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Improving Treatment Outcomes in Pharmacotherapy of Generalized Social Anxiety Disorder
This study is currently recruiting participants.
Verified by National Institute of Mental Health (NIMH), March 2008
Sponsored by: National Institute of Mental Health (NIMH)
Information provided by: National Institute of Mental Health (NIMH)
ClinicalTrials.gov Identifier: NCT00282828
  Purpose

This study will compare the effectiveness of either adding clonazepam or placebo to standard treatment or switching to venlafaxine in treating generalized social anxiety disorder in individuals who have not responded to treatment with sertraline.


Condition Intervention Phase
Social Phobia
Drug: Clonazepam
Drug: Venlafaxine
Drug: Sertraline
Drug: Placebo
Phase IV

MedlinePlus related topics: Anxiety Phobias
Drug Information available for: Sertraline hydrochloride Sertraline Venlafaxine Venlafaxine hydrochloride Clonazepam
U.S. FDA Resources
Study Type: Interventional
Study Design: Treatment, Randomized, Double Blind (Subject, Investigator, Outcomes Assessor), Dose Comparison, Parallel Assignment, Safety/Efficacy Study
Official Title: Improving Outcomes in Pharmacotherapy of Social Phobia

Further study details as provided by National Institute of Mental Health (NIMH):

Primary Outcome Measures:
  • Remission rates less than 30 on the Liebowitz Social Anxiety Scale (LSAS) [ Time Frame: Measured at Week 22 ] [ Designated as safety issue: No ]
  • Post-treatment social phobia severity as defined by endpoint LSAS scores [ Time Frame: Measured at Week 22 ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Treatment response [ Time Frame: Measured at Week 10 ] [ Designated as safety issue: No ]

Estimated Enrollment: 490
Study Start Date: March 2006
Estimated Study Completion Date: March 2011
Estimated Primary Completion Date: March 2011 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
B1: Experimental
Participants will take both sertraline and clonazepam
Drug: Clonazepam
Participants take 0.5 to 3 mg per day of clonazepam for 12 weeks.
Drug: Sertraline
All participants take 50 to 200 mg per day of sertraline for the initial 10 weeks of treatment. Then some participants continue with sertraline and placebo or sertraline and clonazepam for 12 more weeks.
B2: Experimental
Participants will take venlafaxine only
Drug: Venlafaxine
Participants take 37.5 to 225 mg per day of venlafaxine for 12 weeks.
Drug: Sertraline
All participants take 50 to 200 mg per day of sertraline for the initial 10 weeks of treatment. Then some participants continue with sertraline and placebo or sertraline and clonazepam for 12 more weeks.
B3: Experimental
Participants will take both sertraline and placebo
Drug: Sertraline
All participants take 50 to 200 mg per day of sertraline for the initial 10 weeks of treatment. Then some participants continue with sertraline and placebo or sertraline and clonazepam for 12 more weeks.
Drug: Placebo
Participants take placebo with the sertraline for 12 weeks.

Detailed Description:

Generalized social anxiety disorder (GSAD) is one of the most common psychiatric disorders, and often causes significant distress and dysfunction in affected individuals. Although currently available treatments for GSAD are effective, most individuals have residual symptoms after initial psychosocial or psychopharmacologic intervention. Further treatment is necessary for such individuals, but sufficient research has not been done to guide clinicians on what the safest and most effective next step may be. This study will compare the effectiveness of either combining clonazepam or placebo with sertraline or completely switching to venlafaxine in treating GSAD in individuals who have not responded to treatment with sertraline. This study will also examine predictors of treatment response, including factors such as age at disease onset, duration of illness, comorbidities, and genes that influence serotonin and catecholamine metabolism.

Participants in this double-blind study will first partake in an initial 10-week phase in which they will be treated with sertraline. Participants who do not respond to sertraline treatment will proceed to phase two of the study, in which they will be randomly assigned to one of three treatment groups. One group will receive both sertraline and clonazepam, another group will receive both sertraline and placebo, and the third group will receive only venlafaxine. All treatments will continue for 12 weeks. Sertraline and venlafaxine are both FDA-approved for the treatment of GSAD. Clonazepam is widely used for the treatment of anxiety, but is not FDA-approved for the treatment of GSAD. All participants will attend weekly study visits at Weeks 1, 2, 4, 6, 8, and 10. Participants who continue into phase two will attend weekly study visits at Weeks 11-14, 16, 18, 20, and 22. Symptom remission rates and post-treatment social phobia severity will be assessed at Week 20.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Primary psychiatric diagnosis of GSAD as defined by DSM-IV criteria and a score above 60 on the LSAS
  • Agrees to use an effective form of contraception throughout the study

Exclusion Criteria:

