 0 to 2 (None to Mild interference with activities), no change in medication is needed. If the score is 3-4 (Moderate to Marked interference with activites), the side effects need to be addressed (i.e., change in dose, side effect antidote, etc). If the score is 5-6 (Severe interference with activities or Unable to Function), the dose needs to be decreased or the medication needs to be switched. | Baseline to 3 days, 7 days, and 14 days | 
| Change in Fatigue Symptoms From Baseline After 3, 7, and 14 Days of LEU and PBO Treatments Measured With Multidimensional Fatigue Inventory. | Fatigue will be measured with Multidimensional fatigue inventory The Multidimensional Fatigue Inventory (MFI) is a 20-item self-report instrument designed to measure fatigue. It contains five scales: general fatigue (items 1, 5, 12, 16), mental fatigue (items 7, 11, 13, 19), physical fatigue (items 2, 8, 14, 20), reduced motivation (items 4, 9, 15, 18) and reduced activity (items 3, 6, 10, 17). Items are scored on a 5-point scale on which the participant expressed the degree to which the statement applied to him or her (from agreement yes, that is true to disagreement no, that is not true) in the previous days. Item scores are summed to create a sum score for each scale, ranging between 4 (best condition) and 20 (worst condition). Higher scores indicate more fatigue. | Baseline to 3 days, 7 days, and 14 days | 
| Change in Psychosocial Function From Baseline After 3, 7, and 14 Days of LEU and PBO Treatments Measured Using Work and Social Adjustment Scale. | Psychosocial function will be measured using Work and Social Adjustment Scale The Work and Social Adjustment Scale (WSAS) is a 5-item measure for impairment in functioning. Items are scored on an 8-point scale on how much participants' problems impaired their ability to carry out the activity (from Not at all to Very severely). Item scores are summed to create a sum score. The maximum score of the WSAS is 40, lower scores are better. A WSAS score above 20 appears to suggest moderately severe or worse psychopathology. Scores between 10 and 20 are associated with significant functional impairment but less severe clinical symptomatology. Scores below 10 appear to be associated with subclinical populations. | Baseline to 3 days, 7 days, and 14 days | 
| Change in Anhedonia From Baseline After 3, 7, and 14 Days of LEU and PBO Treatments Measured Using Snaith-Hamilton Pleasure Scale (SHAPS) | Anhedonia will be measured using Snaith-Hamilton Pleasure Scale (SHAPS). The Snaith-Hamilton Pleasure Scale (SHAPS) is a 14-item scale that measures anhedonia, the inability to experience pleasure. The items cover the domains of: social interaction, food and drink, sensory experience, and interest/pastimes. A score of 2 or less constitutes a normal score, while an abnormal score is defined as 3 or more. Each item has four possible responses: strongly disagree, disagree, agree, or strongly agree. Either of the disagree responses score one point, and either of the agree responses score 0 points. Thus, the final score ranges from 0 to 14. | Baseline to 3 days, 7 days, and 14 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Antidepressant, Inflammation, Biomarker, Depression, Treatment Resistant Depression, Leucine