Beyond Monoamines: The Role of the Nociceptin/Orphanin FQ Receptor in Major Depression

Mclean Hospital228 enrolled

Overview

This study looks at the role of the Nociceptin/Orphanin FQ receptor system in the brain of individuals with current or past major depressive disorder (MDD). It also examines how individuals with a history of depression make certain decisions and which brain regions are involved in such decisions. Information collected through MRI, PET, biospecimens (i.e., blood, saliva) and behavioral tasks will be used to predict depressive symptoms in the future.

The overarching goals of this research are to investigate: (1) the activity of the Nociceptin/Orphanin FQ receptor system among individuals with current or remitted MDD; (2) neural foundations of approach/avoidance behaviors in current or remitted MDDs; (3) stress-induced inflammation in individuals with remitted MDD; (4) neural markers that predict future disease course. This will be achieved through an innovative method of using functional magnetic resonance imaging (fMRI) during an approach/avoidance decision-making task, in addition to a resting positron emission tomography (PET) scan.

Study Type

OBSERVATIONAL

Enrollment

228

Conditions

Major Depressive Disorder

Interventions

Aversive stimuliDEVICE

Electrotactile stimulation will be used as the aversive stimulus. The aversive stimulus is delivered in the form of a mild half-second stimulation to the ankle, calibrated to a subjective threshold that is uncomfortable but not painful. This stimulation is delivered by Digitimer DS8R Constant Current Stimulator (Digitimer North America, LLC. Ft. Lauderdale, FL). Its previous model DS71 has been safely implemented in studies with previously MGH-approved IRB's (Milad et al., 2013).

PET radiotracerDRUG

A Nociceptin/Orphanin FQ ("N/OFQ") peptide tracer (\[11C\] NOP-1A) will be used as the PET radiotracer. Approximately 10 mCi of this tracer will be delivered intravenously as a slow bolus over 60 seconds with beginning of the PET imaging acquisition. Approximately 60 ml of blood will be drawn from an artery throughout the dynamic PET acquisition in order to measure the blood N/OFQ levels.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 45 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria for all participants: * All genders, races, and ethnic origins, aged between 18 and 45 * Capable of providing written informed consent, and fluent in English * Right-handed * Absence of any psychotropic medications for at least 2 weeks * Has a smartphone (iPhone or Android) (needed for Ecological Momentary Assessment) Inclusion Criteria for "Remitted MDD" group: * Meets inclusion criteria for all subjects, plus: * History of MDD as defined by DSM-5 * Absence of anxiety disorder for the past two months Inclusion Criteria for "Current MDD" group: * Meets inclusion criteria for all subjects, plus: * Presence of MDD as defined by DSM-5 * Absence of anxiety disorder for the past two months Exclusion Criteria for all participants: * Subjects with suicidal ideation where outpatient treatment is determined unsafe by the study clinician. These patients will be immediately referred to appropriate clinical treatment * Pregnant women or women of childbearing potential who are not using a medically accepted means of contraception (defined as oral contraceptive pill or implant, condom, diaphragm, spermicide, IUD, s/p tubal ligation, or partner with vasectomy) * Serious or unstable medical illness, including cardiovascular, hepatic, renal, respiratory, endocrine, neurologic or hematologic disease * History of seizure disorder * History of psychiatric illnesses, other than depression or anxiety disorders among the Current MDD and Remitted MDD groups * History of substance use disorder or alcohol use disorder (as these terms are defined by DSM-5); except depressed subjects may have a history of 'Mild' substance/alcohol use disorder only if it ended as least 12 months ago * History of cocaine or stimulant use or dopaminergic drugs * History or current diagnosis of dementia, or a score of \< 26 on the Mini Mental State Examination at the screening visit; * Patients with mood congruent or mood incongruent psychotic features * Current use of other psychotropic drugs * Clinical or laboratory evidence of hypothyroidism * Patients with a lifetime history of electroconvulsive therapy (ECT) * Failure to meet standard MRI safety requirements * Abnormal ECG and lab results * History of seizure disorder * Contraindications for arterial line (e.g., abnormal result on Allen test, Raynaud's syndrome, history of anemia or bleeding disorder, history of fainting from blood draws).

Locations (1)

McLean Hospital

Belmont, Massachusetts, United States

RECRUITING

Outcomes

Primary Outcomes

Clinical Interview

For assessing psychological state

Time frame: Baseline

Behavioral Performance on the Probabilistic Reward Task (PRT)

the PRT assesses individuals' ability to learn from rewards

Time frame: Baseline

MRI Data

For testing the neural correlates of approach-avoidance decision making behaviors

Time frame: within 30 days of Screening Visit

Salivary Cortisol

For assessing stress level

Time frame: Baseline

PET Data

For assessing the Nociceptin/Oprhanin FQ receptor system activity

Time frame: within 30 days of Screening Visit

Arterial blood data

for PET modeling and assessing Nociceptin/Orphanin FQ levels in bloodstream

Time frame: Baseline

Follow-up Clinical Interviews

To assess psychological state changes

Time frame: Change from Baseline at 6 months and 12 months after the PET visit

Secondary Outcomes

Beck Depression Inventory-II (BDI)

self-report measure of depressive symptoms

Time frame: Change from Baseline at 6 months and 12 months after the PET visit

Childhood Trauma Questionnaire (CTQ)

Central Contacts

Tracy Lam, BS

CONTACT

617-855-4437 mclrew41study@mgb.org

David Crowley, ALM

CONTACT

617-855-4432 djcrowley@mclean.harvard.edu

Data from ClinicalTrials.gov

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