Pramipexole in Treatment-Resistant Depression

描述(由申请者提供)：这是一份以患者为导向的职业发展(K23)指导奖的重新提交申请，旨在提高申请者在研究治疗难治性重度抑郁症的创新疗法方面的专业知识。这一应用的研究部分包括一项随机、双盲、安慰剂对照试验，即多巴胺受体激动剂辅助性普拉克索治疗难治性抑郁症。随机治疗改善的受试者也将进入持续阶段的先导研究。该应用程序利用一种创新的疗法和简单、严格的设计来解决一种对公共健康有重大影响的未被研究的疾病。初步研究表明，在这些患者中使用多巴胺受体激动剂如普拉克索可能是有效的，尽管最佳剂量尚未确定。这项研究的主要目的将是确定灵活剂量普拉克索与安慰剂的疗效。二次分析将包括临床反应预测因素。在获奖期的最后两年，候选人将在这些数据和他的正式培训的基础上进行更大规模的研究。这项拟议的研究将在马萨诸塞州抑郁症临床和研究项目的马萨诸塞州总医院进行，由医学博士安德鲁·尼伦伯格指导，莫里齐奥·法瓦医学博士、A·约翰·拉什医学博士和迈克尔·瑟斯医学博士共同指导，当地和国家专家小组提供咨询。该应用程序还包括丰富的教学内容，将哈佛公共卫生学院的正式课程与研究设计、治疗耐药性的评估和管理、生物统计学和生物伦理学的教程结合在一起。由于联合导师是NIMH资助的两项大型情绪障碍有效性研究的联合首席研究员或首席研究员，候选人还将参与这两项研究的统计审查和持续分析，应用他在课程和教程中培养的技能。拟议的调查和培训计划将提供关键技能、经验和数据，以帮助候选人撰写R01并成为一名独立调查员。

DESCRIPTION (provided by applicant): This is a resubmission of a Mentored Patient-Oriented Career Development (K23) Award application to enhance the applicant's expertise in the study of innovative therapies for treatment-resistant major depression. The research component of this application includes a randomized, double-blind, placebo controlled trial of adjunctive pramipexole, a dopamine receptor agonist, for treatment-resistant depression. Subjects who improve with randomized treatment will also enter a continuation-phase pilot study. The application utilizes an innovative therapy and a simple, rigorous design to address an understudied disorder with major impact on public health. Preliminary studies suggest augmentation with dopamine receptor agonists such as pramipexole may be efficacious in these patients, though the optimum dose has not been established. The primary aim of this study will be to determine the efficacy of flexibly-dosed pramipexole compared to placebo. Secondary analyses will include clinical predictors of response. During the final two years of the award period, the candidate will develop a larger study building on this data and drawing on his formal training. The proposed study will be conducted at Massachusetts General Hospital in the Depression Clinical and Research Program, under the mentorship of Andrew Nierenberg, M.D. and co-mentorship of Maurizio Fava, M.D., A. John Rush, M.D., and Michael Thase, M.D., with consultation from a panel of local and national experts. The application also includes a rich didactic component combining formal coursework at the Harvard School of Public Health with tutorials in study design, assessment and management of treatment resistance, biostatistics, and bioethics. As the co-mentors are co-principal investigator or principal investigator in two large NIMH-funded effectiveness studies in mood disorders, the candidate will also participate in statistical review and ongoing analysis of both studies, applying skills developed in his coursework and tutorials. The proposed investigation and training program will provide critical skills, experience and data to aid the candidate in writing an R01 and becoming an independent investigator.