Baseline cognitive function predicts full remission of suicidal symptoms among patients with treatment-resistant depression and strong suicidal ideation after low-dose ketamine infusion

Lin, Wei‐Chen; Su, Tung‐Ping; Li, Cheng Ta; Wu, Hui-Ju; Tsai, Shih‐Jen; Bai, Ya‐Mei; Tu, Pei-Chi; Chen, Mu Hong

doi:10.1177/02698811231182107

J Psychopharmacol

2023

DOI: 10.1177/02698811231182107

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Baseline cognitive function predicts full remission of suicidal symptoms among patients with treatment-resistant depression and strong suicidal ideation after low-dose ketamine infusion

Wei‐Chen Lin

Tung‐Ping Su

Cheng Ta Li

et al.

Abstract: Background: Whether pretreatment working memory and response inhibition function are associated with the rapid and sustained antisuicidal effect of low-dose ketamine among patients with treatment-resistant depression (TRD) and strong suicidal ideation is unclear. Methods: We enrolled 65 patients with TRD, comprising 33 who received a single infusion of 0.5 mg/kg ketamine and 32 who received a placebo infusion. The participants performed working memory and go/no-go tasks prior to infusion. We assessed suicidal … Show more

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“…The authors speculate that these changes could also be an indirect indicator of the plasticity changes induced by the drug. Lin et al (2023) report on their study about baseline cognitive function, which was shown to predict full remission of suicidal symptoms among patients with TRD and strong suicidal ideation after low-dose ketamine infusion. The authors note that whether pre-treatment working memory and response inhibition function are associated with the rapid and sustained antisuicidal effect of low-dose ketamine among patients with TRD and strong suicidal ideation is unclear.…”

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Ketamine: A new chapter for clinical psychopharmacology?

Young

2023

J Psychopharmacol

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journals.sagepub.com/home/jop Ketamine is an N-methyl-D-aspartate antagonist which has been a major focus of research recently and is being used as a putative treatment for depression and other neuropsychiatric disorders. Along with psychedelic agents, ketamine (and the derivative esketamine) are not only the main harbingers of potentially new classes of psychiatric drugs but may also share some common features (Marguilho et al., 2023). It should be noted that other novel mechanisms, such as those related to anti-inflammatory properties (Husain et al., 2017) are also emerging. However, the evidence base for ketamine and other glutamate receptor modulators for depression in adults with unipolar major depressive disorder is evolving particularly quickly (Borentain et al., 2023) and more work is frequently published. Thus, we have a special edition devoted to novel findings about ketamine and related agents.James et al. ( 2023) contribute a systematic review of the safety of repeated ketamine dosing in paediatrics. Concerns about the long-term safety of ketamine and any potential impact on the developing brain are noted to be limiting research despite the fact that a wealth of paediatric safety and dosing data exists for ketamine, given its extensive use globally as an anaesthetic, analgesic and sedative agent. The results of the review suggest that, despite methodological limitations of the studies, ketamine is well tolerated and safe for use in children, even when given repeatedly in regimens analogous to those used for treatment of depression in adults. The authors suggest that these findings support the extension of research into the use of ketamine as a novel antidepressant in children.Hartland et al. ( 2023) report a transdiagnostic systematic review and meta-analysis of ketamine's anxiolytic effects. As background, they note that ketamine may be effective in treating symptoms of anxiety, although the time profile of ketamine's anxiolytic effect is ill-defined. Thus, this systematic review and meta-analysis examined the anxiolytic effect of ketamine at different time points across a range of clinical settings. They found that ketamine appears to offer rapid and sustained anxiety symptom relief across a range of clinical settings, with anxiolytic effects occurring within the first 12 hours of administration and seemingly remaining effective for 1-2 weeks. The authors suggest that future studies with improved blinding could explore ketamine maintenance therapy for anxiety.Chisamore et al. ( 2023) investigated the real-world effectiveness of repeated intravenous ketamine infusions for treatmentresistant depression (TRD) in transitional age youth (TAY). They note that the efficacy and safety of ketamine in TAY (age 18-25) populations remains understudied. This was a retrospective

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confidence: 99%

Ketamine: A new chapter for clinical psychopharmacology?

Young

2023

J Psychopharmacol

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Ketamine’s efficacy in alleviating acute suicidal thoughts: a comprehensive systematic review and meta-analysis

Seyedoshohadaei,

Darehbagh,

Gholami

et al. 2024

Middle East Curr Psychiatry

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Suicidal ideation in patients with major depressive disorder (MDD) presents a critical challenge in mental health, with conventional antidepressants often having delayed onset. This systematic review and meta-analysis investigates the efficacy of ketamine in rapidly reducing acute suicidal ideation in this patient group. A comprehensive literature search up to June 2023 across PubMed (Medline), Scopus, Web of Science, and Embase yielded 12 studies, including 7 randomized controlled trials (RCTs). The evaluation of the impact of ketamine on Montgomery-Åsberg Depression Rating Scale-Suicidal Ideation (MADRS-SI) scores was conducted using the standardized mean difference (SMD) through the Cohen’s d method for analysis. The assessment of risk of bias was executed utilizing the Cochrane Risk of Bias Tool (RoB2). Subgroup assessments considered study period, geographic location, and follow-up duration. Ketamine administration showed a significant reduction in MADRS SI scores (mean difference, -1.16; 95% CI, -1.89, -0.23). Subgroup analysis revealed varying efficacy based on the study period, geographical location, and follow-up length. Intravenous ketamine demonstrated the most substantial reduction in suicidal thoughts. High heterogeneity among studies was observed. Ketamine offers a rapid and significant reduction in acute suicidal ideation in patients with MDD. It holds promise as an intervention during high-risk periods where conventional treatments are limited by slower onset. However, variability in study results and concerns over long-term safety necessitate further research to optimize treatment protocols and understand the implications of different administration routes. These findings have important implications for developing clinical guidelines in managing acute suicidal ideation in MDD.

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Baseline cognitive function predicts full remission of suicidal symptoms among patients with treatment-resistant depression and strong suicidal ideation after low-dose ketamine infusion

Cited by 2 publications

References 31 publications

Ketamine: A new chapter for clinical psychopharmacology?

Ketamine: A new chapter for clinical psychopharmacology?

Ketamine’s efficacy in alleviating acute suicidal thoughts: a comprehensive systematic review and meta-analysis

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