Role Of Non-Specific Effects in The Treatment of Depression With Esketamine

Study Overview
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Brief Summary
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The investigators aim to examine the magnitude of non-specific effects in the treatment of depressive episodes with esketamine, by providing patients in the intervention group with a pretreatment presentation and post-treatment follow up session, to assess whether nonspecific effects can be used effectively to improve the effectiveness of treatment with esketamine.

Detailed Description
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Primary Objective: To determine whether a positive presentation before first treatment improves expectation of improvement from treatment in patients receiving esketamine for a depressive episode within 24 hours after the first treatment. Secondary Objectives: To determine whether a post-treatment follow up session to provide encouragement and reassurance improves expectation of improvement from treatment in patients receiving esketamine for a depressive episode within 24 hours after the first treatment. To determine whether a positive presentation results in an improved response from treatment in patients receiving esketamine for a depressive episode as measured by MADRS score within 24 hours after the first treatment. To determine whether a positive presentation before first treatment, combined with a posttreatment follow up session after first treatment, result in an improved response from treatment in patients receiving esketamine for a depressive episode as measured by MADRS score by the end of the acute course of esketamine treatment.

Official Title
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Role Of Non-Specific Effects in The Treatment of Depression With Esketamine

Conditions
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Depressive Episode

Intervention / Treatment
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* Behavioral: Pre and Post Treatment Presentations


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Participants must be either male or female and at least 18 years old Deemed clinically appropriate to receive esketamine by a Yale Interventional Psychiatry physician. Written consent for the study procedures Ability and willingness, in the investigator's judgement, to comply with the study schedule, treatment plan, and other trial requirements for the duration of the study. Exclusion Criteria: Hearing or visual impairment to the degree that would interfere with ability to view the presentation Difficulty in understanding spoken or written English Unable to provide informed consent Dementia or other cognitive disorder or intellectual disability that would impair the subject's ability to understand the presentation (per investigator judgment) Any other medical or psychiatric comorbidity that the investigator judges would put the participant at additional undue risk due to study participation or would impair subject's ability to participate in the study. Previous Esketamine or ketamine treatment Unable to give informed consent Was previously enrolled/randomized into the trial

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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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Patients who are deemed clinically appropriate for esketamine will be approached for participation in the study.
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Treatment as usual (TAU)<br>Participants receive TAU | |
| Experimental: Intervention + TAU<br>Participants receive a presentation prior to the first treatment and receive a follow up session within 24 hours after the first treatment in addition to treatment as usual | Behavioral: Pre and Post Treatment Presentations<br>* A short presentation provided to the participants within 72 hours prior to the first treatment of the acute course. The presentation will emphasize the effectiveness of the treatment, and provide notable encouragement and reassurance. The intervention group will additionally receive a follow up session within 24 hours after the first treatment to provide encouragement and reassurance<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Group difference in change in question 6 score on Treatment Credibility and Expectancy Scale (CEQ-6) | Participants' expectations will be assessed by the change in the group score of item 6 of the CEQ-6 at baseline and after the presentation (before treatment 1). Item 6 is scored from 0% (not at all) to 100% (very much). Higher scores indicates expectations have been met. | baseline and after presentation (before treatment 1), up to 30 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Group difference in change in Montgomery-Åsberg Depression Rating Scale (MADRS) score | MADRS score will be used to assess whether a positive presentation results in an improved response from treatment in participants receiving esketamine for a depressive episode within 24 hours after the first treatment. MADRS is a ten-item diagnostic questionnaire used to measure the severity of depressive episodes. Each item is rated on a 0-6 scale, resulting in a maximum total score of 60 points, with higher scores indicative of greater depressive symptomology. | baseline and within 24 hours post treatment 1 |