scholarly journals Neurocognitive effects of repeated ketamine infusion treatments in patients with treatment resistant depression: A retrospective chart review

2021 ◽  
Author(s):  
Danika Dai ◽  
Courtney Miller ◽  
Violeta Valdivia ◽  
Brian Boyle ◽  
Shuang Li ◽  
...  
Keyword(s):  
Chart Review ◽  
Pearson Correlation ◽  
Retrospective Chart Review ◽  
Self Report ◽  
Depression Symptoms ◽  
Induction Phase ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Ketamine Infusion ◽  
Resistant Depression

Abstract BackgroundKetamine has emerged as a rapid-acting antidepressant in treatment-resistant depression (TRD) increasingly used in non-research, clinical settings. Few studies, however, have examined neurocognitive effects of repeated racemic ketamine infusion treatments in patients with TRD. In an effort to identify potential effects after serial infusions, we conducted a retrospective chart review to identify statistically significant changes in cognition in patient undergoing serial intravenous infusions; concomitantly, we examined baseline cognition as potential predictor of anti-depressant potential. MethodsTwenty-two patients with TRD were examined after they finished the induction phase of 8-10 repeated intravenous ketamine infusions and completed the assessments of their depressive symptoms (measured by the 16-item Quick Inventory of Depressive Symptomatology-Self Report Scale: QIDS-SR16) and cognitive function (measured by the Montreal Cognitive Assessment: MoCA) before the first and the last ketamine treatments. ResultsRepeated ketamine infusions administered through an escalating dose protocol with 8-10 infusion sessions produced a 47.2% reduction response in depression; there was no evidence of impairment as reflected in MoCA testing. There was a moderate association between baseline cognition and antidepressant response with a pearson correlation of 0.453. ConclusionIn this naturalistic sample of patients with TRD in our clinical service, repeated ketamine infusions significantly decreased depression symptoms without impairing cognitive performance. The baseline cognition may positively predict antidepressant responses of repeated ketamine treatment.

scholarly journals Functional Dysconnectivity of Frontal Cortex to Striatum Predicts Ketamine Infusion Response in Treatment-Resistant Depression

2020 ◽  
Vol 23 (12) ◽  
pp. 791-798
Author(s):  
Mu-Hong Chen ◽  
Wan-Chen Chang ◽  
Wei-Chen Lin ◽  
Pei-Chi Tu ◽  
Cheng-Ta Li ◽  
...  
Keyword(s):  
Functional Connectivity ◽  
Frontal Cortex ◽  
Depression Symptoms ◽  
Healthy Controls ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Ketamine Infusion ◽  
Resistant Depression ◽  
The Right ◽  
Superior Frontal Cortex

Abstract Background Frontostriatal disconnectivity plays a crucial role in the pathophysiology of major depressive disorder. However, whether the baseline functional connectivity of the frontostriatal network could predict the treatment outcome of low-dose ketamine infusion remains unknown. Methods In total, 48 patients with treatment-resistant depression were randomly divided into 3 treatment groups (a single-dose 40-minute i.v. infusion) as follows: 0.5 mg/kg ketamine, 0.2 mg/kg ketamine, and saline placebo infusion. Patients were subsequently followed-up for 2 weeks. Resting-state functional magnetic resonance imaging was performed for each patient before infusion administration. In addition, the baseline frontostriatal functional connectivity of patients with treatment-resistant depression was also compared with that of healthy controls. Results Compared with the healthy controls, patients with treatment-resistant depression had a decreased functional connectivity in the frontostriatal circuits, especially between the right superior frontal cortex and executive region of the striatum and between the right paracingulate cortex and rostral-motor region of the striatum. The baseline hypoconnectivity of the bilateral superior frontal cortex to the executive region of the striatum was associated with a greater reduction of depression symptoms after a single 0.2-mg/kg ketamine infusion. Conclusion Reduced connectivity of the superior frontal cortex to the striatum predicted the response to ketamine infusion among patients with treatment-resistant depression.

