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Depression, BipolarPhase 4DUAG9NCT05913947

Lithium Versus Cariprazine in the Acute Phase Treatment of Bipolar Depression (DUAG9)

A Phase 4 study testing Lithium and Cariprazine in people with Depression, Bipolar, run by Aalborg University Hospital at 1 site in Denmark.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

The goal is to study the effect of lithium compared to cariprazine in patients with depression in a bipolar disease. The main question it aims to answer is: Difference in change between the two groups from baseline to after 8 weeks treatment on Hamilton Ratings Scale for Depression, 6-item version (HDS-6) Participants… Read more about this study

Who is it for?
Ages 18 to 65 years
Conditions the study is for
Depression, Bipolar
What is being tested?
Lithium and Cariprazine
Type of treatment
Pill or oral medicine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
122 participants
Where
1 siteDenmark
Study dates
13 Dec 2022to 2 Sep 2028
Phase
Phase 4
Are there results?
Not yet: the study is under way

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 65 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • A diagnosis of bipolar disorder, type 1 or type 2, and a current episode of depression according to DSM-5
  • Severity of depression: A score of at least 21 on the self-reported Major Depression Inventory (MDI).
  • No start or dose increase of psychotropic medication (except for benzodiazepines and benzodiazepine-like drugs (zopiclone, zolpidem, and melatonin)) in the two weeks prior to inclusion.
  • No new start of formalized psychotherapy sessions, excluding psychoeducation, during the 4 weeks prior to inclusion.
  • Age criteria: Subjects must be at least 18 years old and below 65 at the time of randomization.
  • The duration of the current depressive episode must be between 4 and 52 weeks as judged by the investigator at the time of randomization.
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  • Clinical uncertainty regarding which of the alternatives, cariprazine and lithium, would be the better choice in the specific case.
  • Female participants should be sterile or non-fertile or, in case of being fertile, they must have a negative pregnancy test AND use safe anticonception.
  • Signed document of informed consent.

Who cannot join

  • Prior or ongoing acute treatment of a depressive episode lasting > 14 days with either lithium or cariprazine as judged by the investigator.
  • ECT within the current depressive episode.
  • A score of MAS > 6.
  • A diagnosis of dementia.
  • High risk of non-adherence at the investigator's discretion.
  • Not understanding the Danish language as judged by the investigator
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  • Psychiatric coercion in the form of forced admission or detainment OR sentence to forensic psychiatric care.
  • Presence of clinically relevant delusions, hallucinations or other psychotic symptoms as judged by the investigator.
  • Suicidality according to C-SSRS with a positive response to question 4 or 5 or upon investigator's discretion.
  • Medical conditions like cancer, kidney failure, epilepsy, deep brain stimulation device, or other medical conditions interfering with study the outcome and safety as judged by investigator's discretion.
  • Current harmful use or dependency of alcohol or drugs according to DSM-5.
  • Known allergy to any of the substances in the study medication.

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Sanne V. Hovgesen, MD contact

+45 25487706

sanne.hovgesen@rn.dk

Simon Johnsen, MsN contact

+45 50589034

simonjohnsen@rn.dk

Denmark1 site, 1 recruiting
  • Aalborg University Hospital

    Aalborg, 9000

    Sanne V. Hovgesen, MD, +45 29217805, sanne.hovgesen@rn.dk

    Simon Johnsen, +45 61395631, simon.johnsen@rn.dk

    Recruiting

Other trials in Denmark

About this study

Official title: Lithium Versus Cariprazine in the Acute Phase Treatment of Bipolar Depression: a Pragmatic Head-to-head Open, Randomized Multicenter Study: The 9th Study of the Danish University Antidepressant Group (DUAG 9)

The goal is to study the effect of lithium compared to cariprazine in patients with depression in a bipolar disease.

