Using ketamine to treat depression in veterans with Parkinson's disease

Examining Ketamine Effects on Depression, Neuroplasticity, and Inflammation in Veterans With Parkinson's Disease

This study is testing if intravenous ketamine can help veterans with Parkinson's disease feel less depressed and improve their brain function.

Quick facts

• Phase: Phase 2
• Study type: Interventional
• Enrollment: 80 (estimated)
• Ages: 40 Years to 80 Years
• Sex: All
• Sponsor: VA Office of Research and Development (Federal)
• Locations: 1 site (San Francisco, California)
• Trial ID: NCT06231563 on ClinicalTrials.gov

What this trial studies

This clinical trial investigates the effects of intravenous ketamine on depression in veterans diagnosed with Parkinson's disease. It is a double-masked, active placebo-controlled study involving 80 participants, aiming to assess the safety, tolerability, and efficacy of ketamine in alleviating depressive symptoms within 24 hours. The study will also explore ketamine's impact on neuroplasticity and inflammation, which are critical factors in Parkinson's disease. Participants will undergo clinical assessments and non-invasive brain stimulation techniques to measure changes in brain function and inflammation levels.

Who should consider this trial

Good fit: Ideal candidates are U.S. veterans aged 40-80 with a diagnosis of idiopathic Parkinson's disease and a history of inadequate response to antidepressant medications.

Not a fit: Patients who do not have Parkinson's disease or those who have not experienced depression may not benefit from this study.

Why it matters

Potential benefit: If successful, this treatment could significantly improve the quality of life for veterans suffering from depression associated with Parkinson's disease.

How similar studies have performed: While ketamine has shown promise in treating depression in other populations, its application in veterans with Parkinson's disease is a novel approach that has not been extensively tested.

Eligibility criteria

Inclusion Criteria:

1. Able to understand and provide written informed consent.
2. Is a United States Veteran.
3. Between 40-80 years old at the time of informed consent
4. Have neurologist-diagnosed idiopathic Parkinson's disease (PD) for at least six months prior to enrollment
5. History of inadequate response to at least one trial of antidepressant medication
6. On a stable regimen of all medications for at least 2 months prior to enrollment and have no planned medication changes during the period of active participation.
7. Commit to attend all in-person and remote study visits and participate in all data collection procedures.
8. Have a score \>/=20 on the Montgomery-Asberg Depression Rating Scale (MADRS), consistent with moderate or greater depressive symptom severity, at Baseline.
9. If already engaged in psychotherapy or other non-pharmacologic treatments for depression, agree to maintain consistent engagement throughout the period of active study participation.
10. If not engaged in psychotherapy or other non-pharmacologic treatments for depression, agree to avoid starting a new course of treatment for the period of active study participation.
11. Agree to abstain from cannabis for a minimum of 72 hours prior to assessments on Day - 1 and to remain abstinent through assessments on Day 0
12. If a regular user of tobacco or nicotine, agree to maintain a consistent pattern of use throughout the period of active study participation; if an infrequent/occasional user, agree to abstain throughout the period of active study participation
13. For people who can become pregnant or trying to conceive: agree to use highly effective contraception from entry into the trial through Day 7 assessments

Exclusion Criteria:

1. Lifetime history of schizophrenia or schizoaffective disorder or bipolar disorder or current psychosis with loss of insight
2. Dementia or cognitive impairment as determined by a MoCA (telephone version) score \<18 at screening.
3. Moderate or severe substance use disorder during the 6 months prior to enrollment or a breathalyzer test showing an alcohol level \> 0% at screening or a positive urine toxicology panel at screening. Note that a positive result for cannabis is an exception; see Inclusion Criteria
4. Pregnancy, breastfeeding, or plans to become pregnant during the period of trial participation.
5. Electroconvulsive therapy (ECT) or transcranial magnetic stimulation (TMS) treatment within 30 days prior to enrollment or plans to begin either therapy during the participation period
6. High risk of self-harm/suicide that warrants immediate treatment as determined by the Columbia-Suicide Severity Rating Scale (C-SSRS) at screening
7. Current severity of depression symptoms warranting immediate treatment (i.e., resulting in inability to provide for basic needs/safety) at screening
8. Meeting standard safety exclusion criteria for TMS (seizure disorder, ferrous metal or implanted devices above the chest, history of severe traumatic brain injury, tinnitus)
9. Meeting standard safety exclusion criteria for ketamine treatment (previous hypersensitivity reaction to ketamine, hepatitis or liver failure, cystitis, or underlying cardiovascular conditions in which increased blood pressure would pose a risk of complications)
10. Concomitant medications that may interfere with ketamine treatment or increase risk of adverse events (e.g., benzodiazepines, sedative-hypnotics, lamotrigine, MAOIs) if it is not medically appropriate or feasible for the participant to abstain from use for at least 5 half-lives prior to assessments on Day -1 and remain abstinent through assessments on Day 0
11. Concomitant medications that may impact motor cortex plasticity (e.g., memantine, dextromethorphan) if it is not medically appropriate or feasible for the participant to abstain from use for at least 5 half-lives prior to assessments on Day -1 and remain abstinent through assessments on Day 0
12. Concomitant medications that may increase risk of adverse events with TMS (i.e,. those that can lower the seizure threshold) if it is not medically appropriate or feasible for the participant to abstain from use for at least 5 half-lives prior to assessments on Day -1 and remain abstinent through assessments on Day 0
13. Autoimmune disorders (e.g., multiple sclerosis, lupus, rheumatoid arthritis) or neoplastic disorders
14. Use of cytokine antagonists or other medications that may modulate inflammation unless regimen has been stable for at least 2 months and there is no plan to alter the regimen during trial participation
15. Another medical condition or diagnosis, physical exam finding, or laboratory abnormality that precludes participation in study procedures due to safety concerns.

Where this trial is running

San Francisco, California

• San Francisco VA Medical Center, San Francisco, CA — San Francisco, California, United States (Recruiting)

Study contacts

• Principal investigator: Ellen R Bradley, MD — San Francisco VA Medical Center, San Francisco, CA
• Study coordinator: Ellen R Bradley, MD

Conditions Parkinson's Disease; Parkinson's disease; Ketamine; Depression; Inflammatory markers; Neuroplasticity; Clinical Trial Protocol