Efficacy of low-dose ketamine infusion in anxious vs nonanxious depression: revisiting the Adjunctive Ketamine Study of Taiwanese Patients with Treatment-Resistant Depression

CNS Spectrums ◽  
2020 ◽  
pp. 1-6
Author(s):  
Mu-Hong Chen ◽  
Wei-Chen Lin ◽  
Hui-Ju Wu ◽  
Ya-Mei Bai ◽  
Cheng-Ta Li ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Low Dose ◽  
Rating Scale ◽  
Estimating Equation ◽  
Antidepressant Effect ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Ketamine Infusion ◽  
Resistant Depression

Abstract Background. The antidepressant effect of low-dose ketamine infusion on Taiwanese patients with anxious vs nonanxious treatment-resistant depression (ANX-TRD vs NANX-TRD) has remained unknown. Methods. In total, 71 patients with TRD were randomized to three groups. Each group had participants who received saline infusions mixed with 0 (a normal saline infusion), 0.2, and 0.5 mg/kg of ketamine. Participants were followed up for 2 weeks. Anxious depression was defined as major depressive disorder with a total score of 7 or more on the 17-item Hamilton Depression Rating Scale Anxiety-Somatization factor. Generalized estimating equation models were used to investigate the effects of treatment (ketamine vs placebo) and depression type (ANX-TRD vs NANX-TRD) in the reduction of depressive symptoms during the follow-up period. Results. Patients with ANX-TRD were less likely to respond to a single low-dose ketamine infusion than those with NANX-TRD. Among patients with NANX-TRD, low-dose ketamine infusion was significantly superior to placebo for reducing depressive symptoms. However, among patients with ANX-TRD, ketamine was not superior to placebo; nonetheless, approximately 30% of the patients responded to ketamine infusion compared to 13% who responded to the placebo. Conclusions. Low-dose ketamine infusion was effective for Taiwanese patients with NANX-TRD but not so effective for those with ANX-TRD. A higher level of anxiety severity accompanying depression was related to greater depression severity. This may confound and reduce the antidepressant effect of ketamine infusion.

Baseline Working Memory Predicted Response to Low-Dose Ketamine Infusion in Patients with Treatment-Resistant Depression

2021 ◽  
Author(s):  
Mu-Hong Chen ◽  
Wei-Chen Lin ◽  
Cheng-Ta Li ◽  
Shih-Jen Tsai ◽  
Hui-Ju Wu ◽  
...  
Keyword(s):  
Working Memory ◽  
Depressive Symptoms ◽  
Treatment Response ◽  
Low Dose ◽  
Memory Function ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Ketamine Infusion ◽  
Treatment Groups ◽  
Resistant Depression

Abstract Introduction Pretreatment neurocognitive function may predict the treatment response to low-dose ketamine infusion in patients with treatment-resistant depression (TRD). However, the association between working memory function at baseline and the antidepressant efficacy of ketamine infusion remains unclear. Methods A total of 71 patients with TRD were randomized to one of three treatment groups: 0.5 mg/kg ketamine, 0.2 mg/kg ketamine, or normal saline. Depressive symptoms were measured using the 17-item Hamilton Depression Rating Scale (HDRS) at baseline and after treatment. Cognitive function was evaluated using working memory and go-no-go tasks at baseline. Results A generalized linear model with adjustments for demographic characteristics, treatment groups, and total HDRS scores at baseline revealed only a significant effect of working memory function (correct responses and omissions) on the changes in depressive symptoms measured by HDRS at baseline (F=12.862, p<0.05). Correlation analysis further showed a negative relationship (r=0.519, p=0.027) between pretreatment working memory function and changes in HDRS scores in the 0.5 mg/kg ketamine group. Discussion An inverse relationship between pretreatment working memory function and treatment response to ketamine infusion may confirm that low-dose ketamine infusion is beneficial and should be reserved for patients with TRD.