The main question it aims to answer is:

Difference in change between the two groups from baseline to after 8 weeks treatment on Hamilton Ratings Scale for Depression, 6-item version (HDS-6)

Participants will be randomized to treatment with either lithium or cariprazin.

  • Will meet for interview and ratings 4 times during study period.
  • In two meetings, there will be made blood samples and ECG. At one meeting also a Urine sample.
  • Will be contacted for telephone interviews at 6 occasions.
Read the detailed description

The primary aim is to investigate whether cariprazine is superior to lithium or vice versa in the acute treatment of patients with bipolar type 1 or 2 in a current depressive episode measured as change on the Hamilton Depression Scale, 6 item version (HDS-6) from baseline to 8 weeks of treatment. Secondarily, we aimed at comparing the two study medications on various other clinically relevant variables.

These include depressive and manic symptomatology, sleep patterns, general well-being, cognitive function, social functioning and suicidal ideation.

Being tested
Lithium, Cariprazine
Medical subject headings
Bipolar Disorder

What participants receive

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

  • LithiumDrug

    Also called Litarex, ATC; N05AN01

    The starting dose (day one) of lithium citrate is 12 mmol (one tablet of lithium citrate contains 6 mmol lithium) given once a day before bedtime. On day three the dose is increased to 18 mmol. Dose adjustments are permitted after 7 days in a flexible manner to result in a 12-hour se-lithium between 0.6 and 0.8 mmol/l, aiming for the upper limit at the treating physician's discretion.

  • CariprazineDrug

    Also called Reagila, ATC: N05AX15

    The starting dose for cariprazine is 1.5 mg daily in a single dose, and subsequently, after a minimum of two weeks, the dose can be increased to 3 mg and decreased again to 1.5 mg daily at the treating physician's discretion.

Study groups in NCT05913947
Study groupRoleWhat they receive
LithiumExperimentalLithium citrate from 12 mmol increased to result in af 12-hour se-lithium between 0.6 and 0.8 mmol/l
Receives: Drug: Lithium
CariprazineExperimentalCariprazine from 1.5 mg to 3 mg daily in a single dose.
Receives: Drug: Cariprazine

What is being measured

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

  1. Change in Hamilton Depressions scale, version 6 (HDS-6)

    The primary aim is to investigate whether cariprazine is superior to lithium or vice versa in the acute treatment of patients with bipolar type 1 or 2 in a current depressive episode measured as change on the Hamilton Depression Scale, 6 item version, HDS-6. (Values 0- 22, higher scores mean a worse outcome).

    Measured: 8 weeks

Secondary outcomes (31)
  1. Difference-in-difference for HDS-17

    Difference-in-differences for secondary continuous measures: Hamilton Depression Scale, 17 item version, HDS-17. (Values 0- 52, higher scores mean a worse outcome)

    Measured: Week 4 and 8

  2. Difference-in-differences in HDS-6 for the PP 8 population

    Difference-in-differences (baseline to 8 weeks) in HDS-6 for the PP 8 population.

    Hamilton Depression Scale, 6 item version, HDS-6. (Values 0- 22, higher scores mean a worse outcome).

    Measured: 8 weeks

  3. Between-groups difference in proportion of responders and remitters in HDS-6 Scores.

    Between-groups difference in proportion of responders and remitters at week 4 and 8 in HDS-6 scores.

    Hamilton Depression Scale, 6 item version, HDS-6. (Values 0- 22, higher scores mean a worse outcome).

    Measured: Week 4 and week 8

  4. Between-groups difference in proportion of responders and remitters

    Between-groups difference in proportion of responders and remitters with response and remission defined by HDS-6 score without clinical relevant manic symptoms (MAS <7) at planned or premature endpoint.

    Hamilton Depression Scale, 6 item version, HDS-6. (Values 0- 22, higher scores mean a worse outcome).

