Baseline insomnia as a predictor of antidepressant efficacy to repeated intravenous ketamine for unipolar and bipolar depression: A preliminary study

Objectives Accumulating evidence has implicated that brain derived neurotrophic factor (BDNF) is thought to be involved in the pathophysiology of depression, but its correlation with ketamine’s antidepressant efficacy focusing on Chinese individuals with depression is not known. This study was aim to determine the correlation of plasma BDNF (pBDNF) concentrations and ketamine’s antidepressant efficacy. Methods Ninety-four individuals with depression received six intravenous infusions ketamine (0.5 mg/kg). Remission and response were defined as Montgomery-Asberg Depression Rating Scale (MADRS) scores less than 10 and a reduction of 50% or more in MADRS scores, respectively. Plasma was collected at baseline and at 24 h and 2 weeks after completing six ketamine infusions (baseline, 13 d and 26 d). Results A significant improvement in MADRS scores and pBDNF concentrations was found after completing six ketamine infusions compared to baseline (all ps < 0.05). Higher baseline pBDNF concentrations were found in ketamine responders/remitters (11.0 ± 6.2/10.1 ± 5.8 ng/ml) than nonresponders/nonremitters (8.0 ± 5.5/9.2 ± 6.4 ng/ml) (all ps < 0.05). Baseline pBDNF concentrations were correlated with MADRS scores at 13 d (t = − 2.011, p = 0.047) or 26 d (t = − 2.398, p = 0.019) in depressed patients (all ps < 0.05). Subgroup analyses found similar results in individuals suffering from treatment refractory depression. Conclusion This preliminary study suggests that baseline pBDNF concentrations appeared to be correlated with ketamine’s antidepressant efficacy in Chinese patients with depression.

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Neurocognitive effects of six ketamine infusions and the association with antidepressant effects in treatment-resistant bipolar depression: a preliminary study

PeerJ ◽

10.7717/peerj.10208 ◽

2020 ◽

Vol 8 ◽

pp. e10208

Author(s):

Wei Zheng ◽

Yan-Ling Zhou ◽

Cheng-Yu Wang ◽

Xiao-Feng Lan ◽

Bin Zhang ◽

...

Keyword(s):

Working Memory ◽

Bipolar Depression ◽

Visual Learning ◽

Verbal Learning ◽

Depression Symptoms ◽

Speed Of Processing ◽

Treatment Resistant ◽

Observational Period ◽

Preliminary Study ◽

Over Time

Objective The N-methyl-D-aspartate subtype glutamate receptor antagonist ketamine has rapid antidepressant and antisuicidal effects in treating treatment-resistant bipolar depression (TRBD). The neurocognitive effects of repeated ketamine infusions in TRBD are not known. Methods Six intravenous infusions of ketamine (0.5 mg/kg over 40 min) were administered on a Monday–Wednesday–Friday schedule during a 12-day period on 16 patients with TRBD followed by a 2-week observational period. The assessment of neurocognitive function was conducted using the MATRICS Consensus Cognitive Battery at baseline, 13 and 26 days. Tasks were designed to test speed of processing, working memory, visual learning and verbal learning. Results A significant improvement was found only in scores of speed of processing (F = 9.9, p = 0.001) after a 2-week observational period, which was accounted for by the improvement of depression symptoms. There were no significant changes over time in terms of working memory, visual learning and verbal learning. Pearson correlation analysis showed that the improvement of depression symptoms through six ketamine infusions was greater among TRBD patients with lower working memory at baseline (r = 0.54, p = 0.03). In multiple regression analysis, the significant correlation was still maintained (beta = 0.67, t = 2.2, p = 0.04). Conclusion This preliminary study indicated that six ketamine infusions were not harmful but were slightly beneficial for speed of processing in TRBD. However, this change was mainly accounted for the improvement of depression symptoms over time. Lower baseline working memory appears to be associated with greater antidepressant response after completion of six ketamine infusions in patients with TRBD.

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P.319 Intravenous ketamine long-term use in two bipolar depression cases: 1-year follow-up

European Neuropsychopharmacology ◽

10.1016/j.euroneuro.2019.09.339 ◽

2019 ◽

Vol 29 ◽

pp. S228

Author(s):

I. Laria Bustillo ◽

N. Olazabal ◽

S. Bustamante ◽

M.A. Madrazo ◽

L. Osa ◽

...

Keyword(s):

Bipolar Depression ◽

Intravenous Ketamine

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Neural mechanisms of antidepressant efficacy of the dopamine receptor agonist pramipexole in treatment of bipolar depression

The International Journal of Neuropsychopharmacology ◽

10.1017/s1461145710001203 ◽

2011 ◽

Vol 14 (4) ◽

pp. 545-551 ◽

Cited By ~ 14

Author(s):

Linda Mah ◽

Carlos A. Zarate ◽

Allison C. Nugent ◽

Jaskaran B. Singh ◽

Husseini K. Manji ◽

...

Keyword(s):

Dopamine Receptor ◽

Receptor Agonist ◽

Bipolar Depression ◽

Neural Mechanisms ◽

Dopamine Receptor Agonist ◽

Antidepressant Efficacy

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Replication of Ketamine's Antidepressant Efficacy in Bipolar Depression: A Randomized Controlled Add-On Trial

Biological Psychiatry ◽

10.1016/j.biopsych.2011.12.010 ◽

2012 ◽

Vol 71 (11) ◽

pp. 939-946 ◽

Cited By ~ 425

Author(s):

Carlos A. Zarate ◽

Nancy E. Brutsche ◽

Lobna Ibrahim ◽

Jose Franco-Chaves ◽

Nancy Diazgranados ◽

...