Repeated subcutaneous esketamine for treatment-resistant depression: Impact of the degree of treatment resistance and anxiety comorbidity

2021 ◽  
Vol 35 (2) ◽  
pp. 142-149
Author(s):  
Ana C Lucchese ◽  
Luciana M Sarin ◽  
Eduardo J Muniz Magalhães ◽  
Lorena C Del Sant ◽  
Camila B Puertas ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Anxiety Disorder ◽  
Rating Scale ◽  
Treatment Algorithm ◽  
Treatment Resistance ◽  
Antidepressant Effect ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Clinical Predictors ◽  
Resistant Depression

Background: A large number of studies indicate that subanesthetic doses of ketamine induce a fast antidepressant effect. Limited studies have investigated the subcutaneous (SC) route, and it remains unclear for whom this treatment is most suitable. Aims: The aim of this study was to examine the effect on depressive symptoms of repeated subanesthetic doses of SC esketamine in unipolar and bipolar treatment-resistant depression (TRD) and clinical predictors of response. Methods: A retrospective analysis of 70 patients who received six SC esketamine doses weekly as an adjunctive treatment was carried out. Doses started at 0.5 mg/kg and it could be titrated up to 1 mg/kg, according to response. The primary outcome was reduction in depressive symptoms. Statistical analysis to investigate clinical predictors of effectiveness included logistic regression analysis using a dependent variable of a 50% reduction in rating scale scores at the end of treatment. Comparisons between groups were made through analysis of variance and treatment effects. Results: At baseline, our sample presented with severe treatment resistance in 65.7%, as assessed by the Maudsley Staging Method (MSM), and 47.1% had anxiety disorder comorbidity. The response rate was 50%. A better outcome was predicted by mild and moderate MSM scores (OR = 3.162, p = 0.041) and anxiety disorder comorbidity (OR = 3.149, p = 0.028). Conclusions: Our results suggest that higher levels of treatment resistance may be associated with a poor response to SC esketamine. Unlike traditional pharmacotherapies, it might benefit those with poor prognosis such as patients with depression and comorbid anxiety. Therefore, future research could investigate whether esketamine should receive a more prominent place in the treatment algorithm for TRD.

Cognitive function of patients with treatment-resistant depression after a single low dose of ketamine infusion

2018 ◽  
Vol 241 ◽  
pp. 1-7 ◽  
Author(s):  
Mu-Hong Chen ◽  
Cheng-Ta Li ◽  
Wei-Chen Lin ◽  
Chen-Jee Hong ◽  
Pei-Chi Tu ◽  
...  
Keyword(s):  
Cognitive Function ◽  
Low Dose ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Ketamine Infusion ◽  
Resistant Depression

scholarly journals Additional intranasal oxytocin to escitalopram improves depressive symptoms in resistant depression: An open trial

2015 ◽  
Vol 30 (1) ◽  
pp. 65-68 ◽  
Author(s):  
G. Scantamburlo ◽  
M. Hansenne ◽  
V. Geenen ◽  
J.J. Legros ◽  
M. Ansseau
Keyword(s):  
Depressive Symptoms ◽  
Rating Scale ◽  
Open Trial ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Hamilton Depression Rating Scale ◽  
Resistant Depression ◽  
Synthetic Oxytocin

AbstractThe aim of this open trial was to assess the antidepressant/anxiolytic effects of oxytocin used as an adjunct to antidepressant in treatment-resistant depression. Fourteen patients, who have not responded to 40 mg of escitalopram, received intranasal synthetic oxytocin during 4 weeks, in association with antidepressant. This is the first open trial study suggesting OT in association with escitalopram significantly reduced scores on Hamilton Depression Rating Scale.

Clinical and neurocognitive characteristics associated with treatment-resistant depression

2017 ◽  
Vol 41 (S1) ◽  
pp. S542-S542 ◽  
Author(s):  
G. Serafini ◽  
G. Adavastro ◽  
G. Canepa ◽  
C. Conigliaro ◽  
M. Pompili ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Early Onset ◽  
Rating Scale ◽  
Color Word ◽  
Late Onset ◽  
Anxiety Symptoms ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Interference Test ◽  
Resistant Depression

IntroductionTreatment resistant depression (TRD) is a disabling condition associated with a relevant psychosocial impairment worldwide.ObjectivesThis exploratory study is aimed to evaluate the main clinical and neurocognitive characteristics in a sample of 21 subjects admitted to the Psychiatric Clinic of University of Genoa as inpatients between 2015 and 2016 and diagnosed with TRD according to Thase and Rush staging method.MethodsPatients have been assessed using the Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale, and Clinical Global Impression (CGI). The Continuous Performance Test (CPT), Trial Making Test (TMT-A/B), Stroop Color Word Interference Test, Verbal Fluency Test, and Rey auditory-verbal learning test (RAVLT) have been administered as well.ResultsSubjects with early-onset (< 50 years) depression had a longer illness duration, higher depressive episodes and more impaired performance at RAVLT while individuals with late-onset (> 50 years) depression showed a higher severity of depressive symptoms and more anxiety symptoms. Depressive symptoms were positively associated with anxiety (r = 0.82; P = 0.00) and negatively with TMT-A/B (r = −0.56, P = 0.01), Stroop Color Word Interference Test (r = −0.72, P = 0.005 and r = −0.616, P = 0.008), and RAVLT (r = −0.60; P = 0.02) performances. According to regression analyses, anxiety symptoms were the only significant predictor of depression severity (P = 0.02).ConclusionsEarly-onset depression is associated with more disability and worse neurocognitive performance whereas late-onset depression is linked to more anxiety symptoms and more depressive symptoms severity. Clinicians should closely monitor patients with TRD for the presence of anxiety symptoms that may represent a significant risk factor of poorer long-term outcome.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Rumination-focused cognitive behaviour therapy for non-responsive chronic depression: an uncontrolled group study

