Transient effects of multi‐infusion ketamine augmentation on treatment‐resistant depressive symptoms in patients with treatment‐resistant bipolar depression – An open‐label three‐week pilot study

Zhuo, Chuanjun; Feng, Jia‐Xun; Tian, Hongjun; Wang, Lina; Jia, Feng; Jiang, Deguo; Chen, Ce; Zhou, Chunhua; Lin, Xiaodong; Zhu, Jingjing

doi:10.1002/brb3.1674

Cited by 24 publications

(20 citation statements)

References 91 publications

(156 reference statements)

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“…Although not statistically significant, this observation is in line with other reports. 34,35 In line with other studies, we observed an antisuicidal effect reflected by a decrease in the score of item 10 in MADRS. This effect is described in a meta-analysis of single-infusion studies of MDD.…”

Section: Discussionsupporting

confidence: 92%

Intravenous Ketamine Infusions in Treatment-Resistant Bipolar Depression: An Open-Label Naturalistic Observational Study

Wilkowska¹,

Włodarczyk²,

Gałuszko-Węgielnik³

et al. 2021

NDT

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Purpose Bipolar disorder is a chronic and recurrent condition often associated with treatment resistance and suicidality. There is an unmet need for effective treatment in this group of patients. Ketamine has been demonstrated to have antidepressant and antisuicidal properties in unipolar depression. Most of the available studies concern unipolar depression. Here, we present the efficacy and safety of IV ketamine as an add-on treatment in patients with bipolar I and bipolar II depression. Patients and Methods Thirteen patients with treatment-resistant bipolar depression (TRBD) received eight IV infusions of 0.5 mg/kg ketamine twice a week over four weeks. This is an open-label naturalistic observational study. Ketamine is an add-on treatment. Depressive symptoms were measured with the Montgomery–Asberg Depression Rating Scale (MADRS), and manic symptoms were measured with the Young Mania Rating Scale (YMRS). Psychomimetic symptoms were assessed with the Clinician-Administered Dissociative States Scale (CADSS) and the Brief Psychiatric Rating Scale (BPRS). Results The rates of response and remission after the seventh infusion of ketamine were 61.5% and 46.2%, respectively. A significant antisuicidal effect was observed in responders at the 7th infusion. Suicidality was measured with item 10 on the MADRS scale. The average time to respond was between 21.1 and 23.2 days to remission. There was an increase in the CADSS scores during the treatment compared to baseline and follow-up, but no differences between responders and non-responders were observed. No affective switch was observed according to the YMRS scale scores. Ketamine treatment was associated with a transient increase in arterial blood pressure. No serious adverse events, however, were observed. Conclusion This report presents the preliminary results of IV ketamine effectiveness and safety in treatment-resistant bipolar depression. The findings suggest that it is a feasible, safe and well-tolerated treatment option in this group of patients. There is a definite need for more studies in this field.

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Section: Discussionsupporting

confidence: 92%

Intravenous Ketamine Infusions in Treatment-Resistant Bipolar Depression: An Open-Label Naturalistic Observational Study

Wilkowska¹,

Włodarczyk²,

Gałuszko-Węgielnik³

et al. 2021

NDT

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“… 35 This aligns more with the findings from Zhuo et al. 32 Baseline differences between patients and controls were also not replicated from Abdallah et al. 31 Although these are small effects in modest sized samples, the inconsistency may also result from scan timing post-ketamine, i.e.…”

Section: Functional Connectivitysupporting

confidence: 56%

“…Continuing the data-driven approach with treatment-resistant bipolar patients, Zhuo did not reveal a relationship between global functional connectivity and HAMD scores in response to ketamine. 32 Oddly in this study, many patients relapsed in the second week of treatment, and the average depression score was higher post-treatment. The authors cited that the atypical clinical findings may be a result of glutamate exhaustion due to multiple glutamate modulating medications.…”

