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Major Depressive DisorderPhase 4PRISMSNCT00592384

Project to Improve Symptoms and Mood in People With Spinal Cord Injury

A Phase 4 study testing venlafaxine XR in people with Major Depressive Disorder and Dysthymia, run by University of Washington at 6 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Depression is likely the most prevalent and disabling psychological complication associated with spinal cord injury (SCI). Yet no controlled depression treatment trials have been performed in this population. Read more about this study

Who is it for?
Ages 18 to 64 years
What is being tested?
venlafaxine XR
Type of treatment
Pill or oral medicine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
133 participants
Where
6 sitesUnited States
Study dates
Jul 2007to Sep 2012
Phase
Phase 4
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 64 years
  • All sexes
  • No healthy volunteers
  • Adult

Who may be able to join

  • Spinal cord injury (ASIA A-D)
  • At least one month post injury
  • Meets DSM IV criteria for major depression or dysthymia on the SCID
  • At least moderately severe depression (PHQ-9 score >= 10)
  • Within reasonable travel distance to one of the study sites

Who cannot join

  • Current DSM IV alcohol or drug dependence
  • History of bipolar disorder or psychosis
  • History of >= 2 suicide attempts or suicide attempt with 5 years
  • Current suicidal intent or plan
  • Medical contraindications
  • Non-English speaker
Show all 16Show fewer
  • Clinically significant cognitive/language impairment
  • History of allergic reaction to venlafaxine XR or use of MAO-I with 2 weeks
  • Current use of antidepressant medications (will not exclude if on low dose of a tricyclic antidepressant or trazodone for pain, sleep, or bladder), psychotherapy for depression, or electroconvulsive therapy
  • Pregnant or lactating women or women of childbearing potential who are not willing to use a reliable form of contraception
  • Unstable medical condition, as determined by physical examination, CBC w/ platelets (including hematocrit, hemoglobin, WBC, differential), serum chemistry panel (serum sodium, potassium, chloride, bicarbonate, BUN, creatinine, glucose), liver transaminases (AST, ALT), thyroid stimulating hormone (TSH), urinalysis, supine diastolic blood pressure (SDBP) > 90 mm Hg, or near terminal illness (primary care physician estimates that patient has < 1 year to live)
  • Anticipated major surgical procedures within the 12 weeks of randomization
  • Use of an investigational drug within 30 days
  • Use of psychoactive medications, including corticosteroids and anticonvulsants, that have not been at a stable dose for at least 2 weeks
  • Use of anxiolytic, sedative-hypnotic, or other psychotropic drug or substance (including St. John's Wort) within 7 days of start of double-blind treatment. If the patient is taking a sedative deemed necessary for sleep induction or spasticity, the dosage must have been stable for at least 2 weeks. Use of anticholinergic, low-dose tricyclic antidepressant, GABAergic or adrenergic medications for spasticity are permitted if at a stable dose for at least 2 weeks.
  • Refusal to participate

Trial locations and contacts

6 sites in 1 country.

6 sites in 1 country

United States6 sites
  • University of Michigan

    Ann Arbor, Michigan, 48109-0491

  • University of Alabama

    Birmingham, Alabama, 35294-0111

  • Rehabilitation Institute of Chicago

    Chicago, Illinois, 60611-2654

  • Baylor Institute for Rehabilitation

    Dallas, Texas, 75246

  • University of Miami

    Miami, Florida, 33124

  • University of Washington/Harborview Medical Center

    Seattle, Washington, 98104

Other trials in United States

About this study

Official title: A Controlled Trial of Venlafaxine XR for Major Depression After Spinal Cord Injury: A Multi-site Study