Keyword(s):

Bipolar Depression ◽

Randomized Controlled ◽

Antidepressant Efficacy

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The brain-gut axis profiles in patients with bipolar depression: a preliminary study

European Neuropsychopharmacology ◽

10.1016/s0924-977x(17)31483-9 ◽

2017 ◽

Vol 27 ◽

pp. S820-S821

Author(s):

S. Hu ◽

Q. Lu ◽

J. Lai ◽

T. Huang ◽

Y. Xu

Keyword(s):

Bipolar Depression ◽

Preliminary Study ◽

The Brain

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Ketamine in the Treatment of Depressive Episodes

Pharmacopsychiatry ◽

10.1055/a-0991-0582 ◽

2019 ◽

Vol 53 (02) ◽

pp. 45-50 ◽

Cited By ~ 3

Author(s):

Philipp Ritter ◽

Hannelore Findeis ◽

Michael Bauer

Keyword(s):

Bipolar Depression ◽

Controlled Trial ◽

Repeated Administration ◽

Precise Position ◽

Long Latency ◽

Antidepressant Efficacy ◽

Insufficient Response ◽

Year 2000 ◽

Depressive Episodes ◽

Fast Acting

AbstractThe treatment of depressive episodes remains complicated by the long latency of antidepressant efficacy, insufficient response, and high risk of suicide. Ketamine and esketamine have been proposed as fast-acting substances able to overcome these impediments.Since the first randomized controlled trial in the year 2000, numerous studies have explored the antidepressant efficacy of ketamine and esketamine. Clear evidence has emerged that a single infusion exerts a significant antidepressant and antisuicidal effect in both unipolar and bipolar depression. A few studies suggest that antidepressant response can be improved and maintained by repeated administration. Although intravenous application has been most common, subcutaneous, intramuscular, and intranasal application has also been successful. There is some evidence that ketamine may accelerate the response to electroconvulsive therapy without improving the overall response rate.The precise position of ketamine and esketamine within treatment algorithms have yet to be defined, and issues surrounding potential toxicity need to be resolved.

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Possibility of a New Indication for Amantadine in the Treatment of Bipolar Depression—Case Series Study

Pharmaceuticals ◽

10.3390/ph13100326 ◽

2020 ◽

Vol 13 (10) ◽

pp. 326

Author(s):

Marek Krzystanek ◽

Artur Pałasz

Keyword(s):

Depressive Symptoms ◽

Side Effects ◽

Bipolar Depression ◽

Therapeutic Option ◽

Case Series ◽

Mood Stabilizer ◽

New Drugs ◽

Case Series Study ◽

Antidepressant Efficacy

Bipolar disorder is a chronic and remitting mental illness. Antidepressants are not effective in treating acute bipolar depression, and antipsychotic drugs used in the treatment of bipolar depression cause frequent side effects. This situation justifies the search for new drugs as well as the repurposing of drugs used in other indications. In an open and naturalistic serious case study, 4 patients diagnosed with bipolar I disorder, chronically treated with a mood stabilizer, in whom at least two antidepressants were ineffective in the depressive phase, were treated with amantadine. The woman received 100 mg/day and 3 men received the target dose of 200 mg/day. All patients treated with amantadine improved their depressive symptoms after 1 week of treatment. None of them experienced side effects or manic switch. To reduce the risk of a manic switch, the treatment with amantadine was discontinued 2 weeks after the improvement of depressive symptoms, and no recurrence of depressive symptoms was observed. Amantadine may be a further therapeutic option for the treatment of acute bipolar depression. The drug in this indication may act quickly and be well tolerated. Confirmation of the antidepressant efficacy of amantadine in this indication requires replication of the results and conducting clinical trials.

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Electroconvulsive therapy in elderly - a preliminary study

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.572 ◽

2016 ◽

Vol 33 (S1) ◽

pp. s230-s230

Author(s):

C. Agostinho ◽

M. Duarte ◽

R. Alves ◽

I. Cunha ◽

A.M. Batista

Keyword(s):

Electroconvulsive Therapy ◽

Rating Scale ◽

Bipolar Depression ◽

Severe Depression ◽

Unipolar Depression ◽

Normal Range ◽

Significant Difference ◽

The Mean ◽

Preliminary Study ◽

Competing Interest

IntroductionStudies with electroconvulsive therapy (ECT) in elderly focus mainly on the assessment of possible side effects on the cognitive functioning; there are few studies that evaluate the effectiveness.ObjectiveEvaluate the effectiveness of this treatment in the population over 65 years.AimsPerform a preliminary study to evaluate the response to ECT of ≥ 65 years patients with depression.MethodsWe carry out a descriptive study based on patients treated in the last 10 years in the ECT Unit of Centro Hospitalar Psiquiátrico de Lisboa.ResultsOur initial sample consisted of 457 patients. We select patients aged ≥ 65 years with depression, and with complete data, including electroconvulsive parameters, and initial and final Hamilton Rating Scale for Depression (HRSD) scores (n = 59). Of this, 81.36% (n = 48) had unipolar depression, and 18.64% (n = 11) had bipolar depression. In the first group, the mean variation between the initial and final scores in HRSD was 13.88 points, and 27.10% (n = 13) of the patients ended the treatment in the normal range of HRSD score. In the second group, the mean variation was 12.82, and 63.60% (n = 7) ended the treatment in the normal range of HRSD. Considering the initial and final HRSD scores, it appears that unipolar depression group presents higher values (severe depression) (P < 0.05). When we compare the mean variation between the initial and final HRSD scores, we didn’t observe a statistically significant difference between the two groups. There was a clinical improvement in both.ConclusionsThe acute treatment with ECT appears to improve depressive symptoms in bipolar and unipolar depression, when considering an elderly population.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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