  • Clinically significant abnormalities found upon physical examination, electrocardiogram, and laboratory tests
  • History of more than two unsuccessful, adequate treatment trials, indicated by a lack of response to over 10 weeks of any of the following: SSRIs (e.g., 40 mg of paroxetine or its equivalent per day); benzodiazepine (e.g. at least 2.5 mg of clonazepam per day) plus antidepressant (adequate dose as above); monoamine oxidase inhibitors (e.g., 60 mg of phenelzine or its equivalent per day); or a single failed trial of over 10 weeks of venlafaxine ( at least 150 mg per day)
  • Pregnant or breastfeeding
  • Simultaneous use of other psychotropic medications; participants must discontinue regular benzodiazepine or antidepressant therapy at least two weeks (5 weeks for fluoxetine) prior to study entry; beta-blockers must be discontinued unless they are indicated medically (e.g., for hypertension)
  • DSM-IV diagnosis of any of the following: lifetime history of schizophrenia or any other psychosis, mental retardation, organic medical disorder, bipolar disorder, or obsessive compulsive disorder; eating disorder in the past 6 months; alcohol or substance abuse in the past 3 months or dependence within the past 6 months (entry of participants with major depression, dysthymia, panic disorder, generalized anxiety disorder, or post-traumatic stress disorder will be permitted if the social anxiety disorder is judged to be the predominant disorder)
  • Significant suicidal ideation as indicated by a score greater than 3 on the Montgomery-Asberg Depression Rating Scale or suicidal behaviors within 6 months prior to study entry
  • Significant personality dysfunction that could interfere with study participation
  • Serious medical illness or instability for which hospitalization may be likely during the study
  • Seizure disorders, with the exception of a childhood history of isolated, non-recurrent febrile seizures
  • Any concurrent psychotherapy initiated within 3 months of study entry, or ongoing psychotherapy of any duration directed specifically toward treatment of GSAD (prohibited psychotherapy includes cognitive behavioral therapy or psychodynamic therapy that focuses on exploring specific, dynamic causes of the phobic symptomatology and that provides management skills; general supportive therapy for more than 3 months is acceptable)
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00282828

Contacts
Contact: Nannette N. Herlands, BA 617-726-1570 nherlands@partners.org

Locations
United States, California
University of California San Diego Recruiting
La Jolla, California, United States, 92093
Contact: Murray B. Stein, MD, MPH     858-534-6400     mstein@UCSD.Edu    
Principal Investigator: Murray B. Stein, MD, MPH            
Sub-Investigator: Denise A. Chavira, PhD            
Sub-Investigator: Laura Campbell-Sills, PhD            
Sub-Investigator: Scott C. Matthews, MD            
Sub-Investigator: Ann Fleming, RN            
United States, Massachusetts
Center for Anxiety and Traumatic Stress Disorders Recruiting
Boston, Massachusetts, United States, 02116
Contact: Nannette N. Herlands, BA     617-736-1570     nherlands@partners.org    
Principal Investigator: Mark H. Pollack, MD            
Sub-Investigator: Naomi M. Simon, MD, MSC            
Sub-Investigator: John J. Worthington, MD            
Sub-Investigator: Elizabeth A. Hoge, MD            
Sub-Investigator: David A. Schoenfeld, PhD            
Sub-Investigator: David J. Dorer, PhD            
Canada, Ontario
McMaster University Medical Centre Anxiety Disorders Clinic Recruiting
Hamilton, Ontario, Canada, L8N 3Z5
Contact: Michael Van Ameringen, MD, FRCPC     905-521-2100 ext 76181     vanamer@mcmaster.ca    
Principal Investigator: Michael Van Ameringen, MD, FRCPC            
Sub-Investigator: Catherine Mancini, MD, FRCPC            
Sub-Investigator: Jonathan Oakman, PhD            
Sub-Investigator: Beth Patterson, BScN, RN            
Sponsors and Collaborators
Investigators
Principal Investigator: Mark H. Pollack, MD Massachusetts General Hospital
Principal Investigator: Murray B. Stein, MD, MPH University of California San Deigo
Principal Investigator: Michael Van Ameringen, MD, FRCPC Anxiety Disorders Clinic McMaster Univeristy Medical Centre
  More Information

Click here for the Center for Anxiety and Traumatic Stress Disorders at Massachusetts General Hospital website  This link exits the ClinicalTrials.gov site
Click here for the Anxiety Disorders Association of America website  This link exits the ClinicalTrials.gov site

Responsible Party: Massachusetts General Hospital ( Mark Pollack, MD )
Study ID Numbers: R01 MH70919, PA-01-123, DSIR 83-ATAS
Study First Received: January 25, 2006
Last Updated: March 18, 2008
ClinicalTrials.gov Identifier: NCT00282828  
Health Authority: United States: Federal Government;   Canada: Health Canada

Keywords provided by National Institute of Mental Health (NIMH):
Social Anxiety Disorder
Pharmacotherapy
Genetics
Treatment Refractory

Study placed in the following topic categories:
Anxiety Disorders
Mental Disorders
Clonazepam
Venlafaxine
Sertraline
Phobic Disorders
Serotonin

Additional relevant MeSH terms:
Neurotransmitter Agents
Neurotransmitter Uptake Inhibitors
Molecular Mechanisms of Pharmacological Action
GABA Modulators
Physiological Effects of Drugs
Psychotropic Drugs
Serotonin Uptake Inhibitors
Pharmacologic Actions
Serotonin Agents
Therapeutic Uses
GABA Agents
Antidepressive Agents, Second-Generation
Central Nervous System Agents
Anticonvulsants
Antidepressive Agents

ClinicalTrials.gov processed this record on January 30, 2009