Depression is likely the most prevalent and disabling psychological complication associated with spinal cord injury (SCI). Yet no controlled depression treatment trials have been performed in this population. The proposed study is a multi-site, randomized, double-blind, placebo controlled trial of venlafaxine XR (Effexor XR) in 133 adults with SCI and major depressive disorder (MDD) or dysthymia who are at least one month post injury. Participants will be recruited from four SCI Model System sites, the University of Washington, Rehabilitation Institute of Chicago, University of Michigan, University of Alabama, Birmingham and Baylor Institute for Rehabilitation, Dallas, TX. The purpose of the study is to examine the efficacy and tolerability of venlafaxine XR as a treatment for MDD. The primary outcome will be the percent of responders (those who report at least a 50% reduction in depression severity from baseline to the end of treatment) in the venlafaxine XR versus placebo control group using intent-to-treat analysis. Secondary outcomes will include changes in pain, health related quality of life depression-related disability and community participation. A successful clinical trial could lead to more aggressive identification and treatment of MDD as well as improved health and quality of life in this important population.

Read the detailed description

Depression is likely the most prevalent and disabling psychological complication associated with spinal cord injury (SCI). The prevalence of major depression in people with SCI is 22% or two to six times higher than in the general population. Depression is linked to a myriad of adverse outcomes including poor subjective health, poor community integration, higher rates of medical complications and high rates of suicide. Surprisingly there are no randomized controlled trials for treating major depressive disorder (MMD) in people with SCI. Despite the widespread use of antidepressants in this population, the common assumption that antidepressant medications are effective and well-tolerated among people with SCI is uncertain. Multiple factors such as severe stresses, bereavement and loss of rewarding activities may complicate treatment. Treatment trials suggest antidepressants may not be as effective in people with medical/neurological conditions as they are with depression that develops as a primary condition. For almost 20 years clinicians and scientists have called for controlled clinical trials of antidepressants among people with SCI in order to establish evidence-based treatment. The proposed study is a multi-site, randomized, double-blind, placebo controlled trial of venlafaxine XR (Effexor XR) in 133 adults with SCI and MDD or dysthymia who are at least one month post injury. Participants aged 18-64 will be recruited from four SCI Model System sites, the University of Washington, Rehabilitation Institute of Chicago, University of Michigan, University of Alabama, Birmingham and Baylor Institute for Rehabilitation, Dallas TX. The purpose of the study is to examine the efficacy and tolerability of venlafaxine XR as a treatment for MDD. The primary outcome will be the percent of responders (those who report at least a 50% reduction in depression severity from baseline to the end of treatment) in the venlafaxine XR versus placebo control group using intent-to-treat analysis. Secondary outcomes will include changes in pain, health related quality of life and participation. A successful clinical trial could lead to more aggressive identification and treatment of MDD as well as improved health and quality of life in this important population.

Being tested
venlafaxine XR, placebo
Keywords
spinal cord injuries, major depressive disorder, dysthymia, antidepressant agents, pain, quality of life, muscle spasticity, community participation, anxiety
Medical subject headings
Depressive Disorder, Major, Dysthymic Disorder, Spinal Cord Injuries, Pain, Muscle Spasticity, Anxiety Disorders

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • venlafaxine XRDrug

    Also called Effexor XR

    Once daily oral dose of venlafaxine XR ranging from 37.5 mg up to 300 mg

  • placeboDrug

    Also called identically encapsulated inactive substance

    Once daily oral dose of placebo ranging from 37.5 mg up to 300 mg

Study groups in NCT00592384
Study groupRoleWhat they receive
placeboPlacebo comparatoridentically encapsulated placebo pills 37.5 - 300 mg/day for 12 weeks
Receives: Drug: placebo
venlafaxine XRExperimentalvenlafaxine XR 37.5 - 300 mg/day for 12 weeks
Receives: Drug: venlafaxine XR

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Hamilton Depression Rating Scale-17

    The 17-item Hamilton Depression Rating Scale is a clinician rated measure of depression severity (we used a structured interview version (Williams 1988) to improve inter-rater reliability). Scores range from 0-52. Higher scores indicate more severe depression. Scores of 7 or less indicate remission from depression.

    Measured: 0 weeks, 12 weeks

  2. Hamilton Depression Rating Scale-Maier Subscale

    The Maier is a 6-item sub scale of the Hamilton derived from Rasch analysis. It is a unidimensional scale with superior sensitivity to change. It excludes somatic items and is therefore especially appropriate for individuals who have substantial physical impairment and medical comorbidity. Scores can range from 0-22 with higher scores indicating more severe depression. Scores of 4 or less indicated in remission from depression.

