Opiate Suicide Study in Patients With Major Depression

NCT04116528 | Completed Phase 3 Results DMC FDA Drug

• 1 other identifier: 51536
• Study Type: interventional
• Target: 50
• Locations: 1 country
• Sites: 1

Brief Summary

To explore whether intravenous ketamine followed by buprenorphine produces more rapid and sustained anti-suicidal effects than ketamine followed by placebo, investigators will conduct a single study that will take approximately 2.5 years to complete. 60 subjects (60 infusions) or approximately 24 infusions per year.

Conditions

Major Depressive Disorder

Outcome Measures

Primary Outcomes (1)

• Change in Scale for Suicidal Ideation (SSI) Total Scores Will be Analyzed as the Primary Outcome Measure Using Mixed Effects Models,

  Analyses included a modified intention-to-treat population, defined as all randomized participants who received one week of treatment and completed the week 1 assessment of buprenorphine or placebo. A linear mixed-effects model tested the primary hypothesis of efficacy, measured by change in SSI total scores. The model included random effects for patient and fixed effects for treatment group, time as a continuous variable (days of study: 1, 3, 10, 17, 24, 31), and the time-by-treatment group interaction, along with an unstructured covariance matrix. The SSI has 19 items, each scored 0-2, for a maximum of 38 points. Higher scores indicate worse suicidal ideation.

  Day 1 and 31

Secondary Outcomes (2)

• MADRS Change Score

  Day 1 and 31

• HAM-D Change Score

  Day 1 and 31

Other Outcomes (3)

• The Investigators Will Assess Opioid Activity of Ketamine as Well as Buprenorphine

  Day 3-31

• Serum Prolactin Level

  Day 1 and 3-31.

• Pupillometry

  change from Day 3-31

Study Arms (2)

Buprenorphine after ketamine

ACTIVE COMPARATOR

Patients will be randomized to receive buprenorphine or placebo under double blind, random assignment conditions for 4 weeks. Prior to starting the comparison all subjects first receive an iv infusion of ketamine.

Drug: Buprenorphine

Placebo after ketamine

PLACEBO COMPARATOR

Patients will be randomized to receive buprenorphine or placebo under double blind, random assignment conditions for 4 weeks. Prior to starting the comparison all subjects first receive an iv infusion of ketamine.

Drug: Placebo

Interventions

Buprenorphine DRUG

Sublingual troches of buprenorphine at doses from 0.2 to 0.8 mg per day (1-4 per day)

Buprenorphine after ketamine

Placebo DRUG

Sublingual troches of placebo (1-4 per day)

Placebo after ketamine

Eligibility Criteria

• Age: 18 Years - 70 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Male or female, 18 to 70 years of age, inclusive, at screen.
• Able to read, understand, and provide written, dated informed consent prior to screening. Participants will be deemed likely to comply with study protocol and communicate with study personnel about adverse events and other clinically important information.
• Diagnosed with Major Depressive Disorder (MDD), single or recurrent or Bipolar-II Disorder and currently experiencing a Major Depressive Episode (MDE) of at least eight weeks in duration, prior to screening, according to the criteria defined in the Diagnosis and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision(DSM-IV-TR™). The diagnosis of MDD will be made by a site psychiatrist and supported by the Structured Clinical Interview for DSM-IV-TR™ (SCID-I/P).
• Has a history of TRD during the current MDE, as assessed by the investigator. TRD is defined as failure to achieve a satisfactory response (e.g., less than 50% improvement of depression symptoms), as perceived by the participant, to at least one "treatment course" of a therapeutic dose of an antidepressant therapy of at least 8 weeks duration. The adequacy of dose and duration of the antidepressant therapy will be determined as per the MGH ATRQ criteria. Participants must currently be on a stable (for at least 4 weeks) and adequate (according to the MGH ATRQ) dose of ongoing SSRI or SNRI antidepressant therapy, of which total duration must be at least 8 weeks. Participants may also have a history of intolerance to at least 2 antidepressant medications. These patients with the intolerance history will not be required to be currently taking an antidepressant medication.
• Meet the threshold on the total SSI score of \>/=6 at screening visit.
• Participants must qualify as "Moderately Treatment Refractory" using the Maudsley staging method, which incorporates past treatments, severity of symptoms and duration of presenting episode.
• In good general health, as ascertained by medical history, physical examination (PE) (including measurement of supine and standing vital signs), clinical laboratory evaluations, and 3-lead electrocardiogram (ECG) if no evaluation available from the last 6 months.
• If female, a status of non-childbearing potential or use of an acceptable form of birth control per the following specific criteria:
• a. Non-childbearing potential (e.g., physiologically incapable of becoming pregnant, i.e., permanently sterilized (status post hysterectomy, bilateral tubal ligation), or is post-menopausal with her last menses at least one year prior to screening); or b. Childbearing potential, and meets the following criteria: i. Childbearing potential, including women using any form of hormonal birth control, on hormone replacement therapy started prior to 12 months of amenorrhea, using an intrauterine device (IUD), having a monogamous relationship with a partner who has had a vasectomy, or is sexually abstinent.
• ii. Negative urinary pregnancy test at screening, confirmed by a negative urinary pregnancy test at randomization prior to receiving study treatment.
• iii. Willing and able to continuously use one of the following methods of birth control during the course of the study, defined as those which result in a low failure rate (i.e., less than 1% per year) when used consistently and correctly: implants, injectable or patch hormonal contraception, oral contraceptives, IUD, double-barrier contraception, sexual abstinence. The form of birth control will be documented at screening and baseline.
• Body mass index between 17-40kg/m2.
• Concurrent psychotherapy will be allowed if the type (e.g., supportive, cognitive behavioral, insight-oriented, et al) and frequency (e.g., weekly or monthly) of the therapy has been stable for at least three months prior to screening and if the type and frequency of the therapy is expected to remain stable during the course of the subject's participation in the study.
• Concurrent hypnotic therapy (e.g., with zolpidem, zaleplon, melatonin, or trazodone) will be allowed if the therapy has been stable for at least 4 weeks prior to screening and if it is expected to remain stable during the course of the subject's participation in the study.

