Real-world effectiveness of ketamine in treatment-resistant depression: A systematic review &amp; meta-analysis

Alnefeesi, Yazen; Chen‐Li, David; Krane, Ella; Jawad, Muhammad Youshay; Rodrigues, Nelson B.; Ceban, Felicia; Vincenzo, Joshua D. Di; Meshkat, Shakila; Ho, Roger; Gill, Hartej; Teopiz, Kayla M.; Cao, Bing; Lee, Yena; McIntyre, Roger S.; Rosenblat, Joshua D.

doi:10.1016/j.jpsychires.2022.04.037

Cited by 86 publications

(48 citation statements)

References 110 publications

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“…Major depressive disorder (MDD) is a common psychiatric condition and leads to significant physical, psychological, and economic distress in individuals, families, and society[ 1 , 2 ]. Traumatic experiences during childhood, as shown by a meta-analysis[ 3 ], are significant psychosocial risk factors for MDD, and their presence represents a major reason for the refractory and recurrent nature of depression[ 1 , 4 , 5 ]. Childhood trauma, also known as early life stress, early life adverse life events, childhood adversity, and early negative events, generally refers to a variety of adverse life events that occurred in childhood or adolescence that the child or adolescent was unable to cope with; these include experiences such as abuse, neglect, parental divorce, and parental death.…”

Section: Introductionmentioning

confidence: 99%

Antidepressants combined with psychodrama improve the coping style and cognitive control network in patients with childhood trauma-associated major depressive disorder

Yu¹,

Tan²,

Wang³

et al. 2022

WJP

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BACKGROUND The use of antidepressant therapy alone has a limited efficacy in patients with childhood trauma-associated major depressive disorder (MDD). However, the effectiveness of antidepressant treatment combined with psychodrama in these patients is unclear. AIM To evaluate the effectiveness of antidepressant treatment combined with psychodrama. METHODS Patients with childhood trauma-associated MDD treated with antidepressants were randomly assigned to either the psychodrama intervention (observation group) or the general health education intervention (control group) and received combination treatment for 6 mo. The observation group received general health education given by the investigator together with the “semi-structured group intervention model” of Yi Shu psychodrama. A total of 46 patients were recruited, including 29 cases in the observation group and 17 cases in the control group. Symptoms of depression and anxiety as well as coping style and resting-state functional magnetic resonance imaging were assessed before and after the intervention. RESULTS Symptoms of depression and anxiety, measured by the Hamilton Depression Scale, Beck Depression Inventory, and Beck Anxiety Inventory, were reduced after the intervention in both groups of patients. The coping style of the observation group improved significantly in contrast to the control group, which did not. In addition, an interaction between treatment and time in the right superior parietal gyrus node was found. Furthermore, functional connectivity between the right superior parietal gyrus and left inferior frontal gyrus in the observation group increased after the intervention, while in the control group the connectivity decreased. CONCLUSION This study supports the use of combined treatment with antidepressants and psychodrama to improve the coping style of patients with childhood trauma-associated MDD. Functional connectivity between the superior parietal gyrus and inferior frontal gyrus was increased after this combined treatment. We speculate that psychodrama enhances the internal connectivity of the cognitive control network and corrects the negative attention bias of patients with childhood trauma-associated MDD. Elucidating the neurobiological features of patients with childhood trauma-associated MDD is important for the development of methods that can assist in early diagnosis and intervention.

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Section: Introductionmentioning

confidence: 99%

Antidepressants combined with psychodrama improve the coping style and cognitive control network in patients with childhood trauma-associated major depressive disorder

Yu¹,

Tan²,

Wang³

et al. 2022

WJP

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“…The latter is now a registered treatment for TRD. Evidence of efficacy has also been shown in a study in real world settings (7)(8)(9). The antidepressant effects of a single administration of ketamine are rapid and robust, yet transient, lasting an average of seven days (5,10,11), which is why many treatment programs offer repeated dosing.…”

