Effects of Ketamine Versus Midazolam on Neurocognition at 24 Hours in Depressed Patients With Suicidal Ideation

Keilp, John G.; Madden, Sean P.; Marver, Julia E.; Frawley, Abigail E.; Burke, Ainsley K.; Herzallah, Mohammad M.; Gluck, Mark A.; Mann, J. John; Grunebaum, Michael F.

doi:10.4088/jcp.21m13921

Cited by 14 publications

(10 citation statements)

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“…As shown in Figure 1 , from 856 records screened on title and abstract, 150 full texts were analyzed. The review process led to the selection of 22 studies (references reported in Table 1 ) referring to 22 independent RCTs (Loo et al, 2012 ; Zarate et al, 2012 ; Price et al, 2014 ; Rasmussen et al, 2014 ; Yoosefi et al, 2014 ; Alizadeh et al, 2015 ; Murrough et al, 2015 ; Singh et al, 2016 ; Zhong et al, 2016 ; Anderson et al, 2017 ; Fernie et al, 2017 ; Ray-Griffith et al, 2017 ; Chen et al, 2018 ; Taylor et al, 2018 ; Zhang et al, 2018 ; Dong et al, 2019 ; Fedgchin et al, 2019 ; Kheirabadi et al, 2019 ; Domany et al, 2020 ; Ochs-Ross et al, 2020 ; Keilp et al, 2021 ; Zou et al, 2021 ), 20 of these trials provided quantitative outcome data, therefore were included in the quantitative synthesis.…”

Section: Resultsmentioning

confidence: 99%

The effect of ketamine on cognition, anxiety, and social functioning in adults with psychiatric disorders: A systematic review and meta-analysis

et al. 2022

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BackgroundIt has been shown that ketamine can improve suicidality and depression. Evidence for other dimensions of psychopathology is lacking. We undertook a systematic review to investigate the effect of ketamine on cognition, anxiety, quality of life, and social functioning in adults with psychiatric disorders.MethodsPubMed (Medline), Scopus, PsycINFO, and EMBASE were searched up to April 2022. Randomized controlled trials (RCTs) on ketamine [or its S (+) enantiomer] reporting data on cognition, anxiety, quality of life, social functioning in adults with psychiatric disorders were included. Standardized mean difference (SMD) was used for summarizing continuous outcomes.ResultsTwenty-two reports were included in the final selection, of which 20, corresponding to 1,298 participants, were included in the quantitative synthesis. Affective disorders were the predominant diagnostic category. Median follow-up time was 21 days. The evidence was rated moderate to very low. In most trials, ketamine was administered intravenously or as adjuvant to electro-convulsant therapy (ECT). Only 2 trials of intranasal esketamine were identified. The effect of ketamine on depression was confirmed (SMD: −0.61 [95% CI: −1.06; −0.16]). Furthermore, by pooling results of 6 RCTs, ketamine may be effective in reducing anxiety symptoms (SMD: −0.42 [95% CI: −0.84; 0.003]), particularly when administered not within ECT (5 trials; SMD: −0.58 [95% CI: −1.07; −0.09]). However, there was moderate heterogeneity of results. Patients treated with ketamine also had an improvement in social functioning (SMD: −0.31 [95% CI: −0.52; −0.10]), although the estimate was based only on 2 studies. No difference to comparators was found with respect to cognition and quality of life.ConclusionAlongside the antidepressant effect, ketamine may also improve anxiety and social functioning in adults with affective disorders.

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Section: Resultsmentioning

confidence: 99%

The effect of ketamine on cognition, anxiety, and social functioning in adults with psychiatric disorders: A systematic review and meta-analysis

et al. 2022

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“…This study has several limitations. First, the model used in this study and others, in which ketamine is used to induce the manic phase, is valid, but the accuracy of this assessment has not been discussed in past years, although the aims of previous studies were to explore new methods for the improvement of treatment effects in patients with treatment-resistant depression and to rapidly reduce suicide attempts due to severe depressive symptoms in BP (Valvassori et al, 2019 ; Kim and Monteggia, 2020 ; McIntyre et al, 2020 ; Chen et al, 2021 ; Dean et al, 2021 ; Keilp et al, 2021 ; Magalhães et al, 2021 ; Nikayin and Sanacora, 2021 ; Wilkowska et al, 2021 ). A reviewer of this article led us to rethink the validity of the use of ketamine to induce the manic phase when studying BP (a physiopathological process), as drug-induced manic behavior may have different underlying mechanisms, Strictly speaking, a ketamine-induced manic phase can only represent such a phase induced by antidepressants, which is usually observed in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Brain Neural Activity Patterns in an Animal Model of Antidepressant-Induced Manic Episodes

Chen

Tian

et al. 2022

Front. Behav. Neurosci.

