This is an ancillary study to a clinical trial that is being conducted at Massachusetts General Hospital. Investigators at MGH are conducting a clinical trial to test the efficacy of ziprasidone together with escitalopram for treatment-resistant depression (NCT00633399). This observational study will involve magnetic resonance scans to examine brain chemistry (neurotransmitter levels), brain activity, and functional connections between brain regions before and after participating in the trial. The neurotransmitters of interest are glutamate, glutamine, and GABA. Comparisons will be made between individuals who receive ziprasidone and individuals who receive an inactive placebo. Differences between participants who respond to standard antidepressants and those who require additional medication will also be examined. All participants will have a baseline magnetic resonance scan before starting medication. The second scan will be after 8 weeks of escitalopram treatment for those who respond or following 8 weeks of escitalopram plus ziaprasidone or placebo (16 weeks after starting) for those who do not respond to escitalopram alone. Participants will complete standard rating scales for depression at each visit.
Study Type
OBSERVATIONAL
Enrollment
1
McLean Hospital - McLean Imaging Center
Belmont, Massachusetts, United States
Glutamate level in antidepressant non-responders
Glutamate levels are measured by magnetic resonance spectroscopy 8 weeks after starting treatment with ziprasidone or placebo in addition to escitalopram.
Time frame: 8 weeks after starting combination therapy phase
Glutamine level in treatment-responders following six weeks of antidepressant and non-responders following six weeks of adjunctive treatment.
Time frame: 8 weeks or 16 weeks
Glutamine level in treatment-responders following six weeks of antidepressant and non-responders following six weeks of adjunctive treatment
Time frame: 8 weeks
GABA level in treatment-responders following six weeks of antidepressant and non-responders following six weeks of adjunctive treatment
Time frame: 8 weeks
Glutamine level in antidepressant non-responders
Glutamine levels are measured by magnetic resonance spectroscopy 6 weeks after starting treatment with ziprasidone or placebo together with escitalopram.
Time frame: 8 weeks
GABA level in antidepressant non-responders
GABA levels are measured by magnetic resonance spectroscopy 6 weeks after starting treatment with ziprasidone or placebo together with escitalopram.
Time frame: 8 weeks
Functional connectivity in default mode network measured by functional magnetic resonance imaging (fMRI) in treatment-resistant individuals receiving adjunctive treatment
Functional connectivity will be measured by performing fMRI in the resting state.
Time frame: 8 weeks after starting combination therapy phase
Functional connectivity in default mode network measured by functional magnetic resonance imaging (fMRI) in treatment-resistant individuals receiving adjunctive treatment and treatment-responders receiving an antidepressant
Time frame: 8 weeks
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