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Postpartum DepressionGnRHaNCT02661789

Neuropsychobiological Correlates of Sex-steroid Hormone Manipulation in Healthy Women: a Risk Model for Depression

A study testing Goserelin 3.6 mg implant in people with Postpartum Depression and Major Depressive Disorder, run by Gitte Moos Knudsen at 1 site in Denmark.

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

The project aimed at identifying neuropsychobiological signatures of pharmacological sex-steroid hormone manipulations in healthy women as a risk model for depression. The study is a double-blind, randomized, placebo-controlled study. Read more about this study

Who is it for?
Ages 18 to 40 years, women onlyHealthy volunteers can take part
What is being tested?
Goserelin 3.6 mg implant
Type of treatment
Injection or infusion
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
63 participants
Where
1 siteDenmark
Study dates
Jan 2011to Dec 2012
Phase
Interventional
Are there results?
None posted in the registry

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 40 years
  • Women only
  • Healthy volunteers accepted
  • Adult

Who may be able to join

  • Healthy women
  • Regular menstrual cycles (23 -35 days cycle length)
  • No systemic or intrauterine steroid hormone use

Who cannot join

  • Psychiatric disorder (DSM IV Axis I or WHO ICD-10 diagnostic classification).
  • Prior or present neurological or other severe medical condition including substance abuse.
  • No drug intake suspected to influence results
  • Conditions that may increase risk by participating in the study program including ovarian cysts
  • Pregnancy during the last year
  • Delivery during the last 2 years
Show all 12Show fewer
  • Presently wishing to obtain pregnancy
  • Breast feeding
  • Not fluent in Danish or severe visual or hearing impairments
  • Earlier or present learning disabilities
  • Claustrophobia (due to MRI scans)
  • Metal implants (excludes MRI)

Trial locations and contacts

1 site in 1 country.

Denmark1 site
  • Neurobiology Research Unit, Rigshospitalet

    Copenhagen, 2100

Other trials in Denmark

About this study

The project aimed at identifying neuropsychobiological signatures of pharmacological sex-steroid hormone manipulations in healthy women as a risk model for depression.

The study is a double-blind, randomized, placebo-controlled study. Investigators included 63 healthy female volunteers with regular menstrual cycles between 23 and 35 days. Participants were randomized to active Gonadotrophin-Releasing-Hormone agonist (GnRHa) (goserelin 3.6 mg implant) or placebo (saline injection) intervention, which was initiated in the mid follicular phase (i.e. cycle day 22.6 ±2.5). Sixty women completed follow-up and entered the analyses, except for a few drop outs on some domains. The following domains were addressed at baseline and at follow-up (16±3 days post intervention), (which corresponded to the early ovarian suppression phase of the biphasic hormone response to GnRHa): 1) serotonin transporter binding as imaged by 11CDASB Positron Emission Tomography (PET), 2) functional Magnetic Resonance Imaging (fMRI) emotional processing, 3) fMRI reward processing, 3) rating state fMRI (rsfMRI), 4) structural MRI, 5) Neuropsychology, 6) Psychophysiology, 7) Hypothalamus-Pituitary-Adrenal cortex (HPA)-axis dynamics, 8) Peripheral markers of immunoactive cell responses, 9) Epigenetic factors.

Psychometrics in terms of self reported mental distress and interview based ratings were monitored across the intervention period to monitor potential symptoms of mental distress and psychopathology. Also ovarian hormone responses, peripheral blood markers, and side effects scores were collected across the intervention period.

Read the detailed description

Aims and hypotheses:

Gender matters in normal brain function as well as in neuropsychiatric disorders. E.g. the vulnerability to mood and anxiety disorders is considerably greater in women. Among other factors, this possibly reflects gender differences in central serotonergic function since dysfunction of serotonergic neurotransmission is critically involved in the pathophysiology of mood and anxiety disorders, schizophrenia, and Alzheimer's disease. In particular, women going through phases in life where sex hormones decline rapidly from high levels or fluctuate, have a higher frequency of severe mood state changes and are more vulnerable to psychiatric disorders, e.g. across the pre to postpartum and menopausal transition. Interestingly, this risk is associated with increased variability of the plasma levels of the sex-hormone estradiol. Therefore, sex-hormone manipulation with a pharmacologically induced biphasic ovarian hormone response serve as a unique opportunity to study how sex-hormone fluctuations provoke mood state changes and increase vulnerability to neuropsychiatric disorders.

In this project investigators aimed at investigating whether sex-hormone manipulation affects: 1. Molecular imaging markers of serotonergic neurotransmission in vivo, 2. Brain structure, architecture and functional connectivity, 3. Stress and inflammatory responses, and 4. Cognitive functions, emotional processing, and information filtering, of importance in the pathophysiology of neuropsychiatric disorders.

