Is one or two infusions better in the first week of low-dose ketamine treatment for medication-resistant depression? A post hoc pooled analysis of randomized placebo-controlled and open-label trials

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

doi:10.1016/j.jpsychires.2021.11.006

Cited by 3 publications

(2 citation statements)

References 32 publications

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“…Specifically, patients experiencing depressive episodes that have persisted ≥12 but <24 months or who have failed to respond to >2 but ≤4 antidepressants may benefit the most from ketamine infusion. Second, our previous study suggested that the symptoms of clinical depression can be ameliorated by biweekly ketamine infusion but that the inflammatory profiles of interleukin-2 and tumor necrosis factor-α may be improved more by weekly infusion ( Chen,Wu et al, 2021b ). However, for suicide prevention, we suggest biweekly ketamine infusion for patients with TRD and prominent suicidal ideation because the antisuicidal effect persists only 5 days.…”

Section: Discussionmentioning

confidence: 99%

A Randomized, Double-Blind, Midazolam-Controlled Trial of Low-Dose Ketamine Infusion in Patients With Treatment-Resistant Depression and Prominent Suicidal Ideation

Lin

et al. 2023

International Journal of Neuropsychopharmacology

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Background The benefits of low-dose ketamine for patients with treatment-resistant depression (TRD) and prominent suicidal ideation require further investigation. The effects of treatment refractoriness, the duration of the current depressive episode, and the number of prior antidepressant failures on ketamine efficacy also require clarification. Methods We recruited 84 outpatients with TRD and prominent suicidal ideation— defined as a score of ≥4 on Item 10 of the Montgomery–Asberg Depression Rating Scale (MADRS)—and randomized them into two groups to receive 0.5 mg/kg ketamine or 0.045 mg/kg midazolam. We assessed depressive and suicidal symptoms prior to infusion, 240 min postinfusion, and 2, 3, 5, 7, and 14 days postinfusion. Results According to the MADRS scores, the antidepressant effect (p = .035) was noted significantly in the ketamine group up to 14 days than in the midazolam group. However, the antisuicidal effect of ketamine, as measured by the Columbia-Suicide Severity Rating Scale Ideation Severity Subscale (p = .040) and MADRS Item 10 (p = .023) persisted only 5 days postinfusion. Furthermore, the antidepressant and antisuicidal effects of ketamine infusion were noted particularly in patients whose current depressive episode lasted for <24 months or whose number of failed antidepressants was ≤4. Discussion Low-dose ketamine infusion is a safe, tolerable, and effective treatment for patients with TRD and prominent suicidal ideation. Our study highlights the importance of timing; specifically, ketamine is more likely to achieve therapeutic response when the current depressive episode lasted for <24 months and the number of failed antidepressants is ≤4.

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Section: Discussionmentioning

confidence: 99%

A Randomized, Double-Blind, Midazolam-Controlled Trial of Low-Dose Ketamine Infusion in Patients With Treatment-Resistant Depression and Prominent Suicidal Ideation

Lin

et al. 2023

International Journal of Neuropsychopharmacology

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“…Ketamine, as a non-competitive N-methyl-D-aspartate (NMDA) receptor antagonist, blocks transmission of glutamate at the NMDA receptor ( Molero et al, 2018 ). Ketamine has anti-inflammatory properties ( Loix et al, 2011 ; Cathomas et al, 2022 ; Chen et al, 2021 ; Kopra et al, 2021 ). Moreover, ketamine modulates the DMN and reduces self-directed negative cognition (e.g., rumination; Lehmann et al, 2016 ).…”

Section: Alternative Treatmentsmentioning

confidence: 99%

Neuroinflammation and neuroprogression in depression: Effects of alternative drug treatments

Richardson

Bambico

2022

Brain, Behavior, & Immunity - Health

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The effects of ketamine and classic hallucinogens on neurotrophic and inflammatory markers in unipolar treatment-resistant depression: a systematic review of clinical trials

Rossi

Hallak

Baker

et al. 2022

Eur Arch Psychiatry Clin Neurosci

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Is one or two infusions better in the first week of low-dose ketamine treatment for medication-resistant depression? A post hoc pooled analysis of randomized placebo-controlled and open-label trials

Cited by 3 publications

References 32 publications

A Randomized, Double-Blind, Midazolam-Controlled Trial of Low-Dose Ketamine Infusion in Patients With Treatment-Resistant Depression and Prominent Suicidal Ideation

A Randomized, Double-Blind, Midazolam-Controlled Trial of Low-Dose Ketamine Infusion in Patients With Treatment-Resistant Depression and Prominent Suicidal Ideation

Neuroinflammation and neuroprogression in depression: Effects of alternative drug treatments

The effects of ketamine and classic hallucinogens on neurotrophic and inflammatory markers in unipolar treatment-resistant depression: a systematic review of clinical trials

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