You may not qualify if:

• A potential participant will NOT be eligible for participation in this study if any of the following criteria are met:
• Female of childbearing potential who is not willing to use one of the specified forms of birth control during the study.
• Female that is pregnant or breastfeeding.
• Female with a positive pregnancy test at screening or baseline.
• Total SSI score of \<6 at the screening visit.
• \. Current diagnosis of a Substance Use Disorder (Abuse or Dependence, as defined by DSM-IV-TR™), with the exception of nicotine dependence, at screening or within six months prior to screening.
• \. Current diagnosis of Axis I disorders other than Dysthymic Disorder, Generalized Anxiety Disorder, Social Anxiety Disorder, Panic Disorder, Agoraphobia, or Specific Phobia (unless one of these is comorbid and clinically unstable, and/or the focus of the participant's treatment for the past six months or more).
• \. History of schizophrenia or schizoaffective disorders, or any history of psychotic symptoms in the current or previous depressive episodes.
• \. History of anorexia nervosa, bulimia nervosa, or eating disorder not otherwise specified, within one year of screening.
• \. Any Axis I or Axis II Disorder, which at screening is clinically predominant to their MDD or has been predominant to their MDD at any time within six months prior to screening. A diagnosis of borderline personality disorder is excluded.
• \. In the judgment of the investigator, the subject is at significant risk for suicidal behavior during the course of his/her participation in the study.
• \. Has dementia, delirium, amnestic, or any other cognitive disorder.
• \. Has a clinically significant abnormality on the screening physical examination that might affect safety, study participation, or confound interpretation of study results.
• \. Participation in any clinical trial with an investigational drug or device within the past month or concurrent to study participation.
• \. Known history or current episode of:

Sponsors & Collaborators

• Stanford University: lead

Study Sites (1)

Stanford University School of Medicine

Stanford, California, 94305, United States

Location

MeSH Terms

Conditions

Depressive Disorder, Major

Interventions

Buprenorphine

Condition Hierarchy (Ancestors)

Depressive Disorder; Mood Disorders; Mental Disorders

Intervention Hierarchy (Ancestors)

Morphinans; Opiate Alkaloids; Alkaloids; Heterocyclic Compounds; Heterocyclic Compounds, Bridged-Ring; Heterocyclic Compounds, 4 or More Rings; Heterocyclic Compounds, Fused-Ring; Phenanthrenes; Polycyclic Aromatic Hydrocarbons; Polycyclic Compounds

Results Point of Contact

• Title: Alan F. Schatzberg, MD
• Organization: Stanford University

afschatz@stanford.edu

650-723-6811

Study Officials

• Alan F. Schatzberg

  Stanford University

  STUDY DIRECTOR

Publication Agreements

• PI is Sponsor Employee: Yes

Study Design

• Study Type: interventional
• Phase: phase 3
• Allocation: RANDOMIZED
• Masking: QUADRUPLE
• Who Masked: PARTICIPANT, CARE PROVIDER, INVESTIGATOR, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor

Study Record Dates

• First Submitted: July 3, 2019
• First Posted: October 4, 2019
• Study Start: August 1, 2020
• Primary Completion: April 28, 2025
• Study Completion: April 28, 2025
• Last Updated: May 22, 2026
• Results First Posted: May 22, 2026

Record last verified: 2026-04

Locations

US (1)