Using omega-3 fatty acids to treat treatment-resistant depression

Specialized Pro-resolving Lipid Mediators and Treatment Resistant Depression

This study is testing if taking omega-3 fatty acids can help adults with treatment-resistant depression feel better when other medications haven't worked.

Quick facts

• Phase: PHASE2
• Study type: Interventional
• Enrollment: 80 (estimated)
• Ages: 18 Years to 65 Years
• Sex: All
• Sponsor: Massachusetts General Hospital (other)
• Drugs / interventions: chemotherapy
• Locations: 3 sites (Atlanta, Georgia and 2 other locations)
• Trial ID: NCT05774665 on ClinicalTrials.gov

What this trial studies

This clinical trial investigates the effects of omega-3 fatty acids on inflammation and depressive symptoms in adults with treatment-resistant major depressive disorder (MDD). Participants, aged 18 to 65, who have not responded adequately to standard antidepressant treatments will be randomly assigned to receive either an omega-3 preparation or a placebo for 12 weeks. The study aims to measure changes in anti-inflammatory compounds and improvements in depressive symptoms through blood tests and questionnaires. The primary goal is to determine if omega-3 supplementation can enhance the effectiveness of existing antidepressant therapies.

Who should consider this trial

Good fit: Ideal candidates are adults aged 18 to 65 with treatment-resistant MDD who have not responded to at least two antidepressant trials.

Not a fit: Patients with certain psychiatric disorders, such as bipolar disorder or psychotic disorders, will not benefit from this study.

Why it matters

Potential benefit: If successful, this approach could provide a new treatment option for patients with treatment-resistant depression.

How similar studies have performed: Previous studies have shown promise in using omega-3 fatty acids for depression, but this specific approach is novel in targeting treatment-resistant cases.

Eligibility criteria

Inclusion Criteria:

* Age: 18 to 65 years
* Patients with treatment-resistant MDD who have not responded to at least 2 and no more than 5 antidepressant trials of at least 8 weeks duration during the current episode and have been on a current stable antidepressant regiment for at least 4 weeks. The diagnosis of MDD will be confirmed using the MINI and the historical failure to respond to antidepressant therapy will be documented using the Antidepressant Treatment Response Questionnaire (ATRQ), with failure to respond defined as less than 50% improvement by subject history.
* hs-CRP ≥ 3 mg/L and ≤ 10 mg/L
* BMI \>25 kg/m2 and ≤ 40 kg/m2
* 17-item Hamilton Depression Rating Scale (HAM-D) score ≥15, and \<25% decrease in score between screen and baseline

Exclusion Criteria:

Diagnostic Exclusions:

* Meeting lifetime DSM-5 criteria for: a neurocognitive disorder, psychotic disorder, bipolar disorder, obsessive compulsive disorder, bulimia nervosa, or anorexia nervosa in the 3 months prior to the screening; any substance use disorder (except for nicotine or caffeine use disorder).
* Patients who, in the investigator's judgment, pose a current, serious suicidal or homicidal risk
* Presence of a serious or unstable medical illness, including insulin-dependent diabetes mellitus or bleeding disorder which, in the investigator's opinion, could compromise response to treatment, participant safety, or interpretation of study results.
* Currently breastfeeding, pregnant women, or women of childbearing ability, who do NOT agree to use a study approved method of birth control (described in the MOP) for the duration of the study.
* Currently or within 90 days of screen participating in another clinical trial (excluding large natural cohort trials such as 'All of Us').

Treatment and Concomitant Medication Exclusions:

* Failure to respond during the course of the current major depressive episode to \>5 adequate antidepressant trials
* Current use of antipsychotic medications or lithium
* Having received ketamine therapy within 90 days of the screening visit
* Patients who have initiated psychotherapy ≤ 90 days prior to screening.Having received electroconvulsive therapy during the current depressive episode or within 6 months of the screening visit
* Concomitant use of any psychotropic agents within 2 weeks of the baseline visit, except for the ongoing antidepressant, prescription hypnotics, diphenhydramine, or a stable daily dose of a benzodiazepine.
* Concomitant medications that might confound the biomarker findings within 1 week of the baseline visit and during the trial, including: regular (i.e. more than three times per week) ingestion of non-steroidal anti-inflammatory drugs (NSAIDs) or cyclooxygenase (COX)-2 inhibitors; any use of oral steroids, immunosuppressants, interferon, chemotherapy, or anticoagulants.

Omega-3 Exclusions:

* A history of severe sensitivity to soy products, fish products, or PUFA supplements
* Patients who had taken supplements enriched with n-3 fatty acids within 60 days of the screening visit or who, at baseline, were consuming a diet containing \> 3 g/day of n-3 fatty acids, or who consume \> 2 meals of fatty fish per week.
* Having taken a supplement of ≥1 g/day of n-3 fatty acids for ≥6 weeks during the current major depressive episode
* Patients who have had either a poor response or intolerable side effects from n-3s in the past.
* Patients with the following conditions: - Patients with the following conditions: history of atrial fibrillation or atrial flutter, left ventricle hypertrophy, stroke, cardiovascular disease (including coronary artery disease, heart failure, and moderate or severe valve disease or prior valve procedure), uncontrolled hypertension, Crohn's disease, Irritable Bowel Syndrome-diarrhea type, history of gastric bypass surgery, history of cholecystectomy, recent/current history of bulimia with purging, use of prokinetic medications that affect GI transit time, and small intestinal bacterial overgrowth (SIBO)
* Sustained atrial fibrillation or atrial flutter of greater than 30 seconds detected by Holter monitor between V1 (screen) and V2 (baseline)

Where this trial is running

Atlanta, Georgia and 2 other locations

• Emory University School of Medicine — Atlanta, Georgia, United States (RECRUITING)
• Depression Clinical and Research Program at Massachusetts General Hospital — Boston, Massachusetts, United States (RECRUITING)
• University of Utah — Salt Lake City, Utah, United States (RECRUITING)

Study contacts

• Principal investigator: Mark H Rapaport, MD — University of Utah
• Study coordinator: David Mischoulon, MD, PhD

Conditions: Treatment Resistant Depression, Inflammation, Overweight, omega-3, fatty acid, major depressive disorder