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D-Cycloserine for Major Depressive Disorder
This study is currently recruiting participants.
Verified by Herzog Hospital, August 2008
First Received: December 3, 2006   Last Updated: August 6, 2008   History of Changes
Sponsors and Collaborators: Herzog Hospital
National Alliance for Research on Schizophrenia and Depression
Information provided by: Herzog Hospital
ClinicalTrials.gov Identifier: NCT00408031
  Purpose

For many depression patients treatment changes are required, including switching to another antidepressant and addition of a second antidepressant or a non-antidepressant agent ("augmentation"). The need to modify treatment is usually necessary because of partial or no response to first-line monotherapy or the failure to achieve remission although treatment response (improvement) has been obtained. These caveats of presently available antidepressant drugs highlight the need for innovative pharmacological treatment strategies. Recent data suggest that N-methyl-D-aspartate receptor (NMDAR) antagonists and partial agonists at the NMDAR-associated glycine binding site may represent a novel type of antidepressant medications. These types of compounds protect vulnerable neurons against a variety of insults, including stress-induced damage, and may serve to enhance and maintain normal synaptic connectivity. In animal models, these compounds mimic the effects of clinically effective antidepressants. Furthermore, down-regulation of the glycine site of the NMDAR was found to be a common feature of currently used antidepressant medications. D-cycloserine (DCS , Seromycin) is a broad spectrum antibiotic, in use for over thirty years against tuberculosis, that acts as a partial agonist at the NMDAR-associated glycine site. Beneficial antidepressant effects have been reported with 500-1000 mg/day DCS regimens in depressed tuberculosis patients and recent preliminary findings suggest that DCS may also be beneficial in the treatment of major depressive disorder. The antidepressant effects of DCS seem to reflect consequences of its capacity to reduce NMDAR receptor function. In the present project, it is proposed to assess, using a random assignment, parallel-group, double blind, placebo controlled design, the effects of a NMDAR -antagonist DCS dose regimen, 250 --> 1000 mg/day for 6 wks, as adjuvant pharmacotherapy for treatment-resistant major depressive disorder patients. The study methodology includes the assessment of DCS effects upon symptoms profile, neurocognitive tests performance, amino acids serum levels, and brain electrophysiology parameters associated with the prepulse inhibition-startle response paradigm. It is hypothesized that significant beneficial DCS treatment effects will be registered.


Condition Intervention Phase
Major Depressive Disorder
Drug: D-cycloserine
Phase II

Study Type: Interventional
Study Design: Treatment, Randomized, Double Blind (Subject, Caregiver, Investigator), Placebo Control, Parallel Assignment, Efficacy Study
Official Title: N-Methyl-D-Aspartate Receptor (NMDAR)-Based Pharmacotherapy With D-Cycloserine for Treatment-Resistant Major Depressive Disorder

Resource links provided by NLM:


Further study details as provided by Herzog Hospital:

Primary Outcome Measures:
  • Change in 24 item Hamilton Depression Rating Scale (HAMD) scores. Safety measures: UKU scale, vital signs assessments, laboratory parameters (SMA-20, CBC, UA) [ Time Frame: 6 weeks ] [ Designated as safety issue: Yes ]
  • Change in Hamilton Rating Scale for Anxiety (HAMA) scores. [ Time Frame: 6 weeks ] [ Designated as safety issue: No ]

Estimated Enrollment: 40
Study Start Date: January 2007
Estimated Study Completion Date: January 2010
Estimated Primary Completion Date: January 2009 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
1: Experimental

Randomization to 2 treatment groups. One group receives adjuvant treatment with D-cycloserine, up to 1 g/day.

The second group receives adjuvant treatment with placebo, up to 1 g/day.

Drug: D-cycloserine
D-cycloserine (DCS , Seromycin) is a broad spectrum antibiotic, in use for over thirty years against tuberculosis, that acts as a partial agonist at the NMDAR-associated GLY site.

  Eligibility

Ages Eligible for Study:   18 Years to 75 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • DSM-IV diagnosis of major depression .
  • HAMD scale score of ≥20 despite at least two adequate antidepressant treatment trials during the current episode.

Exclusion Criteria:

  • Underwent ECT treatment during the 3 months preceding the study.
  • Change in psychotropic medications doses during the 3 weeks preceding the study.
  • Concurrent unstable medical or neurological illness.
  • Patients are judged to be potentially violent towards themselves or others, or have a history of drug/alcohol abuse.
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00408031

Contacts
Contact: Uriel Heresco-Levy, M.D. 972-2-5316906 Heresco@md.huji.ac.il
Contact: Baruch Shapira, M.D 972-2-5316928 shapirab@md.huji.ac.il

Locations
Israel
Ezrath Nashim - Herzog Memorial Hospital & Community Clinics Recruiting
Jerusalem, Israel
Contact: Uriel Heresco-Levy, M.D.     972-2-5316906     Heresco@md.huji.ac.il    
Contact: Baruch Shapira, M.D.     972-2-5316928        
Ezrath Nashim - Herzog Memorial Hospital Not yet recruiting
Jerusalem, Israel
Contact: Uriel Heresco-Levy, M.D.     972-2-5316906     Heresco@md.huji.ac.il    
Contact: Baruch Shapira, M.D.     972-2-5316928     shapirab@md.huji.ac.il    
Principal Investigator: Uriel Heresco-Levy, M.D.            
Sub-Investigator: Baruch Shapira, M.D.            
Sub-Investigator: Yevgenia Gelfin, M.D.            
Sponsors and Collaborators
Herzog Hospital
National Alliance for Research on Schizophrenia and Depression
Investigators
Principal Investigator: Uriel Heresco-Levy, M.D. Ezrath Nashim - Herzog Memorial Hospital
  More Information

No publications provided

Responsible Party: Herzog Hospital ( Uriel Heresco-Levy )
Study ID Numbers: Heresco 4 CTIL, Herzog - protocol 5372
Study First Received: December 3, 2006
Last Updated: August 6, 2008
ClinicalTrials.gov Identifier: NCT00408031     History of Changes
Health Authority: Israel: Ministry of Health

Keywords provided by Herzog Hospital:
Major depressive disorder
NMDA receptor
Treatment-Resistant
D-cycloserine

Study placed in the following topic categories:
Cycloserine
Antimetabolites
Anti-Infective Agents
Depression
Aspartic Acid
Anti-Infective Agents, Urinary
Depressive Disorder, Major
Depressive Disorder
N-Methylaspartate
Behavioral Symptoms
Anti-Bacterial Agents
Mental Disorders
Mood Disorders
Antitubercular Agents

Additional relevant MeSH terms:
Antimetabolites
Cycloserine
Anti-Infective Agents
Depression
Disease
Molecular Mechanisms of Pharmacological Action
Anti-Infective Agents, Urinary
Depressive Disorder, Major
Renal Agents
Depressive Disorder
Pharmacologic Actions
Antibiotics, Antitubercular
Behavioral Symptoms
Anti-Bacterial Agents
Pathologic Processes
Mental Disorders
Therapeutic Uses
Mood Disorders
Antitubercular Agents

ClinicalTrials.gov processed this record on September 01, 2009