Inadequate resources to complete the study

The investigators are doing this research study to find out if using aspirin along with antidepressant treatment can lessen symptoms of depression. This study also aims to find out if some people improve more from taking aspirin than others. The investigators also want to see if it is possible to predict which participants will do better based on a blood test.

Aspirin is approved by the U.S. Food and Drug Administration (FDA) as an over-the-counter pain medication. But, aspirin is not approved by the FDA to make antidepressant treatment better.

This research study will compare aspirin to placebo.

This study is a randomized, double-blind, placebo-control trial. The primary aims of this study are:

Aim 1: To evaluate the clinical effect of aspirin augmentation on depression.

Aim 2: To assess the inflammatory profile of the blood of the aspirin augmentation responders compared with the non-responders.

Aim 3: To evaluate whether immune gene expression patterns are associated with antidepressant response to aspirin.

Aim 4: To collect samples for later, more detailed immunologic characterization.

Inclusion Criteria:

• Current diagnosis of major depressive disorder
• Hamilton Depression Rating Scale (HDRS) score of >19
• Stable treatment regimen (no medication changes or changes in psychotherapy treatment in past 8 weeks, and no participation in stepped treatments, such as completion of a course of cognitive behavioral therapy, during the trial)
• Failed to remit with at least 1 antidepressant trial, or combination of 1 antidepressant and 1 augmentation agent
• Women of childbearing age must agree to use an approved method of contraception for the duration of the study

Exclusion Criteria:

• Active suicidal ideation
• History of manic episodes or psychosis
• Alcohol or substance use disorder up to one month prior to first testing session
• Comorbid neurologic condition affecting the central nervous system
• Comorbid autoimmune condition
• Uncorrected thyroid disease or a current abnormal thyroid-stimulating hormone (TSH)
• Active or recent (within the past month) infection (such as otitis, pneumonia, urinary tract infection); temperature > 100.3 or white blood cell (WBC) count > 11 K/microL will be considered evidence of active infection even in the absence of other symptoms
• History of GI bleed
• History of stroke
• History of a bleeding disorder
• Platelet count < 150,000/mm3 on initial screening
• On a blood-thinning agent or taking NSAIDs daily
• Current use of oral steroids or other immunomodulating medications
• Salicylate sensitivity
• Pregnancy or breastfeeding

8 weeks

In Mar. 2020 study placed on prolonged pause due to the pandemic. Research activities resumed with limitations later that year. The last study participant was screened in Feb. 2021. However, personnel departure affected study activities, so study was again paused, with plans to resume once adequate personnel were hired. However no additional support was provided. In Dec. 2022, it was decided to terminate the study when it became clear that resources would be insufficient to complete the trial.

Study team will be blinded to participant condition. Pharmacy will be responsible for providing study drug versus identical placebo to participants.