Section: Introductionmentioning

confidence: 91%

Holding on or letting go? Patient experiences of control, context, and care in oral esketamine treatment for treatment-resistant depression: A qualitative study

et al. 2022

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BackgroundKetamine and its enantiomer esketamine represent promising new treatments for treatment-resistant depression (TRD). Esketamine induces acute, transient psychoactive effects. How patients perceive esketamine treatment, and which conditions facilitate optimal outcomes, remains poorly understood. Understanding patient perspectives on these phenomena is important to identify unmet needs, which can be used to improve (es)ketamine treatments.AimsTo explore the perspectives of TRD patients participating in “off label” oral esketamine treatment.Materials and methodsIn-depth interviews were conducted with 17 patients (11 women) after a six-week, twice-weekly esketamine treatment program, and subsequently after six months of at-home use. Interviews explored participants’ perspectives, expectations, and experiences with esketamine treatment. Audio interviews were transcribed verbatim and analysed following an Interpretative Phenomenological Analysis (IPA) framework.ResultsKey themes included overwhelming experiences; inadequate preparation; letting go of control; mood states influencing session experiences; presence and emotional support, and supportive settings. Patients’ attempts to let go and give into vs. attempts to maintain control over occasionally overwhelming experiences was a central theme. Multiple factors influenced patients’ ability to give into the experience and appeared to impact their mood and anxiety about future sessions, including level of preparation and education, physical and emotional support, and setting during the session.ConclusionBetter preparation beforehand, an optimized treatment setting, and emotional and psychological support during (es)ketamine sessions can help patients to “let go” and may lead to better quality of care and outcomes. Recommendations to improve quality of patient care in (es)ketamine treatment are provided, including suggestions for the training of nurses and other support staff.

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“…Accordingly, Berman et al (35) published, at the beginning of 2000, a study showing that ketamine, a drug that was well known as a NMDA receptor antagonist, was able to induce 10.3389/fpsyt.2022.990405 fast (within hours) and lasting (up to 3 days) antidepressant effects with only one low dose. Since then, numerous clinical trials investigating the antidepressant effects of ketamine have been carried out (36) and some are still ongoing (37)(38)(39). The blockade of NMDA receptors by ketamine favors a series of events that are thought to be responsible for its antidepressant effect [see ref.…”

Section: Additional Mechanismsmentioning

confidence: 99%

3,4-Methylenedioxy methamphetamine, synthetic cathinones and psychedelics: From recreational to novel psychotherapeutic drugs

et al. 2022

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The utility of classical drugs used to treat psychiatric disorders (e.g., antidepressants, anxiolytics) is often limited by issues of lack of efficacy, delayed onset of action or side effects. Psychoactive substances have a long history of being used as tools to alter consciousness and as a gateway to approach the unknown and the divinities. These substances were initially obtained from plants and animals and more recently by chemical synthesis, and its consumption evolved toward a more recreational use, leading to drug abuse-related disorders, trafficking, and subsequent banning by the authorities. However, these substances, by modulation of certain neurochemical pathways, have been proven to have a beneficial effect on some psychiatric disorders. This evidence obtained under medically controlled conditions and often associated with psychotherapy, makes these substances an alternative to conventional medicines, to which in many cases the patient does not respond properly. Such disorders include post-traumatic stress disease and treatment-resistant depression, for which classical drugs such as MDMA, ketamine, psilocybin and LSD, among others, have already been clinically tested, reporting successful outcomes. The irruption of new psychoactive substances (NPS), especially during the last decade and despite their recreational and illicit uses, has enlarged the library of substances with potential utility on these disorders. In fact, many of them were synthetized with therapeutic purposes and were withdrawn for concrete reasons (e.g., adverse effects, improper pharmacological profile). In this review we focus on the basis, existing evidence and possible use of synthetic cathinones and psychedelics (specially tryptamines) for the treatment of mental illnesses and the properties that should be found in NPS to obtain new therapeutic compounds.

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Real-world effectiveness of ketamine in treatment-resistant depression: A systematic review & meta-analysis

Cited by 86 publications

References 110 publications

Antidepressants combined with psychodrama improve the coping style and cognitive control network in patients with childhood trauma-associated major depressive disorder

Antidepressants combined with psychodrama improve the coping style and cognitive control network in patients with childhood trauma-associated major depressive disorder

Holding on or letting go? Patient experiences of control, context, and care in oral esketamine treatment for treatment-resistant depression: A qualitative study

3,4-Methylenedioxy methamphetamine, synthetic cathinones and psychedelics: From recreational to novel psychotherapeutic drugs

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