Clinical TrialTreatment-Resistant Depression (TRD)PsilocybinCompleted

Effect of Psilocybin on the Positive Valence System in Treatment-resistant Depression (PSILODAC)

Single-group interventional study (n=10) testing a single 25 mg oral dose of psilocybin with pre/post MRI in patients with treatment-resistant depression to assess effects on the positive valence system.

Target Enrollment
10 participants
Study Type
Phase NA interventional
Design
Non-randomized

Detailed Description

This single-group study tests the hypothesis that psilocybin’s antidepressant effects are mediated by normalisation of the positive valence system, reducing anhedonia and increasing reward anticipation and motivation.

Psilocybin (single 25 mg oral dose) will be administered to patients with treatment-resistant major depressive episodes; outcomes include pre/post MRI of effort-evaluation circuits (amygdala, dACC, ventral pallidum, ventral striatum, VTA), depression and anhedonia scales, and behavioural measures with follow-up over four months.

Study Protocol

Preparation

sessions

Dosing

1 sessions

Integration

sessions

Study Arms & Interventions

Psilocybin

experimental

Single-group single-dose psilocybin with pre/post MRI in patients with treatment-resistant depression.

Interventions

  • Psilocybin25 mg
    via Oral• single dose• 1 doses total

    Oral capsule, single 25 mg dose.

  • Compound
    via Other• pre and post• 2 doses total

    1.5 hour brain MRI before and after psilocybin administration.

Participants

Ages
25 – 60
Sexes
Male & Female

Inclusion Criteria

  • Inclusion Criteria:
  • The patient must have given their free and informed consent and signed the consent form
  • The patient must be a member or beneficiary of a health insurance plan
  • Patient with a current DSM-IV diagnosis of moderate or severe major depressive episode (MDE) without psychotic features (based on clinical assessment and confirmed by the MINI interview and the QIDS).
  • Patient who has not responded to at least two antidepressant treatments of different classes, administered appropriately in terms of dose and duration, for a moderate to severe major depressive episode.
  • Patients receiving antidepressant treatment of the SSRI (Selective Serotonin Reuptake Inhibitors) or SNRI (Serotonin Norepinephrine Reuptake Inhibitors) classes may maintain this treatment for the duration of the trial, without modification
  • Patient with a score > 10 on the QIDS scale.
  • Patient available for a 4-month follow-up.
  • Patient able to speak and understand French easily.

Exclusion Criteria

  • Exclusion Criteria:
  • The patient is participating in a medical product-based interventional study, or is in a period of exclusion determined by a previous study
  • Patient unable to express consent
  • It is impossible to give the subject informed information
  • The patient is under safeguard of justice or state guardianship
  • Patient with allergy, hypersensitivity or other adverse reaction to previous use of psilocybin or other hallucinogens.
  • Patient who has used hallucinogenic substances (excluding cannabis) more than 5 times in his/her lifetime or at any time in the last twelve months.
  • Patient on medication or illicit substances likely to interfere with the effects of psychedelics (urine analysis and breathalyzer on D0).
  • Patient with regular consumption of alcoholic beverages (>20 drinks/week)
  • Any other major clinically significant concomitant disease that, in the opinion of the investigator, may interfere with the interpretation of the study results or constitute a risk to the health of the participant, if he or she participates in the study
  • Patient with a prolonged QTc interval (interval corrected by the Fridericia formula >450 ms for men and >470 ms for women)
  • Participant planning to donate sperm within three months of psilocybin administration
  • Female participant having sexual intercourse that could result in pregnancy and not agreeing to use a highly effective contraceptive method throughout their participation in the study and for at least three months after psilocybin administration.
  • Positive serum pregnancy test at inclusion for participants of childbearing potential. NB: a urine pregnancy test will also be performed on the day of psilocybin administration.
  • Pregnant patient (confirmed by pregnancy test), parturient or breastfeeding, or wishing to become pregnant during their participation in the study
  • Active substance dependence according to the MINI questionnaire (excluding tobacco).
  • Patient whose psychotropic treatment (anxiolytics, antipsychotics, hypnotics, mood stabilizers) has been modified in the last month.
  • Patient on antidepressant treatment other than SSRIs or SNRIs. (Antidepressant treatments other than SSRIs or SNRIs are prohibited in the trial.)
  • Patient suffering from intellectual disability (IQ less than or equal to 75).
  • Patient with a history of bipolar disorder, schizophrenia, schizoaffective disorder or psychosis not otherwise specified during life.
  • Patient with a family history of schizophrenia, schizoaffective disorder or bipolar disorder type 1 in first or second degree relatives.
  • Patient who has started psychotherapy in the 30 days preceding the screening visit, or whose psychotherapy is likely to undergo changes during the clinical trial.
  • Patient who has received in the last 6 months treatments such as: ECT, vagus nerve stimulation, deep brain stimulation, transcranial magnetic stimulation.
  • Patient with any disease or unstable physical condition determined by clinical examination, history or laboratory tests (ECG, blood test at inclusion) These pathologies include cardiovascular comorbidities: history of stroke, myocardial infarction, heart failure, intracranial hypertension, arrhythmia, uncontrolled hypertension (greater than 140/90 mmHg at screening), tachycardia (resting heart rate > 100 beats per minute); organic epileptic syndrome and active neurological comorbidities; endocrine pathologies (dysthyroidism and adrenals, type I diabetes or insulin-requiring type II diabetes, history of severe hypoglycemia requiring hospitalization); significant impairment of liver function; glaucoma; symptomatic prostatic hypertrophy or bladder neck obstruction; renal failure; respiratory failure; presence of fever or inflammatory syndrome.
  • Patient with contraindications to magnetic resonance imaging: patients with a metallic foreign body, pacemaker, neurostimulator or any electronic medical equipment implanted in a non-removable manner, implantable cardiac defibrillators, prostheses, transdermal patches (placed under the skin), catheters (tubes introduced into a vessel or organ), implantable pumps, artificial heart valves, implants to treat deafness.

Study Details

Locations

CHU de Nîmes, Hôpital Universitaire Carémeau — Nîmes, France

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