Mentally healthy female volunteers were assessed at baseline (i.e cycle day 6.6 ±2.2) and at follow-up (i.e 16.2 ±2.6 days post intervention) in the early ovarian suppression phase af a Gonadotrophin-Releasing-Hormone agonist response in a placebo-controlled, double-blinded design (cohort size aim: N=30x2).

Research in neurobiological correlates of vulnerability related to sex-hormone changes is pivotal to improve the etiological understanding of brain disorders with gender differences in their incidence and/or nature. Such research may contribute to ameliorate fertility treatment, to improve treatment of mood disorders and schizophrenia, and, ideally, shed light on possible preventive strategies in vulnerable phases of women's lives such as the pre- to post-partum and menopausal transition period.

Hypotheses:

Investigators hypothesised that sex-hormone manipulation is associated with the following: 1. Compromised serotonergic neurotransmission, 2. Changes in functional and structural connectivity and lower hippocampal brain volumes and/or markers of decreased neurogenesis, 3. Increased stress reactivity and inflammatory responses, and 4. Changes in neurocognitive functioning and negative bias in emotional processing and information filtering. Investigators further hypothesised that these changes occur in a manner dependent on the magnitude of the estradiol drop from baseline and dependent on symptoms of depressed and anxious mood.

General study design:

The study is a prospective, double-blinded, placebo-controlled, combined within-subject and between-group design of neuropsychobiological changes in response to hormonal down-regulation. The investigation program will be performed at baseline in the mid-follicular phase, at day 5-8 of the menstrual cycle, and in the down-regulated state, 14-19 days after GnRHa intervention.

Participants. Investigators aimed at including 60 healthy female volunteers, in the age range 18-40 years. Group 1 (N=30) will receive sex-hormone manipulation with GnRHa, and group 2 (N=30) will receive placebo (saline injection). The inclusion will be stratified according to a polymorphism in the serotonin transporter promoter region (5-HTLPR).

The investigation program includes functional brain imaging of the serotonin transporter with [11C]DASB PET (6) and fMRI, structural brain imaging, blood measurements of sex-hormone levels, inflammatory and epigenetic biomarkers, characterization of the cortisol awakening response, and psychophysiological measures of information processing, and monitoring of symptoms of mental distress and psychopathology across the intervention period. An initial screening program will secure inclusion of healthy controls only and determine trait parameters such as genotypes, IQ and personality measures.

The study was registered at and approved by the Danish Ethical Committee before participant inclusion under the protocol identification number: H-2-2010-108. All participants gave written informed consent.

Being tested
Goserelin 3.6 mg implant, Placebo
Keywords
Mental health, Brain Imaging, Steroid hormones, Serotonin, PET, MRI, fMRI, human, gender, risk model
Medical subject headings
Depression, Postpartum, Depressive Disorder, Major, Nerve Degeneration, Schizophrenia, Psychological Well-Being, Coitus

What participants receive

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

  • Goserelin 3.6 mg implantDrug

    Also called Zoladex

    Pharmacologically induced biphasic sex-steroid hormone fluctuation

  • PlaceboDrug

    Also called Saline

    Injection of saline

Study groups in NCT02661789
Study groupRoleWhat they receive
GnRHaActive comparatorGoserelin 3.6 mg implant
Receives: Drug: Goserelin 3.6 mg implant
PlaceboPlacebo comparatorInjection of saline
Receives: Drug: Placebo

What is being measured

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

  1. Changes from baseline in symptoms of depression

    Hamilton 17 item score

    Measured: Baseline to follow-up 16±3 days after intervention

  2. Changes from baseline in serotonin transporter binding in volumes of interest (VOIs)

    PET scan assessed serotonin transporter binding changes

    Measured: Baseline to follow-up 16±3 days after intervention

  3. Changes from baseline in fMRI response to emotional faces

    fMRI response changes to emotional faces in emotion processing network including amygdala reactivity

    Measured: Baseline to follow-up 16±3 days after intervention

  4. Changes from baseline in fMRI response to gambling paradigm

    fMRI response changes to reward (monetary win) paradigm in reward processing network

    Measured: Baseline to follow-up 16±3 days after intervention

  5. Changes from baseline in rsfMRI changes in functional connectivity

    rsfMRI changes in functional connectivity in response to intervention

    Measured: Baseline to follow-up 16±3 days after intervention

  6. Changes from baseline in affective cognition (VAMT-24 test)

    Neuropsychological (VAMT-24 test) outcomes on affective cognition

    Measured: Baseline to follow-up 16±3 days after intervention

  7. Changes from baseline in reaction time

    Changes in reaction time

    Measured: Baseline to follow-up 16±3 days after intervention

  8. Serial mood fluctuations (SD of total mood disturbance (TMD) score of daily POMS across intervention period)

    Mood fluctuations measured by serial collection of daily POMS

    Measured: Intervention start to follow-up 16±3 days after intervention

  9. Changes from baseline in hippocampal volume

    Hippocampal volumes from structural MRI

    Measured: Baseline to follow-up 16±3 days after intervention

  10. Changes in pre-pulse-inhibition (PPI) from baseline

    Change in amplitude of the startle response to pulse after pre-pulse warning as measured by EMG in the orbicularis oculi muscle (subtraction of averages across a series of 10 repititions at baseline and at follow-up 16±3 days).