    Measured: 0 weeks, 12 weeks

Secondary outcomes (12)
  1. Symptom Checklist-20 Depression Subscale

    Measured: Weeks 0, 1, 3, 6, 8, 10, 12, 24

  2. Modified Brief Pain Inventory

    Measured: Weeks 0, 1, 3, 6, 8, 10, 12

  3. Modified Ashworth Spasticity Scale

    Measured: Weeks 0, 1, 3, 6, 8, 10, 12

  4. Structured Clinical Interview for DSM IV Depression Module

    Measured: Weeks 0, 12, 24

  5. SF-12

    Measured: Weeks 0, 12, 24

  6. Side Effects Checklist

    Measured: Weeks 0, 1, 3, 6, 8, 10, 12

  7. Craig Handicap and Reporting Technique

    Measured: Weeks 0, 12

  8. Satisfaction With Life

    Measured: Weeks 0, 12

  9. Sheehan Disability Scale

    Measured: Weeks 0, 12

  10. Clinical Global Impression

    Measured: Weeks 0, 1, 3, 6, 8, 10, 12

  11. Patient Global Impression

    Measured: Weeks 0, 1, 3, 6, 8, 10, 12

  12. Hamilton Rating Scale for Anxiety

    Measured: Weeks 0, 12

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted14 Jan 2008 (estimated)
  2. Study startJul 2007
  3. Primary completionSep 2012
  4. Study completionSep 2012

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
133 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT00592384
Sponsor's protocol ID
31665-D
Other IDs
H133A060107;
Acronym
PRISMS
Status last verified
Dec 2014
First submitted
1 Jan 2008
Last updated
1 Jan 2015
Data monitoring committee
Yes

Publications

  • McCullumsmith CB, Kalpakjian CZ, Richards JS, Forchheimer M, Heinemann AW, Richardson EJ, Wilson CS, Barber J, Temkin N, Bombardier CH, Fann JR; PRISMS Investigators. Novel risk factors associated with current suicidal ideation and lifetime suicide attempts in individuals with spinal cord injury. Arch Phys Med Rehabil. 2015 May;96(5):799-808. doi: 10.1016/j.apmr.2014.12.017. Epub 2015 Jan 19.

    PubMed 25613597
  • Fann JR, Bombardier CH, Richards JS, Wilson CS, Heinemann AW, Warren AM, Brooks L, McCullumsmith CB, Temkin NR, Warms C, Tate DG; PRISMS Investigators. Venlafaxine extended-release for depression following spinal cord injury: a randomized clinical trial. JAMA Psychiatry. 2015 Mar;72(3):247-58. doi: 10.1001/jamapsychiatry.2014.2482.

    PubMed 25607727
  • Bombardier CH, Fann JR, Tate DG, Richards JS, Wilson CS, Warren AM, Temkin NR, Heinemann AW; PRISMS Investigators. An exploration of modifiable risk factors for depression after spinal cord injury: which factors should we target? Arch Phys Med Rehabil. 2012 May;93(5):775-81. doi: 10.1016/j.apmr.2011.12.020. Epub 2012 Mar 20.

    PubMed 22440484
  • Fann JR, Bombardier CH, Richards JS, Tate DG, Wilson CS, Temkin N; PRISMS Investigators. Depression after spinal cord injury: comorbidities, mental health service use, and adequacy of treatment. Arch Phys Med Rehabil. 2011 Mar;92(3):352-60. doi: 10.1016/j.apmr.2010.05.016. Epub 2011 Jan 20.

    PubMed 21255766

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing venlafaxine XR in people with Major Depressive Disorder and Dysthymia, run by University of Washington at 6 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 16 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 1 Jan 2015. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 6 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 1 Jan 2015). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Hamilton Depression Rating Scale-17 (time frame: 0 weeks, 12 weeks). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT00592384, which also lists 4 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 1 Jan 2015.

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