Lithium Versus Cariprazine in the Acute Phase Treatment of Bipolar Depression A Pragmatic Head-to-head Open, Randomized Multicenter Study The 9th Study of the Danish University Antidepressant Group (DUAG 9)
Led by Aalborg University Hospital · Updated on 2026-01-21
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Sponsors
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Aalborg University Hospital
Lead Sponsor
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Glostrup University Hospital, Copenhagen
Collaborating Sponsor
AI-Summary
What this Trial Is About
Researchers are evaluating the effects of lithium compared to cariprazine in adults with bipolar disorder experiencing a current depressive episode. The main focus is to see the difference in improvement on the Hamilton Depression Scale, 6-item version (HDS-6), from the start of treatment to after 8 weeks. The study also compares these medications on other important factors like mood symptoms, sleep, cognitive function, social functioning, and suicidal thoughts.
Participants will be randomly assigned to receive either lithium or cariprazine. Lithium treatment starts at 12 mmol once daily before bedtime and may be adjusted to maintain specific blood levels. Cariprazine begins at 1.5 mg daily with possible adjustment to 3 mg after at least two weeks. The study lasts 8 weeks, during which participants have scheduled visits for interviews, ratings, blood samples, ECGs, and urine samples. Telephone interviews are also conducted six times throughout the study.
During the study, participants will attend four visits for interviews and assessments, including blood tests and heart monitoring. They will also participate in six telephone interviews. Researchers will measure changes in depression scores and other clinical outcomes. Safety and treatment adherence will be monitored closely. The trial runs until September 2028, allowing thorough assessment of both treatments over the acute phase of bipolar depression.
CONDITIONS
Brief Title
Lithium Versus Cariprazine in the Acute Phase Treatment of Bipolar Depression (DUAG9)
Who Can Participate
Age: 18Years - 65Years
All Genders
Eligibility Criteria
You may qualify if you...
Diagnosis of bipolar disorder type 1 or 2 with a current depressive episode according to DSM-5
Score of at least 21 on the self-reported Major Depression Inventory (MDI)
No start or dose increase of psychotropic medication (except specified sleep aids) within 2 weeks before inclusion
No new formal psychotherapy sessions (except psychoeducation) in the 4 weeks before inclusion
Age between 18 and 64 years at randomization
Current depressive episode duration between 4 and 52 weeks
Clinical uncertainty about whether lithium or cariprazine is the better choice
Female participants must be sterile, non-fertile, or have a negative pregnancy test and use safe contraception
Signed informed consent form
You will not qualify if you...
Prior or ongoing acute treatment of the current depressive episode with lithium or cariprazine for more than 14 days
Electroconvulsive therapy (ECT) during the current depressive episode
MAS score greater than 6
Diagnosis of dementia
High risk of non-adherence as assessed by investigator
Inability to understand Danish language
Psychiatric coercion such as forced admission or forensic psychiatric care
Presence of clinically relevant delusions, hallucinations, or other psychotic symptoms
Suicidality indicated by positive responses on C-SSRS question 4 or 5 or investigator judgment
Medical conditions like cancer, kidney failure, epilepsy, or deep brain stimulation device that interfere with study outcomes or safety
Current harmful use or dependency of alcohol or drugs
Known allergy to any ingredients in the study medications
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Your Study Journey
Screening
Duration - 2 to 4 weeks
Participants are screened for eligibility to participate in the trial.
1 visit (in-person)
Treatment
Duration - 8 weeks
Participants receive active treatment with either lithium or cariprazine for acute bipolar depression to evaluate effectiveness and safety.
Baseline visit and periodic visits during treatment
Lithium versus cariprazine in the acute phase treatment for depressive episodes in patients with bipolar disorder: a protocol for a pragmatic open, randomised multicentre study - the 9th trial of the Danish University Antidepressant Group, DUAG-9.