    Measured: Baseline to follow-up 16±3 days after intervention

  11. Changes in a set of markers of immunoactivity across study period

    Cytokines, hsCRP and gene transcript profile markers of

    Measured: Baseline, intervention time, flare-up phase and follow-up

  12. Changes in epigenetic markers of estrogen sensitivity

    Epigenetic (methylation) markers

    Measured: Baseline to follow-up 16±3 days after intervention

  13. Changes in HPA-axis dynamics (the cortisol awakening response)

    The cortical awakening response

    Measured: Baseline to follow-up 16±3 days after intervention

  14. Changes in sensorimotor gating (P50 suppression) from baseline

    Changes in sensorimotor gating (P50 suppression) from baseline

    Measured: Baseline to follow-up 16±3 days after intervention

  15. Changes from baseline in hippocampal microstructure

    Hippocampal microstructure from MRI

    Measured: Baseline to follow-up 16±3 days after intervention

Secondary outcomes (7)
  1. Changes from baseline in fMRI responses to emotional memory paradigm

    Changes in brain activation to fMRI emotional memory paradigm - delayed recall forgetting of word prior to emotional disturbance

    Measured: Baseline to follow-up 16±3 days after intervention

  2. Changes from baseline in Cohens perceived stress score

    Changes Cohens perceived stress score

    Measured: Baseline to follow-up 16±3 days after intervention

  3. Changes in Pittsburg Sleep Quality Inventory (PSQI)

    Sleep quality self reported weekly across intervention period

    Measured: Baseline and 1 time per week until follow-up at 16 ±3 days

  4. Side effects scores (project specific 15 items questionnaire)

    Total side effect score across and after intervention period

    Measured: 7, 12 and 30 days post intervention

  5. Changes in SCL-R (Symptom check-list revised)

    Changes in symptoms of psychopathology across intervention period

    Measured: Baseline and 1 time per week from intervention to follow up at 16±3 days post intervention

  6. Major Depression Inventory (MDI)

    Changes in self-reported symptoms of depression across intervention period

    Measured: Baseline and 1 time per week from intervention to follow up at 16±3 days post intervention

  7. Changes in profile of mood states (POMS TMD score)

    Changes in self-reported symptoms of mental distress across intervention period

    Measured: Baseline and 1 time per week from intervention to follow up at 16±3 days post intervention

Timeline

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

  1. First posted22 Jan 2016 (estimated)
  2. Study startJan 2011
  3. Primary completionDec 2012
  4. Study completionDec 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 N/A
Primary purpose
Basic science
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
63 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02661789
Sponsor's protocol ID
GnRHa
Other IDs
H-2-2010-108
Acronym
GnRHa
Status last verified
Jan 2016
First submitted
13 Jan 2016
Last updated
22 Jan 2016
Results posted
No
Data monitoring committee
Yes
Individual data sharing
Yes: Via database of Center for Integrated Molecular Brain Imaging (Knudsen et al 2016, NeuroImage) data will be available for neuroscience research community contingent on approval by scientific board

Publications

  • Mehta D, Rex-Haffner M, Sondergaard HB, Pinborg A, Binder EB, Frokjaer VG. Genome-wide gene expression in a pharmacological hormonal transition model and its relation to depressive symptoms. Acta Psychiatr Scand. 2019 Jul;140(1):77-84. doi: 10.1111/acps.13038. Epub 2019 May 24.

    PubMed 31099405
  • Fisher PM, Larsen CB, Beliveau V, Henningsson S, Pinborg A, Holst KK, Jensen PS, Svarer C, Siebner HR, Knudsen GM, Frokjaer VG. Pharmacologically Induced Sex Hormone Fluctuation Effects on Resting-State Functional Connectivity in a Risk Model for Depression: A Randomized Trial. Neuropsychopharmacology. 2017 Jan;42(2):446-453. doi: 10.1038/npp.2016.208. Epub 2016 Sep 21.

    PubMed 27649641

Questions about this trial

What is this clinical trial studying?

A study testing Goserelin 3.6 mg implant in people with Postpartum Depression and Major Depressive Disorder, run by Gitte Moos Knudsen at 1 site in Denmark.

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 3 inclusion and 12 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 22 Jan 2016. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Denmark. 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.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

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?

Changes from baseline in symptoms of depression (time frame: Baseline to follow-up 16±3 days after intervention). The study lists 15 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 NCT02661789, which also lists 2 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 22 Jan 2016.

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