Adjunctive gabapentin in treatment-resistant depression: a retrospective chart review

2001 ◽  
Vol 63 (1-3) ◽  
pp. 243-247 ◽  
Author(s):  
Sarah Yasmin ◽  
Linda L. Carpenter ◽  
Zelko Leon ◽  
Jason M. Siniscalchi ◽  
Lawrence H. Price
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Resistant Depression

scholarly journals Efficacy and safety of fixed doses of intranasal Esketamine as an add-on therapy to Oral antidepressants in Japanese patients with treatment-resistant depression: a phase 2b randomized clinical study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nagahide Takahashi ◽  
Aya Yamada ◽  
Ayako Shiraishi ◽  
Hiroko Shimizu ◽  
Ryosuke Goto ◽  
...  
Keyword(s):  
Nasal Spray ◽  
Japanese Patients ◽  
Controlled Study ◽  
Induction Phase ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Madrs Total Score ◽  
Link Type ◽  
Randomized Clinical Study ◽  
Resistant Depression

Abstract Background Esketamine nasal spray (Spravato) in conjunction with oral antidepressants (ADs) is approved in the European Union, United States, and other markets for treatment-resistant depression (TRD). Efficacy, safety, and tolerability of esketamine nasal spray in Japanese patients with TRD needs to be assessed. Methods This Phase 2b, randomized, double-blind (DB), placebo-controlled study was conducted in adult Japanese patients with TRD meeting the Diagnostic and Statistical Manual of Mental Disorders (fifth edition) criteria of major depressive disorder with nonresponse to ≥ 1 but < 5 different ADs in the current episode at screening. Patients were treated with a new oral AD for 6 weeks (prospective lead-in phase); nonresponders were randomized (2:1:1:1) to placebo or esketamine (28-, 56-, or 84-mg) nasal spray along with the continued use of AD for 4 weeks (DB induction phase). Responders (≥50% reduction from baseline in the Montgomery-Asberg Depression Rating Scale [MADRS] total score) from the DB induction phase continued into the 24-week posttreatment phase and patients who relapsed could participate in a 4-week open-label (OL) second induction (flexibly-dosed esketamine). The primary efficacy endpoint, change from baseline in the MADRS total score at Day 28 in the DB induction phase, was based on mixed-effects model using repeated measures pairwise comparisons using a Dunnett adjustment. Results Of the 202 patients randomized in the DB induction phase (esketamine [n = 122] or placebo [n = 80]), the MADRS total scores decreased from baseline to Day 28 of the DB induction phase (− 15.2, − 14.5, − 15.1, and − 15.3 for esketamine 28 mg, 56 mg, 84 mg, and placebo groups, respectively), indicating an improvement in depressive symptoms; however, the difference between the esketamine and placebo groups was not statistically significant. The most common treatment-emergent adverse events during the DB induction phase in the combined esketamine group (incidences ranging from 12.3 to 41.0%) were blood pressure increased, dissociation, dizziness, somnolence, nausea, hypoaesthesia, vertigo, and headache; the incidence of each of these events was > 2-fold higher than the corresponding incidence in the placebo group. Conclusions Efficacy of esketamine plus oral AD in Japanese TRD patients was not established; further investigation is warranted. All esketamine doses were safe and tolerated. Trial registration ClinicalTrials.gov Identifier: NCT02918318. Registered: 28 September 2016.

scholarly journals Understanding Treatment-Resistant Depression: A Missionary’s Autobiographical Case Report

2019 ◽  
Vol 6 (1) ◽  
pp. 43-50
Author(s):  
Hunter York
Keyword(s):  
Case Report ◽  
Depression Symptoms ◽  
Primary Concern ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Spiritual Discipline ◽  
Convulsive Therapy ◽  
Service Oriented ◽  
Resistant Depression ◽  
Electro Convulsive Therapy

As a career cross-cultural missionary in Southeast Asia, the author has seen first-hand and has personally experienced the devastating effects of colleagues, families, leaders, clinicians, and the sufferers themselves misunderstanding the symptoms and the reality of major depressive disorder, an increasing global health problem.  This autobiographical case report reflects on twenty years of treatment-resistant depression and a journey through pharmacological approaches, psychotherapy treatment, Christian prayer counselling, and electro convulsive therapy without improvement in this condition.  The primary concern is how to remain faithful and effective with this condition in a service-oriented occupation that requires regular emotional expenditure.  In lieu of effective conventional and non-conventional therapies, the remaining option is to find a way to manage chronic depression; identify personal trends, weaknesses, and triggers; and find a personalized way to live that minimizes the effects of the condition.  In any chronic, incurable disorder, the sufferer must inevitably come to terms with his or her reality and find peace in the acceptance of that reality.  By expressing the journey through treatment-resistant depression, the author encourages readers to persevere in ministry and to respond more appropriately to the afflicted with clearer understanding and empathy.  A companion article on mitigating depression symptoms through the spiritual discipline of identifying with Christ and His experience of human emotional pain during His passion is available.  

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.

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