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Background: In the treatment of patients with bipolar disorder (BP), antidepressant-induced mania is usually observed. The rate of phase switching (from depressive to manic) in these patients exceeds 22%. The exploration of brain activity patterns during an antidepressant-induced manic phase may aid the development of strategies to reduce the phase-switching rate. The use of a murine model to explore brain activity patterns in depressive and manic phases can help us to understandthe pathological features of BP. The novel object recognition preference ratio is used to assess cognitive ability in such models.Objective: To investigate brain Ca2+ activity and behavioral expression in the depressive and manic phases in the same murine model, to aid understanding of brain activity patterns in phase switching in BP.Methods: In vivo two-photon imaging was used to observe brain activity alterations in a murine model in which induce depressive-like and manic-like behaviors were induced sequentially. The immobility time was used to assess depressive-like symptoms and the total distance traveled was used to assess manic-like symptoms.Results: In vivo two-photon imaging revealed significantly reduced brain Ca2+ activity in temporal cortex pyramidal neurons in the depressive phase in mice exposed to chronic unpredictable mild stress compared with naïve controls. The brain Ca2+ activity correlated negatively with the novel object recognition preference ratio within the immobility time. Significantly increased brain Ca2+ activity was observed in the ketamine-induced manic phase. However, this activity did not correlate with the total distance traveled. The novel object recognition preference ratio correlated negatively with the total distance traveled in the manic phase.

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“…After removing duplicates and carefully reading the full text, we ultimately included 17 RCTs for the study. [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] Two reviewers (CCC and NZ) independently screened the titles, abstracts, and full texts against the eligibility criteria. A consensus was reached through follow-up discussions.…”

Section: Search Strategy and Eligibility Criteriamentioning

confidence: 99%

Acute Effects of Intravenous Sub-Anesthetic Doses of Ketamine and Intranasal Inhaled Esketamine on Suicidal Ideation: A Systematic Review and Meta-Analysis

Chen¹,

Zhou²,

Hu³

et al. 2023

NDT

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Suicide is a major public health concern with currently no validated and efficacious treatments approved. Preliminary evidence suggests that intravenous ketamine has rapid and sustained antidepressant effects, making it a candidate with therapeutic potential for depressed patients at risk for suicide. We conducted a meta-analysis to evaluate the efficacy of ketamine and esketamine in reducing suicidal ideation (SI), as well as their respective onset and duration of action. Data Sources: We searched PubMed, Embase, Ovid, Cochrane, and Web of Science databases for studies published from inception to September 29, 2022. Study Eligibility Criteria: We conducted a systematic review of all parallel randomized controlled trials (RCTs) examining the effect and duration of ketamine or esketamine on SI. Our primary outcome measure was the Suicide Scale score, which was measured using the Scale for Suicidal Ideation (SSI), Beck Scale for Suicide Ideation (BSS), Beck Depression Inventory (BDI), or Modified Scale for Suicidal Ideation (MSSI). To obtain effect sizes (Cohen's d), we calculated the difference in Suicide Scale scores before and after administration in each group. Results: Our study showed that intravenous sub-anesthetic doses of ketamine and intranasal inhaled esketamine had a significant anti-SI effect. Specifically, ketamine produced a large degree of anti-SI effect within the 4-6 hours (Cohen's d = 1.16, 95% CI: 0.50, 1.81) and a medium-large degree in the 24 hours (Cohen's d = 0.95, 95% CI: 0.48, 1.41). Esketamine, on the other hand, produced a small-medium degree of anti-SI effect within the 4-6 hours timeframe (Cohen's d = 0.26, 95% CI: 0.09, 0.44) and the 24 hours (Cohen's d = 0.30, 95% CI: 0.17, 0.47). Conclusion: Intravenous sub-anesthetic doses of ketamine and intranasal inhaled esketamine could reduce SI within 4 hours and last for 24 hours.

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Effects of Ketamine Versus Midazolam on Neurocognition at 24 Hours in Depressed Patients With Suicidal Ideation

Cited by 14 publications

References 0 publications

The effect of ketamine on cognition, anxiety, and social functioning in adults with psychiatric disorders: A systematic review and meta-analysis

The effect of ketamine on cognition, anxiety, and social functioning in adults with psychiatric disorders: A systematic review and meta-analysis

Brain Neural Activity Patterns in an Animal Model of Antidepressant-Induced Manic Episodes

Acute Effects of Intravenous Sub-Anesthetic Doses of Ketamine and Intranasal Inhaled Esketamine on Suicidal Ideation: A Systematic Review and Meta-Analysis

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