Antidepressant Medication Plus Donepezil for Treating Late-life Depression

Official Title: “Maintenance Therapies in Late-Life Depression: MTLD III”

This study will determine the effectiveness of combining escitalopram, venlafaxine, or duloxetine with donepezil, a medication used in Alzheimer's disease, in improving memory, concentration, attention, and problem solving abilities, and reducing the risk of depressive relapse in older individuals with depression.

The purpose of this research study is to learn if combining an antidepressant medication (escitalopram, venlafaxine, or duloxetine) with a medication used in Alzheimer's Disease (donepezil), in elderly patients age 65 and older with major depression, will help to 1) improve and/or maintain memory, concentration, attention, and problem solving abilities such as ability to balance a checkbook, pay bills, use the telephone, and 2) reduce the risk of depressive symptoms from returning. Study participation will last up to two years.

We aim to investigate pharmacologic strategies for improving and stabilizing cognitive functioning in late-life depression and minimizing progression of cognitive and associated functional impairment. Cognitive impairment in late-life depression has not been adequately addressed in previous intervention research, is a core feature of the illness, contributes markedly to disability and impaired quality of life, and is an overlooked but potentially critical target of intervention. Data from the MTLD II study suggest that treating depression does not normalize cognitive functions and may not prevent their progression. We will test a pharmacologic strategy involving the cholinesterase inhibitor donepezil, in combination with maintenance antidepressant pharmacotherapy (escitalopram, venlafaxine, or duloxetine), to improve and to maintain cognitive functioning and functional competence in elderly patients with major depression.

We hypothesize that maintenance antidepressant pharmacotherapy combined with donepezil will be superior to maintenance antidepressant pharmacotherapy combined with placebo/clinical management in (1) improving cognitive performance; and (2) slowing progression of cognitive impairment and decline in functional competence. We plan to recruit 200 patients aged 65 and above in current episodes of major depression. Those who respond to antidepressant pharmacotherapy with citalopram, venlafaxine, or duloxetine will then be randomly assigned on a double-blind basis to one of two 24-month treatments: 1)antidepressant pharmacotherapy plus donepezil/clinical management; or 2)antidepressant pharmacotherapy plus placebo/clinical management.

For information on related studies, please follow these links:

http://clinicaltrials.gov/show/NCT00000377

http://clinicaltrials.gov/show/NCT00178100

Intervention(s) in this Clinical Trial

• Drug: Escitalopram
  • Escitalopram, 10mg to 20mg daily.
• Drug: Donepezil
  • Donepezil, 5mg to 10mg daily.
• Drug: Venlafaxine
  • Venlafaxine, 150mg to 300mg daily.
• Drug: Placebo
• Drug: Duloxetine

Arms, Groups and Cohorts in this Clinical Trial

• Experimental: 1
  • escitalopram plus donepezil (DNP)in the experimental maintenance phase of the study. For subjects failing to respond to escitalopram during the initial open phase of acute treatment we allowed the use of duloxetine or venlafaxine to bring about remission and establish eligibility for randomized assignment to maintenance treatment with augmentation donepezil. Participants remained on the same antidepressant medication and dosage throughout the 2 year maintenance phase of the study. In the event of a recurrence of major depression during maintenance treatment, dosages of antidepressant medication were raised, or the antidepressant was switched to venlafaxine or duloxetine. For subjects failing to respond to escitalopram during the initial open phase of acute treatment, we allowed the use of duloxetine to bring about remission and establish eligibility for randomized assignment to maintenance treatment with augmentation placebo.
• Placebo Comparator: 2
  • escitalopram plus placebo (PBO) in the experimental maintenance phase of the study. For subjects failing to respond to escitalopram during the initial open phase of acute treatment, we allowed the use of duloxetine or venlafaxine to bring about remission and establish eligibility for randomized assignment to maintenance treatment with augmentation placebo. Participants remained on the same antidepressant medication and dosage throughout the 2 year maintenance phase of the study. In the event of a recurrence of major depression during maintenance treatment, dosages of antidepressant medication were raised, or the antidepressant was switched to venlafaxine or duloxetine. For subjects failing to respond to escitalopram during the initial open phase of acute treatment, we allowed the use of venlafaxine or duloxetine to bring about remission and establish eligibility for randomized assignment to maintenance treatment with augmentation placebo.

Primary Measures

• Global Cognitive Performance
  • Time Frame: Measured at baseline and Years 1 and 2 in maintenance
    Safety Issue?: No
• Cognitive Instrumental Activities of Daily Living (IADL)
  • Time Frame: baseline, year 1 and year 2
    Safety Issue?: No
• Number of Participants With Recurrence of Major Depression
  • Time Frame: 2 years
    Safety Issue?: No

Inclusion Criteria:

• Current episode of major depression
• HRS-D 17-item score of 15 or higher
• Must be able to speak English
• Willing to discontinue other psychotropics
• Availability of family member/caregiver
• Hearing capacity adequate to respond to raised conversational voice
• Must have no formal diagnosis of dementia

Exclusion Criteria:

• Meets DSM-IV criteria for bipolar disorder, schizophrenia, schizoaffective disorder, or a psychotic disorders
• Alcohol/drug abuse within 12 months of study entry
• History of treatment non-adherence in other clinic protocols
• History of non-response to citalopram in other clinic protocols
• History of non-tolerance to SSRI therapy

Gender Eligibility for this Clinical Trial: Both

Minimum Age for this Clinical Trial: 65 Years

Maximum Age for this Clinical Trial: N/A

Are Healthy Volunteers Accepted for this Clinical Trial?: Accepts Healthy Volunteers

Lead Investigator: National Institute of Mental Health (NIMH) NIH

Overall Clinical Trial Officials and Contacts

Bruce G. Pollock, MD, PhD Principal Investigator University of Pittsburgh Professor of Psychiatry, Pharmacology, and Nursing  

Information obtained from ClinicalTrials.gov on February 09, 2012

Link to the current ClinicalTrials.gov record. http://clinicaltrials.gov/show/NCT00177671

Study ID Number: R01 MH043832-03

ClinicalTrials.gov Identifier: NCT00177671

Health Authority: United States: Federal Government

An online resource for older individuals with mental health problems and their families.