Ziprasidone Augmentation of SSRIs for Patients With Major Depressive Disorder (MDD) That do Not Sufficiently Respond to Treatment With SSRIs

The proposed study involves three phases. The first phase is an 8-week, open-label trial of
an SSRI for MDD. Patients who do not experience sufficient symptom improvement following
this open-label trial will be enrolled in a 6-week, double-blind, placebo controlled trial
of ziprasidone augmentation (second phase). Ziprasidone and placebo-remitters will then
enter a 12-month, double-blind extension phase (third phase). We estimate that
approximately 400 patients will enter phase 1 of the study so that a minimum of 180 subjects
will enter double-blind treatment (phase 2) over 5 years. Each treatment arm during phase 2
will have 90 subjects.

Hypothesis B1: During phase 2, there will be a difference between the two groups in the
percentage of responders (50% or greater reduction in symptom severity) with regards to
anxious symptoms of MDD as measured by the 14-item Hamilton Anxiety Rating Scale (HAM-A);
response rates will be higher for the ziprasidone group.

Hypothesis B2: During phase 2, there will be a difference between the two groups in the
percentage of responders (50% or greater reduction in symptom severity) with regards to
painful symptoms of MDD, as measured by the overall visual analogue pain (VAS-pain) scale
scores; response rates will be higher for the ziprasidone group.

Hypothesis C: The time to relapse during phase 3 will be shorter among adjunctive placebo-
than ziprasidone-remitters.

Inclusion Criteria:

- Written informed consent.

- Men or women, 18-65 years of age.

- MDD, current, according to DSM-IV criteria and as diagnosed by the SCID- I/P during
the screen and baseline visit of phase 1.

- A HAM-D-17 score > 14 during the screen and baseline visit of phase 1.

Exclusion Criteria:

- Pregnant women or women of child bearing potential who are not using a medically
accepted means of contraception (oral contraceptive or implant, condom, diaphragm,
spermicide, intrauterine

- Device, tubal ligation, or partner with vasectomy).

- Serious suicide or homicide risk, as assessed by evaluating clinician.

- Unstable medical illness including cardiovascular, hepatic, renal, respiratory,
endocrine, neurological, or hematological disease or uncontrolled seizure disorder.

- History of multiple adverse drug reactions or allergy to the study drug.

- The following DSM-IV diagnoses: substance use disorders active within the last six
months, any bipolar disorder (current or past), any psychotic disorder (current or
past).

- Patients requiring excluded medications (see appendix 1 for details).

- Psychotic features in the current episode or a history of psychotic features.

- Prior course of ziprasidone, or intolerance to ziprasidone at any dose.

- Any investigational psychotropic drug within the last 3 months.

- Have failed more than 3 adequate antidepressant trials during the current MDE. Some
examples of adequate dosage of an antidepressant trial include either > 150 mg of
imipramine (or its tricyclic equivalent), > 60 mg of phenelzine (or its monoamine
oxidase inhibitor equivalent), > 20 mg of fluoxetine (or its SSRI-equivalent), >
150mg of bupropion, > 300mg of trazodone (or nefazodone), >75 mg of venlafaxine,
>60mg of duloxetine, or > 15mg of mirtazapine. A trial of adequate duration was
defined as one during which the patient was on any given antidepressant at an
adequate dose for a minimum of 6 weeks.