Section: Functional Connectivitymentioning

confidence: 51%

“…As an example, Kraus and colleagues were unable to replicate Abdallah et al's findings, 31,33,34 and instead found that there were no differences in GBCr post-ketamine or placebo. 35 This aligns more with the findings from Zhuo et al 32 Baseline differences between patients and controls were also not replicated from Abdallah et al 31 Although these are small effects in modest sized samples, the inconsistency may also result from scan timing post-ketamine, i.e. Kraus et al scanned participants at least 2 days after infusion, where the other studies scanned 24 hours postinfusion.…”

Section: Functional Magnetic Resonance Imaging (Fmri)mentioning

confidence: 58%

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Biomarkers of ketamine’s antidepressant effect: a clinical review of genetics, functional connectivity, and neurophysiology

Alario

Niciu

2021

Chronic Stress

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Major depressive disorder (MDD) is one of the leading causes of morbidity and all-cause mortality (including suicide) worldwide, and, unfortunately, first-line monoaminergic antidepressants and evidence-based psychotherapies are not effective for all patients. Subanesthetic doses of the N-methyl-D-aspartate receptor antagonists and glutamate modulators ketamine and S-ketamine have rapid and robust antidepressant efficacy in such treatment-resistant depressed patients (TRD). Yet, as with all antidepressant treatments including electroconvulsive therapy (ECT), not all TRD patients adequately respond, and we are presently unable to a priori predict who will respond or not respond to ketamine. Therefore, antidepressant treatment response biomarkers to ketamine have been a major focus of research for over a decade. In this article, we review the evidence in support of treatment response biomarkers, with a particular focus on genetics, functional magnetic resonance imaging, and neurophysiological studies, i.e. electroencephalography and magnetoencephalography. The studies outlined here lay the groundwork for replication and dissemination.

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“…This receptor is believed to be responsible for the psychotropic effects [5]. Another natural product like ketamine also can rapidly relieve depressive symptoms among depressed patients [25].…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Psilocybin on Depression: A Qualitative Study

2021

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The objective of this study is to explore the experiences and effects of psilocybin on patients with depression and anxiety.Method: A qualitative study was conducted interviewing ten participants currently taking psilocybin while experiencing depression and/or anxiety. Ethical approval was obtained from the University ethics committee. Participants were recruited via social media and groups are known to have used psilocybin for the treatment of anxiety and/or depression. Participants were informed of study aims and consent was obtained before interviews commenced. Confidentiality was maintained throughout this study. Interviews began with informing participants that psilocybin may be effective in the management of depression. Initially, information around the way treatment with psilocybin was obtained was sought. This was followed by queries around the effects of the drug in terms of experiences both during and after treatment. Finally, participants were asked to outline the positive effects of psilocybin on their lives. Results:The data were thematically coded using Grounded Theory as an underpinning philosophical paradigm. Emerging themes included enhancement of smell, vision, hearing, and taste sensations. Another theme emerging was the experience of being 'connected with the universe' while on the drug. Additionally, participants reported a stabilization of mood, an increase in optimism and emotional control, and a healthier emotional connection with others. Most also felt an increase in comfort, peace and calmness. Another theme that emerged centered on the mechanism of action of psilocybin. Participants stated that this substance seemed to 'make new connections in their brain,' resulting in new perspectives. Some participants felt this resulted in a calming influence on the mind and body. This aligns with research showing that psilocybin works by changing the thinking and improving information processing. Conclusion:Psilocybin has promising effects on the patients with depression/anxiety even after a single dose. Psilocybin is safe but the administration should be guided by a health professional to yield safe and positive outcomes.

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Transient effects of multi‐infusion ketamine augmentation on treatment‐resistant depressive symptoms in patients with treatment‐resistant bipolar depression – An open‐label three‐week pilot study

Cited by 24 publications

References 91 publications

Intravenous Ketamine Infusions in Treatment-Resistant Bipolar Depression: An Open-Label Naturalistic Observational Study

Intravenous Ketamine Infusions in Treatment-Resistant Bipolar Depression: An Open-Label Naturalistic Observational Study

Biomarkers of ketamine’s antidepressant effect: a clinical review of genetics, functional connectivity, and neurophysiology

Effectiveness of Psilocybin on Depression: A Qualitative Study

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