Study of Neural Responses Induced by Antidepressant Effects

Study Overview
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Brief Summary
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The proposed work aims to examine the neural changes associated with fast-acting antidepressant treatments in order to develop imaging-based biomarkers of treatment response for depression.

Detailed Description
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Over the past decade, neuroimaging tools have rapidly advanced the field of neural biomarkers of treatment response in depression. Still, despite obvious scientific progress in this field, the ability to implement neuroimaging biomarkers of antidepressant treatment response in clinical trial settings is lacking. In order to objectively assess the neural bases of treatment response in depression, the investigators will use a Real-time Neurofeedback fMRI task, specifically designed to record and modulate mood improvement by providing neurofeedback in the context of the administration of an antidepressant treatment. In a pilot study, positive neurofeedback during the administration of the drug was associated with significant acute mood improvement and increased blood oxygen level dependent (BOLD) responses in the rostral anterior cingulate cortex (rACC), a common neural target of antidepressant treatments. The central hypothesis is that antidepressant effects in depression are mediated by increased neural activity in the rACC (AIM1), which can be used in clinical trials of antidepressant treatment to predict antidepressant effects (AIM 2) and assess the effect of antidepressant treatment on antidepressant-induced rACC neural responses (AIM 3). The results obtained from this project are expected to have an important impact on our ability to understand the cognitive and neural mechanisms implicated in antidepressant treatment responses in patients with depression, as well as on the ability to implement neuroimaging biomarkers of treatment response in the clinical trial settings.

Official Title
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Study of Neural Responses Induced by Simulated Antidepressants

Conditions
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Major Depressive Disorder

Intervention / Treatment
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* Drug: Escitalopram
* Drug: Placebo
* Behavioral: Real-time Neurofeedback fMRI task pre- and post-RCT


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: A man or woman age of 18 or older. Currently experiencing a depressive episode as part of Major Depressive Disorder. Able to tolerate lying still on your back for 60 minutes at a time. Have had no more than one failed antidepressant trial of adequate dose and duration. Have been antidepressant medication-free for at least 21 days prior to collection of imaging data (5 weeks for fluoxetine) Exclusion Criteria: Are currently taking any psychiatric medication, or any potentially augmenting or sedative drugs. Have a history of inadequate response/tolerability to escitalopram; or history of resistant depression Pregnant or breastfeeding or plan to become pregnant over the duration of the study. Have a history (lifetime) of psychotic depressive, schizophrenic, bipolar, schizoaffective, or other Axis I psychotic disorders. Meet criteria for substance dependence in the last 6 months, except nicotine, or substance abuse in the last 2 months. Have a medical condition that contradicts treatment with escitalopram. Are currently receiving psychotherapy or any other treatment for your depression.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

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: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Antidepressant Treatment<br>20mg of escitalopram will be taken over an 8-week period, starting with 10mg for the first week. | Drug: Escitalopram<br>* Selective Serotonin Reuptake Inhibitor (SSRI)<br>* Other names: Lexapro;Behavioral: Real-time Neurofeedback fMRI task pre- and post-RCT<br>* Placebo experiment during an fMRI scanning session<br>|
| Placebo Comparator: Placebo<br>A placebo pill will be taken over an 8-week period. | Drug: Placebo<br>* Placebo<br>Behavioral: Real-time Neurofeedback fMRI task pre- and post-RCT<br>* Placebo experiment during an fMRI scanning session<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Montgomery-Åsberg Depression Rating Scale (MADRS) Scores | The Montgomery-Åsberg Depression Rating Scale (MADRS) is a ten-item diagnostic questionnaire which psychiatrists use to measure the severity of depressive episodes in patients with mood disorders. It was designed in 1979 by British and Swedish researchers as an adjunct to the Hamilton Rating Scale for Depression (HAMD) which would be more sensitive to the changes brought on by antidepressants and other forms of treatment than the Hamilton Scale was.[2] There is, however, a high degree of statistical correlation between scores on the two measures. | baseline and week 8 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Quick Inventory of Depressive Symptomatology (QIDS) Scores | The Quick Inventory of Depressive Symptomatology (QIDS) is a 16-item, self-reported measure of depression that ranges from 1 (no depression) to 27 (very severe depression). | baseline and 8 weeks | 
| Neural Responses During the Sham Neurofeedback fMRI Task. | Voxel-wise BOLD changes during the expectancy condition of the Sham Neurofeedback fMRI task. | Baseline | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Neuroimaging biomarkers, MDD, Neurofeedback, Depression