Purpose

Apimostinel shows initial promise as a novel rapid-acting antidepressant medication with minimal side effects or safety concerns. Cognitive Training (CT) is a digital intervention that has shown promise in extending the durability of another similar drug (ketamine). This randomized controlled trial will test the efficacy and safety of apimostinel (vs. placebo) for the acute treatment of depression, and will test the potential of CT to enhance and/or extend the durability of apimostinel's antidepressant effect.

Condition

Eligibility

Eligible Ages
Between 18 Years and 60 Years
Eligible Genders
All
Accepts Healthy Volunteers
No

Inclusion Criteria

  1. Participants of any gender are eligible 2. Aged 18 to 60 years 3. Meets Diagnostic and Statistical Manual, Fifth Edition (DSM-V) criteria for major depressive disorder (MDD) 4. MADRS score ≥ 25 at screening 5. Have not responded to one or more adequate trials of FDA-approved antidepressants within the current depressive episode, determined by Antidepressant Treatment History Form (ATHF-SF) criteria [score ≥ 1] 6. Score >1SD above the normative mean on the Cognitive Triad Inventory (CTI) "self" subscale *OR* <1SD below the normative mean on the Rosenberg self-esteem scale 7. Participants of childbearing potential with a negative serum pregnancy test prior to entry into the study and who are practicing an adequate method of birth control (eg oral or parenteral contraceptives, intrauterine device, barrier, abstinence) and who do not plan to become pregnant during the course of the study. Participants may be included without a negative serum pregnancy test if they are surgically sterile or at least 2 years post- menopausal. Participants who could impregnate a sexual partner should use an acceptable method of birth control during the study, from the day of dosing to 28 days following dose. 8. Participants who could impregnate a partner and their sexual partner of childbearing potential should use an acceptable method of birth control during the study, from day of dosing to 28 days following dose. 9. Clinical laboratory values < 1.5 times the upper limit of normal (ULN) or deemed not clinically significant per the investigator 10. Ability to understand the requirements of the study, provide written informed consent, abide by the study restrictions, and agree to return for the required assessments 11. Based on the investigator's clinical judgment, participants with eating disorders, obsessive compulsive disorder (OCD), panic disorder, post-traumatic stress disorder (PTSD), and generalized anxiety disorders secondary to major depressive episodes are permitted.

Exclusion Criteria

  1. Presence of lifetime bipolar, psychotic, or autism spectrum; or current problematic, moderate-to-severe substance use disorder 2. Use of a Monoamine Oxidase Inhibitor (MAOI) within 28 days of infusion date 3. Huntington's, Parkinson's, Alzheimer's, Multiple Sclerosis, or a history of strokes or with one or more seizures without a clear and resolved etiology 4. Currently hospitalized or residing in an in-patient facility during the study participation 5. Acute suicidality or other psychiatric crises requiring treatment escalation, using the Columbia-Suicide Severity Rating Scale (C-SSRS) as both an initial exclusion criteria (C-SSRS "Baseline/Screening" Version for past 1-month period) and as grounds for rescue/removal (C-SSRS "Since Last Visit" form). Participants with C-SSRS suicide ideation scores scored "yes" on items 4 (active suicidal ideation with some intent to act) and/or 5 (active suicidal ideation with specific plan and intent) will be excluded from the study, and if enrolled, will be exited from the study and referred immediately to the nearest emergency mental health facility for additional thorough assessment and appropriate treatment referral. 6. Changes made to treatment regimen within 28 days of drug infusion (Day 0) 7. Reading level <6th grade as per patient self-report 8. Serious, unstable medical illnesses including respiratory [obstructive sleep apnea, or history of difficulty with airway management during previous anesthetics], cardiovascular [including ischemic heart disease and uncontrolled hypertension], and neurologic [including history of severe head injury diagnoses. 9. Clinically significant abnormal findings of laboratory parameters [including urine toxicology screen for drugs of abuse], physical examination, or ECG. 10. Uncontrolled or poorly controlled hypertension, as determined by the study physician's review of vitals collected during screening and any other relevant medical history/records. 11. Patient has clinically significant renal dysfunction as assessed by the estimated glomerular filtration rate <70 mL/min using the Chronic Kidney Disease Epidemiology Collaboration -creatinine methodology. 12. Patient has liver enzyme test results >1.5 times the upper limit of normal. 13. Patient has resting heart rate (supine) <60 or >100 bpm at the Screening Visit or Pre-Dose Baseline, in the absence of an etiology that, in the judgment of the investigator, is related to exceptionally good cardiovascular fitness. 14. Patient has PR interval >250 msec at the Screening Visit or Pre-Dose Baseline 15. Patients starting hormonal treatment (e.g., estrogen) in the 3 months prior to Screening. 16. Patients taking medications with known activity at the NMDA or AMPA glutamate receptor [e.g., riluzole, amantadine, memantine, topiramate, dextromethorphan (including AuvelityTM), D-cycloserine, ketamine or esketamine], or the mu-opioid receptor. 17. Patients taking any of the following medications: St John's Wort, theophylline, tramadol, metrizamide. 18. Patients who have received ECT in the past 6 months prior to Screening. 19. Patients currently receiving treatment with vagus nerve stimulation (VNS) or repetitive transcranial stimulation (rTMS). 20. Participation in any clinical trial of an investigational product or device within 30 days of enrollment in this trial 21. Positive screen for unreported drugs of abuse, including: cocaine, PCP, opioid or other agent that in the opinion of the investigator is being abused. Positive marijuana screen is not exclusionary if use is consistent with clinical diagnostic interview findings and is seen in the absence of a moderateto-severe substance use disorder. 22. Participants or sexual partners of participants who are currently pregnant or planning to become pregnant during the course of the study 23. Participants who are breastfeeding 24. History of allergy, sensitivity, or intolerance to apimostinel, zelquistinel, NMDAR ligands including ketamine,dextromethorphan, memantine, methadone, dextropropoxyphene, or ketobemidone.

Study Design

Phase
Phase 2
Study Type
Interventional
Allocation
Randomized
Intervention Model
Parallel Assignment
Primary Purpose
Treatment
Masking
Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)

Arm Groups

ArmDescriptionAssigned Intervention
Experimental
Apimostinel + Cognitive Training
  • Drug: Apimostinel Infusion, Intravenous
    Single injection of Apimostinel (10mg)
  • Behavioral: Cognitive Training
    8 sessions of digital active training
Sham Comparator
Apimostinel + Sham Training
  • Drug: Apimostinel Infusion, Intravenous
    Single injection of Apimostinel (10mg)
  • Behavioral: Sham Training
    8 sessions of digital sham training
Placebo Comparator
Placebo + Cognitive Training
  • Behavioral: Cognitive Training
    8 sessions of digital active training
  • Drug: Isotonic Solution, Intravenous
    Single injection of placebo

Recruiting Locations

More Details

Status
Recruiting
Sponsor
Rebecca Price

Study Contact

Rebecca B Price, PhD
4123832150
canlab@pitt.edu

Notice

Study information shown on this site is derived from ClinicalTrials.gov (a public registry operated by the National Institutes of Health). The listing of studies provided is not certain to be all studies for which you might be eligible. Furthermore, study eligibility requirements can be difficult to understand and may change over time, so it is wise to speak with your medical care provider and individual research study teams when making decisions related to participation.