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Trial registered on ANZCTR
Registration number
ACTRN12619000311156
Ethics application status
Approved
Date submitted
6/02/2019
Date registered
28/02/2019
Date last updated
7/07/2021
Date data sharing statement initially provided
28/02/2019
Type of registration
Prospectively registered
Titles & IDs
Public title
Ketamine and Internalizing Disorders
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Scientific title
Ketamine Therapy For Internalizing Disorders: Is There A Single Mechanism?
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Secondary ID [1]
297321
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None
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Universal Trial Number (UTN)
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Trial acronym
KIDs
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Linked study record
N/A
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Health condition
Health condition(s) or problem(s) studied:
Depression
311429
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Post-Traumatic Stress Disorder
311430
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Obsessive-Compulsive Disorder
311431
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Phobic Disorders
311432
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Condition category
Condition code
Mental Health
310069
310069
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0
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Depression
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Mental Health
310070
310070
0
0
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Anxiety
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Mental Health
310071
310071
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0
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Other mental health disorders
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
There are 4 groups; treatment-resistant MDE, OCD, PTSD, phobic states.
Each participant will receive a single dose of each of these treatments plus a psychoactive control, with a washout of at least 7 days between treatments:
Ketamine 0.5mg/kg intramuscular injection, single dose
Ketamine 1mg/kg intramuscular injection, single dose
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Intervention code [1]
313575
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Treatment: Drugs
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Comparator / control treatment
Fentanyl 50mcg intramuscular injection, single dose (psychoactive control)
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Control group
Active
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Outcomes
Primary outcome [1]
318964
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10 minute relaxation 16 lead EEG
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Assessment method [1]
318964
0
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Timepoint [1]
318964
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2h after each dose
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Primary outcome [2]
318965
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Clinician-Administered PTSD Scale-5
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Assessment method [2]
318965
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Timepoint [2]
318965
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24h after each dose
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Primary outcome [3]
318966
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Yale-Brown Obsessive-Compulsive Scale
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Assessment method [3]
318966
0
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Timepoint [3]
318966
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24h after each dose
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Secondary outcome [1]
366551
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Montgomery Asberg Depression Rating Scale
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Assessment method [1]
366551
0
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Timepoint [1]
366551
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24h after each dose
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Secondary outcome [2]
366552
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Fear Questionnaire Item 18
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Assessment method [2]
366552
0
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Timepoint [2]
366552
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24h after each dose
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Secondary outcome [3]
366553
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Clinician Administered Dissociative States Scale
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Assessment method [3]
366553
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Timepoint [3]
366553
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30 minutes after each dose
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Secondary outcome [4]
366554
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Bladder pain/interstitial cystitis symptom scale
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Assessment method [4]
366554
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Timepoint [4]
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Weekly for 3 weeks
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Eligibility
Key inclusion criteria
• Capable of understanding and signing an informed consent
• diagnosed with one of the following DSM-5 diagnoses:
-post-traumatic stress disorder (PTSD) with a CAPS score >60;
-obsessive-compulsive disorder (OCD) with a YBOCS score >26;
-major depressive disorder (MDD) with a MADRS score >20;
-phobic state with FQ18 score >6
• Patients with PTSD, OCD or phobic state must not have MADRS scores >20 at screening.
• Patients must have had an inadequate response to prior treatment i.e. have not responded to at least two adequate trials of relevant medication and at least one trial of relevant psychotherapy.
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Minimum age
18
Years
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Maximum age
45
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
• evidence of severe acute or chronic medical disorders,
• past or current diagnoses of schizophrenia, bipolar disorder, or current psychotic symptoms
• female patients who are pregnant or lactating
• drug use or dependence in the last 6 months
• current significant suicidal ideation
• prior history of seizures; susceptibility to photosensitivity; or a history of allergic skin reactions
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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)
Central randomization
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Computer-generated random code
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people receiving the treatment/s
The people administering the treatment/s
The people assessing the outcomes
The people analysing the results/data
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Intervention assignment
Crossover
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Other design features
4 diagnostic groups.
