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Trial registered on ANZCTR
Registration number
ACTRN12610000390088
Ethics application status
Not yet submitted
Date submitted
5/05/2010
Date registered
14/05/2010
Date last updated
4/06/2010
Type of registration
Prospectively registered
Titles & IDs
Public title
Pilot study for the rapid alleviation of depression in depressed alcohol dependent persons using ketamine
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Scientific title
Pilot study for the rapid alleviation of depression in depressed alcohol dependent persons using ketamine
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Secondary ID [1]
251692
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nil
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
depression
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alcohol dependence
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Condition category
Condition code
Mental Health
257435
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0
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Depression
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Mental Health
257450
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0
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Addiction
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
The intervention is utilising ketamine at sub-anaesthetic doses. Dose range of ketamine is 0.1 to 2mgs/kg intramuscular (IM).
All subjects are scheduled to receive 4 separate infusions of blinded ketamine/saline placebo, with each administration separated by ~7 days. IM doses of ketamine in cohort 1 will be 0.1, 0.25 and 0.5mg/kg. In cohort 2, doses will be 0.5, 1, and 2 mg/kg (note: there is a common dose level between groups). Placebo will be inserted randomly into the dosing sequence. Clinic visits for each subject are the ketamine dose procedure, Follow-up visits at day1, day 3 & day 7 post infusion (a total 4 visits per participant). For each participant there is an ascending dose subject to safety and tolerability of preceding dose. As above the 2nd cohort has a higher dose range.
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Intervention code [1]
256423
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Treatment: Drugs
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Comparator / control treatment
Saline 0.9% IM as a bolus of 1ml
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Control group
Placebo
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Outcomes
Primary outcome [1]
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Proportion of subjects showing remission indicated by a Montgomery-Asberg Depression Rating Scale (MADRAS) <7.
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Assessment method [1]
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Timepoint [1]
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The timepoints for the primary outcome are 2, 4, 24, 48, 72 and 168hrs post infusion of ketamine
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Primary outcome [2]
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Reduction in alcohol consumption. Assessed at interview with timeline follow-back recording, Leeds Dependency Questionnaire, Negative Alcohol expectancy Questionnaire
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Assessment method [2]
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Timepoint [2]
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2, 4, 24, 48, 72 and 168hrs post infusion of ketamine
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Secondary outcome [1]
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Safety and tolerability based on self-report by interview and on Medication Side-effects Questionnaire by interview
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Assessment method [1]
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Timepoint [1]
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baseline, post-infusion, 2, 4, 24, 48, 72 and 168h post infusion
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Secondary outcome [2]
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Psychiatric symptoms: Symptom Checklist (SCL-90R), Mini International Neuropsychiatric Interview (M.I.N.I.)
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Assessment method [2]
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Timepoint [2]
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2, 4, 24, 48, 72 and 168hrs post infusion of ketamine
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Eligibility
Key inclusion criteria
Diagnostic Statistical Manual - fourth edition, text revision (DSM-IV-TR) alcohol dependence; major depression with Montgomery-Asberg Depression Rating Scale (MADRS) scores >20 able and willing to give informed consent.
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Minimum age
18
Years
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Maximum age
65
Years
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Current chaotic multiple substance use (excluding alcohol, and tobacco — see medication below); currently in active moderate to severe alcohol withdrawal; actively suicidal or homicidal; pregnancy, nursing or refusal to use a reliable method of birth control in female subjects; severe psychiatric symptoms for which hospitalisation is being seriously considered; evidence of significant cerebral, renal, thyroid or cardiac disease; severe liver disease or liver failure.
Medication: Disallowed medication: lamotrigine, memantine, amantadine, riluzole, N-acetylcysteine within 2 weeks; Monamine Oxidase Inhibitors (MAOIs) within 4 weeks; escalating doses of opioids.
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Enrollment by referrals of eligible individuals at the local alcohol and drug service by the Principal Investigator (PI). The off-site research clinician administers the ketamine or placebo by numbered container which have been randomly allocated by computer.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Simple randomisation created by a computer number sequence generator
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
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Intervention assignment
Crossover
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Other design features
Stage 1: Open label IM ketamine 0.5mg/kg (single dose).
Stage 2: Double blind, randomised, placebo-controlled administration of single dose IM ketamine; doses 0 (saline placebo), 0.1, 0.5 or 1mg/kg. All subjects in this stage are scheduled to receive 4 separate administrations of blinded ketamine/saline placebo, with each administration separated by ~7 days. Saline placebo will be inserted randomly into the dosing sequence
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Phase
Phase 2 / Phase 3
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
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Recruitment
Recruitment status
Not yet recruiting
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Date of first participant enrolment
Anticipated
1/09/2010
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Actual
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
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Actual
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Sample size
Target
24
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Accrual to date
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Final
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Recruitment outside Australia
Country [1]
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New Zealand
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State/province [1]
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Otago
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Funding & Sponsors
Funding source category [1]
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University
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Name [1]
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University of Otago Research Grant
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Address [1]
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University of Otago
Dunedin School of Medicine
PO Box 913
Dunedin 9054
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Country [1]
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New Zealand
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Primary sponsor type
University
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Name
University of Otago
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Address
University of Otago
Dunedin School of Medicine
PO Box 913
Dunedin 9054
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Country
New Zealand
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Secondary sponsor category [1]
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None
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Name [1]
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Address [1]
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Country [1]
256183
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Ethics approval
Ethics application status
Not yet submitted
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Ethics committee name [1]
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Health and Disability Ethics Committees
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Ethics committee address [1]
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Lower South Ethics Committee 229 Moray Place PO Box 5849, Dunedin 9001, NZ
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Ethics committee country [1]
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New Zealand
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Date submitted for ethics approval [1]
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20/05/2010
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Approval date [1]
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Ethics approval number [1]
258918
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Summary
Brief summary
The co-existence of alcohol dependence and depression is common in clinical populations. The use of antidepressant drugs to treat depression is widespread however effects are modest and onset of effects are delayed. Availability of antidepressants with alternative pharmacological mechanisms, and potentially faster onset of action might be of particular benefit to this group of patients. One approach to developing novel antidepressants is via targeting the central glutamate system using Ketamine, a well established anaesthetic agent. Ketamine has the potential to rapidly alleviate depression and reduce alcohol consumption. This pilot study is to characterize the best use of ketamine for the rapid antidepressant treatment in depressed alcoholics. To date, most antidepressant data has been collected in patients without concomitant alcohol dependence, and therefore it is important to establish an appropriate dose-response and safety profile for ketamine in an alcohol-dependent population.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Address
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Country
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Phone
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Fax
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Email
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Contact person for public queries
Name
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Gavin Cape
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Address
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Dept of Psychological Medicine
University of Otago
P.O. Box 913, Dunedin 9054, New Zealand
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Country
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New Zealand
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Phone
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+64 3 474 7989
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Fax
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+64 3 474 7934
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Email
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[email protected]
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Contact person for scientific queries
Name
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Gavin Cape
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Address
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Dept of Psychological Medicine
University of Otago
P.O. Box 913, Dunedin 9054, New Zealand
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Country
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New Zealand
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Phone
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+64 3 474 7989
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Fax
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+64 3 474 7934
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Email
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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