    Measured: Week 4 and 8

  5. Between-groups difference in the proportion of patients with 'acceptable wellbeing'

    Between-groups difference in the proportion of patients with 'acceptable wellbeing', defined as the subject reporting ≥50 on the WHO-5 questionnaire at endpoint. WHO-five Well-being Index, WHO-5 (Values 0- 100, higher scores mean a better outcome).

    Measured: up to 8 weeks

  6. Between-groups difference in proportion of switches to mania/hypomania.

    Between-groups difference in proportion of switches to mania/hypomania with or without mixed features, defined as mania/hypomania after DSM-5 or symptoms requiring treatment (switch or response occurring at any time in the study period)

    Measured: up to 8 weeks

  7. Between-groups difference in "(switch to mania or hypomania) / (response) -ratio",

    Between-groups difference in "(switch to mania or hypomania) / (response) -ratio", defined as the number of subjects switching to mania or hypomania (as defined above) divided by the total number of responders, including those responders switching to mania

    Measured: up to 8 weeks

  8. Between-group differences in reason for and time to all cause treatment discontinuation

    Between-group differences in reason for and time to all cause treatment discontinuation (lack of effect, lack of tolerability, lost to follow-up, or other cause).

    Measured: up to 8 weeks

  9. Between-group difference in treatment compliance.

    Between-group difference in treatment compliance. Treatment compliance is defined as the proportion of received treatments out of the planned until drop-out or end of study.

    Measured: up to 8 weeks

  10. Between-group difference in reasons for premature discontinuation

    Between-group difference for the ITT population in reasons for premature discontinuation

    Measured: up to 8 weeks

  11. Difference-in-difference for MAS

    Difference-in-differences for secondary continuous measures: MAS Bech-Rafaelsens Mania scale .(Values 0- 44, higher scores mean a worse outcome).

    Measured: Week 4 and 8

  12. Difference-in-difference for MES

    Difference-in-differences for secondary continuous measures: MES Bech-Rafaelsens Melancholia scale, MES .(Values 0- 44, higher scores mean a worse outcome).

    Measured: Week 4 and 8

  13. Difference-in-differences for MADRS

    Difference-in-differences for secondary continuous measures: MADRS Montgomery-Aaberg Depression Rating Scale, MADRS .(Values 0- 60, higher scores mean a worse outcome).

    Measured: Week 4 and 8

  14. Difference-in-difference for YMRS

    Difference-in-differences for secondary continuous measures:YMRS Young Mania Rating Scale, YMRS .(Values 0- 60, higher scores mean a worse outcome).

    Measured: Week 4 and 8

  15. Difference-in-differences for ASRM-14

    Difference-in-differences for secondary continuous measures:ASRM-14 Altman Self-Rating Mania Scale-14, .(Values 0- 56, higher scores mean a worse outcome).

    Measured: Week 4 and 8

  16. Difference-in-differences for MDI

    Difference-in-differences for secondary continuous measures:MDI Major Depression Inventory, MDI (Values 0- 58, higher scores mean a worse outcome).

    Measured: Week 4 and 8

  17. Difference-in-differences for WHO-5 questionnaire

    Difference-in-differences for secondary continuous measures: WHO-5 questionnaire.

    WHO-five Well-beeing Index, WHO-5 (Values 0- 100, higher scores mean a better outcome).

    Measured: Week 4 and 8

  18. Difference-in-difference for SCIP

    Difference-in-differences for secondary continuous measures: SCIP Screen for Cognitive Impairment in Psychiatry, SCIP (Values 0- 64+, higher scores mean a better outcome)

    Measured: Week 8

  19. Difference-in-difference for COBRA

    Difference-in-differences for secondary continuous measures: COBRA Cognitive complaints in bipolar disorder Ratings assessment, COBRA, (Values 0- 48, higher scores mean a worse outcome).

    Measured: Week 8

  20. Difference-in-difference for FAST

    Difference-in-differences for secondary continuous measures: FAST Functioning Assessment Short Test, FAST (Values 0 - 72, higher scores mean a worse outcome).

