Clinical TrialMajor Depressive Disorder (MDD)KetaminePlaceboRecruiting

Ketamine for Veterans With Parkinson’s Disease (KPD)

This double-masked, active placebo-controlled, single-dose randomised trial (n=80) will investigate the effects of intravenous (IV) ketamine versus remimazolam for depression in Veterans with Parkinson’s disease (PD).

Target Enrollment
80 participants
Study Type
Phase II interventional
Design
Randomized, triple Blind

Detailed Description

Randomised, triple-masked, active placebo-controlled, single-dose trial comparing IV ketamine 0.5 mg/kg versus remimazolam 0.25 mg/kg in 80 Veterans with Parkinson's disease and moderate-to-severe depression; primary clinical outcome is change in MADRS at 24 hours.

Mechanistic measures include non-invasive neurophysiological assays of LTP-like plasticity and blood cytokine panels to assess ketamine's effects on neuroplasticity and inflammation; safety, tolerability, and adverse events will also be recorded.

Study Protocol

Preparation

sessions

Dosing

1 sessions

Integration

sessions

Study Arms & Interventions

Ketamine

experimental

IV ketamine 0.5 mg/kg single infusion

Interventions

  • Ketamine0.5 mg/kg
    via IV• single dose• 1 doses total

Remimazolam

active comparator

IV remimazolam 0.25 mg/kg active placebo infusion

Interventions

  • Placebo0.25 mg/kg
    via IV• single dose• 1 doses total

    Remimazolam 0.25 mg/kg (active placebo)

Participants

Ages
40 – 80
Sexes
Male & Female

Inclusion 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

  • 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.

Study Details

Locations

San Francisco VA Medical Center, San Francisco, CA — San Francisco, California, United States

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