For each group, treatments will be administered as a 3 way single dose crossover using balanced randomization. Each dose is separated by 1 week
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Phase
Phase 1 / Phase 2
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Type of endpoint/s
Pharmacodynamics
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Statistical methods / analysis
Correlations and univariate analyses will be perfomed for ketamine and norketamine plasma concentrations and mood rating scores and EEG changes in an exploratory data analysis. Further analyses using pharmacokinetic, pharmacodynamic (PKPD) modelling effects will be conducted to investigate relationships between ketamine exposure (plasma concentrations) and pharmacological effects (mood scores and EEG changes).
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Recruitment
Recruitment status
Recruiting
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Date of first participant enrolment
Anticipated
29/04/2019
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Actual
2/11/2020
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Date of last participant enrolment
Anticipated
31/05/2023
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Actual
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Date of last data collection
Anticipated
30/06/2023
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Actual
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Sample size
Target
48
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Accrual to date
14
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Final
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Recruitment outside Australia
Country [1]
21258
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New Zealand
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State/province [1]
21258
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Otago, Canterbury
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Funding & Sponsors
Funding source category [1]
301889
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Charities/Societies/Foundations
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Name [1]
301889
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Otago Medical Research Foundation
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Address [1]
301889
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PO Box 5726
Moray Place
Dunedin 9058, NZ
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Country [1]
301889
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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
PO Box 56
Dunedin 9054, NZ
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Country
New Zealand
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Secondary sponsor category [1]
301640
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None
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Name [1]
301640
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Address [1]
301640
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Country [1]
301640
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
302578
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Central HDEC
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Ethics committee address [1]
302578
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Ministry of Health Health and Disability Ethics Committees PO Box 5013 Wellington 6140, NZ
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Ethics committee country [1]
302578
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New Zealand
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Date submitted for ethics approval [1]
302578
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20/02/2019
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Approval date [1]
302578
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08/07/2020
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Ethics approval number [1]
302578
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19/CEN/21
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Summary
Brief summary
Internalizing disorders, characterized by quiet, internal distress, include DSM5 diagnoses such as Generalized Anxiety Disorder, Social Anxiety Disorder, Major Depressive Disorder, Panic Disorder, Post-Traumatic Stress Disorder, Obsessive Compulsive Disorder and phobic states. In contrast to slow and variable responsiveness to conventional medications, ketamine is rapidly effective in all internalizing disorders assessed so far. To account for these differences in speed of onset and breadth of activity between conventional treatments and ketamine, we have recently proposed a ‘double hit’ model for internalizing disorders, with 2 distinct forms of neural dysfunction to coincide. One hit, which is sensitive to ketamine, is disorder general: dysfunction of a neural system linked to high levels of the personality trait of neuroticism. The other hit is disorder-specific: dysfunction of one of a set of disorder-specific neural modules (already identified by theory), each with its own particular pattern of sensitivity to conventional drugs. We predict that ketamine will produce similar right frontal EEG changes that will correlate with symptom improvement across all of these internalizing disorders. These findings will potentially provide clinicians and researchers with results that could produce major theoretical advances (e.g. for reclassification of anxiety and depressive disorders) and may support wider use of ketamine as a treatment for internalizing disorders.
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Trial website
N/A
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Trial related presentations / publications
N/A
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Public notes
N/A
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Contacts
Principal investigator
Name
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Prof Paul Glue
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Address
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Dunedin School of Medicine, PO Box 56, Dunedin 9054
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Country
90706
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New Zealand
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Phone
90706
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+64 3 479 7272
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Fax
90706
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Email
90706
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[email protected]
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Contact person for public queries
Name
90707
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Paul Glue
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Address
90707
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Dunedin School of Medicine, PO Box 56, Dunedin, 9054
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Country
90707
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New Zealand
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Phone
90707
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+64 3 479 7272
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Fax
90707
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Email
90707
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[email protected]
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Contact person for scientific queries
Name
90708
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Shabah Shadli
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Address
90708
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Department of Psychology
University of Otago
PO Box 56
Dunedin 9054
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Country
90708
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New Zealand
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Phone
90708
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+64 3 479 7644
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Fax
90708
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Email
90708
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[email protected]
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Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
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No/undecided IPD sharing reason/comment
Need to discuss with co-investigators
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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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