    Measured: Week 4 and 8

  21. Difference-in-difference for PSQI

    Difference-in-differences for secondary continuous measures:PSQI PIttsburgh Sleep Quality Index, PSQI (Values 0 - 21, higher scores mean a worse outcome).

    Measured: Week 4 and 8

  22. Difference-in-difference for CGI-S

    Difference-in-differences for secondary continuous measures: CGI-S Clinical Global Impression Scale - Severity, CGI-S (Values 1 -7, higher scores mean a worse outcome).

    Measured: Week 4 and 8

  23. Difference-in-difference for CGI-I

    Difference-in-differences for secondary continuous measures:CGI-I Clinical Global Impression Scale - Global Improvement CGI- I (Values 1 -7, higher scores mean a worse outcome).

    Measured: Week 4 and 8

  24. Difference-in-difference for C-SSRS

    Difference-in-differences for secondary continuous measures: C-SSRS Columbia-Suicide Severity Rating Scale, C-SSRS (Values 1 - 5, higher scores mean a worse outcome).

    Measured: Week 4 and 8

  25. Difference-in-difference for accumulated benzodiazepine dose

    Difference-in-differences for secondary continuous measures: accumulated benzodiazepine dose as diazepam equivalents (DSKP)

    Measured: Up to 8 weeks

  26. Difference-in-difference for time to all-causes discontinuation

    Difference-in-differences for secondary continuous measures: for time to all-causes discontinuation

    Measured: Up to 8 weeks

  27. Difference-in-difference for time to all-causes. all-causes study endpoint.

    Difference-in-differences for secondary continuous measures: all-causes study endpoint.

    Measured: Up to 8 weeks

  28. Between-group difference in reasons for time to all cause discontinuation.

    Between-group difference for the ITT population in reasons for time to all cause discontinuation.

    Measured: Up to 8 weeks

  29. Between-group difference in reasons for treatment expectation.

    Between-group difference for the ITT population in reasons for treatment expectation.

    Measured: Up to 8 weeks

  30. Between-group difference in reasons for adverse events.

    Between-group difference for the ITT population in reasons for adverse events.

    Measured: Up to 8 weeks

  31. Between-group difference in reasons for serious adverse events.

    Between-group difference for the ITT population in reasons for serious adverse events.

    Measured: Up to 8 weeks

Timeline

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

  1. First posted22 Jun 2023
  2. Study start13 Dec 2022
  3. Primary completion1 Sep 2028 (estimated)
  4. Study completion2 Sep 2028 (estimated)

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
None (open label)
Enrolment
122 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05913947
Sponsor's protocol ID
2021-006706-69
Acronym
DUAG9
Status last verified
Apr 2026
First submitted
29 Mar 2023
Last updated
29 Oct 2026
Results posted
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Hovgesen SV, Licht RWW, Straszek SPV, Christensen AE, Vinberg M, Videbech P, Miskowiak KW, Johnsen S, Munk MM, Mai ML, Baethge C, Kessing LV, Nielsen RE. Lithium versus cariprazine in the acute phase treatment for depressive episodes in patients with bipolar disorder: a protocol for a pragmatic open, randomised multicentre study - the 9th trial of the Danish University Antidepressant Group, DUAG-9. BMJ Open. 2025 Aug 27;15(8):e102406. doi: 10.1136/bmjopen-2025-102406.

    PubMed 40866064

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Lithium and Cariprazine in people with Depression, Bipolar, run by Aalborg University Hospital 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 9 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: looking for participants now, as of the sponsor's last update on 29 Oct 2026. 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. 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?

This study is still under way. Results are not available in the source record yet.

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

Contact Sanne V. Hovgesen, MD (+45 25487706, sanne.hovgesen@rn.dk), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change in Hamilton Depressions scale, version 6 (HDS-6) (time frame: 8 weeks). 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 NCT05913947, which also lists 1 linked publication.

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 29 Oct 2026.

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