2019 ◽  
Vol 48 (3) ◽  
pp. 376-381
Author(s):  
Stine Bjerrum Moeller ◽  
Stephen F. Austin ◽  
Morten Hvenegaard ◽  
Morten Kistrup ◽  
Stine Gran ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Small Sample ◽  
Post Treatment ◽  
Chronic Depression ◽  
Hamilton Depression Scale ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Cognitive Behaviour ◽  
Resistant Depression

AbstractBackground:One-third of patients with depression do not respond satisfactorily to treatment, and approximately 20% of all patients treated for depression develop a chronic depression. One approach to more effective treatment of chronic and treatment-resistant depression is to target rumination – an underlying mechanism implicated in the development and maintenance of depression.Aim:The purpose of this uncontrolled group study was to investigate the feasibility of individual rumination-focused cognitive behavioural therapy (RfCBT) for patients with chronic and treatment-resistant depression.Method:A total of 10 patients with chronic and treatment-resistant depression were offered 12–16 individual sessions of RfCBT. The primary outcome was depressive symptoms as measured by Hamilton Depression Scale at pre-, post- and 3-month follow-up. Secondary symptoms measured included self-reported rumination and worry.Results:There was a significant reduction in depressive symptoms (p < 0.05), rumination (p < 0.01) and worry (p < 0.5) from pre- to post-treatment. Half of the participants (n = 5) showed significant reliable change on levels of depressive symptoms post-treatment. The reduction in depressive symptoms, rumination and worry were maintained at follow-up.Conclusions:RfCBT was associated with significant reductions in depressive symptoms in a small sample with chronic and treatment-resistant depression. Despite limitations of being a small uncontrolled study with limited follow-up, these results are promising in a difficult to treat population. RfCBT warrants further systematic evaluation.

scholarly journals Repeated, low-dose oral esketamine in patients with treatment-resistant depression: pilot study

BJPsych Open ◽  
2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Sanne Y. Smith-Apeldoorn ◽  
Jolien K. E. Veraart ◽  
Henricus G. Ruhé ◽  
Marije aan het Rot ◽  
Jeanine Kamphuis ◽  
...  
Keyword(s):  
Low Dose ◽  
Rating Scale ◽  
Controlled Trial ◽  
Minimum Clinically Important Difference ◽  
Therapeutic Effects ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Point Change ◽  
Dose Oral ◽  
Resistant Depression

Background Intravenous infusion of ketamine can produce rapid and large symptom reduction in patients with treatment-resistant depression (TRD) but presents major obstacles to clinical applicability, especially in community settings. Oral esketamine may be a promising addition to our TRD treatment armamentarium. Aims To explore the safety, tolerability and potential clinical effectiveness of a 3-week treatment with repeated, low-dose oral esketamine. Method Seven patients with chronic and severe TRD received 1.25 mg/kg generic oral esketamine daily, over 21 consecutive days. Scores on the Systematic Assessment for Treatment Emergent Events (SAFTEE), Community Assessment of Psychic Experiences (CAPE), Clinician Administered Dissociative States Scale (CADSS) and Hamilton Rating Scale for Depression (HRSD) instruments, as well as blood pressure and heart rate, were repeatedly assessed. Results Treatment with oral esketamine was well-tolerated. No serious side-effects occurred, and none of the participants discontinued treatment prematurely. Psychotomimetic effects were the most frequently reported adverse events. Mean HDRS score decreased by 16.5%, from 23.6 to 19.7. Three participants showed reductions in HDRS scores above the minimum clinically important difference (eight-point change), of whom two showed partial response. No participants showed full response or remission. Conclusions These results strengthen the idea that oral esketamine is a safe and well-tolerated treatment for patients with chronic and severe TRD, but therapeutic effects were modest. Results were used to design a randomised controlled trial that is currently in progress.

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