Cardiovascular Biomarkers and Quetiapine in Depression and Anxiety Patients

Official Title: “Cardiovascular Biomarkers During Quetiapine Treatment of Depression”

No suitable treatment has been identified to reverse and ideally prevent, the cardiovascular disease risk associated with depression and anxiety. The purpose of this study is to determine if quetiapine treatment of depression can reverse the signs of arterial stiffening that often occurs in depression and anxiety, and which are believed to be risk factors for future heart disease.

The evidence that depressive and anxiety disorders confer a high relative risk (RR) for cardiovascular disease development is clear and compelling. A cadre of inflammation, platelet activation and other biomarkers of endothelial dysfunction strongly suggest multiple and possibly interrelated mechanisms underlying this co-morbidity. Early detection of the vulnerability to develop CVD has become an urgent health issue. However, detection alone of vulnerability without proper therapeutic intervention aimed at reversing it, is merely of scientific interest. The evidence to date that antidepressant drugs, while highly efficacious in restoring euthymia, may not normalize the biomarkers of CVD vulnerability.

Hence, there is a need to identify other pharmacologic interventions for depression.

Quetiapine, due to its unique molecular structure and unique pharmacological profile, belongs to none of the known classes of antidepressants. However, quetiapine clearly has antidepressant and anti-anxiety efficacies. Now, we propose to explore whether quetiapine can reverse those pathophysiological changes occurring in mixed depression/anxiety that have been linked causally to the development of CVD.

Intervention(s) in this Clinical Trial

• Drug: Quetiapine-XR
  • Quetiapine-XR (Seroquel-XR) 50-300mg daily for 12 weeks.

Arms, Groups and Cohorts in this Clinical Trial

• Experimental: 1
  • Patients will undergo baseline psychological and laboratory tests then receive Quetiapine-XR(Seroquel-XR) with flexible dosing at the discretion of the treating physician based on clinical response and tolerability. The dose range will be from 50-300mg. The total duration of the treatment will be 12 weeks.

Primary Measures

• Improvement in biomarkers of CV disease. Do patients with Major Depressive Disorder and co-morbid anxiety and increased platelet reactivity, endothelial dysfunction, and inflammation normalize these parameters following treatment with quetiapine.
  • Time Frame: 12 weeks
    Safety Issue?: No

Secondary Measures

• Determine whether treatment with a low-dose quetiapine will alleviate symptoms of depression and anxiety.
  • Time Frame: 12 weeks
    Safety Issue?: No

Inclusion Criteria:

• A diagnosis of Major Depressive Disorder, first episode or recurrent, by Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) requiring treatment. The index episode must be at least 14 days of persistent symptoms. If first episode, patients must not have been previously treated. If recurrent, must not be receiving treatment for the recurrence.
• Females and males 20-65 years of age
• Female patients of childbearing potential must be using a reliable method of contraception and have a negative urine human chorionic gonadotropin (HCG) test at time of enrolment
• Able to understand and comply with the requirements of the study

Exclusion Criteria:

• Females who are pregnant, lactating, breast feeding or on oral contraceptives
• Any DSM-IV Axis I disorder not defined in the inclusion criteria except MDD co-morbid with GAD
• Patients who, in the opinion of the investigator, pose an imminent risk of suicide or a danger to self or others
• Known intolerance or lack of response to quetiapine (Seroquel) as judged by the investigator
• Use of any of the following cytochrome P450 3A4 inhibitors in the 14 days preceding enrolment including but not limited to: ketoconazole, itraconazole, fluconazole, erythromycin, clarithromycin, troleandomycin, indinavir, nelfinavir, ritonavir, fluvoxamine and saquinavir
• Use of any of the following cytochrome P450 inducers in the 14 days preceding enrolment including but not limited to: phenytoin, carbamazepine, barbiturates, rifampin, St. John's Wort, and glucocorticoids
• Concomitant use of any other antidepressant, anxiolytic, or antipsychotic agent
• Administration of a depot antipsychotic injection within one dosing interval (for the depot) before the study begins
• Substance or alcohol dependence at enrolment (except dependence in full remission, and except for caffeine or nicotine dependence), as defined by DSM-IV criteria
• History of heavy smoking within the preceding 6 months
• Opiates, amphetamine, barbiturate, cocaine, cannabis, or hallucinogen abuse by DSM-IV criteria within 4 weeks prior to enrolment
• Restrictions prior to blood drawings: Aspirin (previous 240 hours), antihistamines (previous 72 hours), Tylenol (previous 72 hours), Vitamin C or E (previous 72 hours), sleeping pills (previous 72 hours), caffeinated beverages (8 hours), physical exertion (8 hours) and tobacco products (2 hours).
• Medical conditions that would affect absorption, distribution, metabolism, or excretion of study treatment
• Unstable or inadequately treated medical illness (e.g. diabetes, angina pectoris, hypertension) as judged by the investigator
• Involvement in the planning and conduct of the study
• Previous enrolment in the present study.
• Participation in another drug trial within 4 weeks prior enrolment into this study or longer in accordance with local requirements
• A patient with Diabetes Mellitus (DM) fulfilling one of the following criteria:
• Unstable DM defined as enrolment glycosylated hemoglobin (HbA1c) >8.5%.
• Admitted to hospital for treatment of DM or DM related illness in past 12 weeks.
• Not under physician care for DM
• Physician responsible for patient's DM care has not indicated that patient's DM is controlled.
• Physician responsible for patient's DM care has not approved patient's participation in the study

Gender Eligibility for this Clinical Trial: Both

Minimum Age for this Clinical Trial: 20 Years

Maximum Age for this Clinical Trial: 65 Years

Are Healthy Volunteers Accepted for this Clinical Trial?: No

Lead Investigator: Loyola University Other

Overall Clinical Trial Officials and Contacts

John Piletz, PhD Principal Investigator Loyola University  

Overall Contact: John Piletz, PhD 708-216-5090 jpiletz@lumc.edu

Information obtained from ClinicalTrials.gov on February 08, 2012

Link to the current ClinicalTrials.gov record. http://clinicaltrials.gov/show/NCT00951483

Study ID Number: 201880

ClinicalTrials.gov Identifier: NCT00951483

Health Authority: United States: Institutional Review Board