Sleep improvement is associated with the antidepressant efficacy of repeated-dose ketamine and serum BDNF levels: a post-hoc analysis

Wang, Mingqia; Zhang, Bin; Zhou, Yangling; Wang, Chengyu; Zheng, Wei; Liu, Weijian; Zhan, Yongle; Lan, Xiaofeng; Ning, Yuping

doi:10.1007/s43440-020-00203-1

Cited by 19 publications

(14 citation statements)

References 52 publications

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“… 14 , 15 , 16 , 17 In addition to its antidepressant actions, ( R,S )-ketamine infusion has been demonstrated to improve sleep disturbance in patients with MDD and sleeping problems, suggesting the potential of ( R,S )-ketamine for sleep disturbance. 18 , 19 , 20 It has been suggested that the antidepressant effect of ( R,S )-ketamine is connected with the neurobiological structure of the wake, sleep, and circadian rhythms. 21 However, it is unknown whether IV infusions of low-dose esketamine intraoperatively can reduce the incidence of PSD.…”

Section: Introductionmentioning

confidence: 99%

Effect of Intraoperative Esketamine Infusion on Postoperative Sleep Disturbance After Gynecological Laparoscopy

et al. 2022

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ImportancePostoperative sleep disturbance (PSD) is common in patients after surgery.ObjectiveTo examine the effect of intraoperative esketamine infusion on the incidence of PSD in patients who underwent gynecological laparoscopic surgery.Design, Setting, and ParticipantsThis single-center, double-blind, placebo-controlled randomized clinical trial was conducted from August 2021 to April 2022 in the First Affiliated Hospital of Zhengzhou University in China. Participants included patients aged 18 to 65 years with an American Society of Anesthesiologist Physical Status classification of I to III (with I indicating a healthy patient, II a patient with mild systemic disease, and III a patient with severe systemic disease) who underwent gynecological laparoscopic surgery. Patients were randomly assigned to either the esketamine group or control group. Data were analyzed using the per protocol principle.InterventionsPatients in the esketamine group received a continuous infusion of esketamine, 0.3 mg/kg/h, intraoperatively. Patients in the control group received an equivalent volume of saline.Main Outcomes and MeasuresThe primary outcome was the incidence of PSD on postoperative days (PODs) 1 and 3. Postoperative sleep disturbance was defined as a numeric rating scale score of 6 or higher or an Athens Insomnia Scale score of 6 points or higher. The secondary outcomes included postoperative anxiety and depression scores using the Hospital Anxiety and Depression Scale, postoperative pain using the visual analog scale, postoperative hydromorphone consumption, and risk factors associated with PSD.ResultsA total of 183 female patients were randomized to the control group (n = 91; median [IQR] age, 45 [35-49] years) and the esketamine group (n = 92; median [IQR] age, 43 [32-49] years). The incidence of PSD in the esketamine group was significantly lower than in the control group on POD 1 (22.8% vs 44.0%; odds ratio [OR], 0.38 [95% CI, 0.20-0.72]; P = .002) and POD 3 (7.6% vs 19.8%; OR, 0.33 [95% CI, 0.13-0.84]; P = .02). There were no differences in postoperative depression and anxiety scores between the 2 groups. Postoperative hydromorphone consumption in the first 24 hours (3.0 [range, 2.8-3.3] mg vs 3.2 [range, 2.9-3.4] mg; P = .04) and pain scores on movement (3 [3-4] vs 4 [3-5] points; P &lt; .001) were significantly lower in the esketamine group than in the control group. On multivariable logistic regression, preoperative depression (OR, 1.31; 95% CI, 1.01-1.70) and anxiety (OR, 1.67; 95% CI, 1.04-1.80) scores, duration of anesthesia (OR, 1.04; 95% CI, 1.00-1.08), and postoperative pain score (OR, 1.92; 95% CI, 1.24-2.96) were identified as risk factors associated with PSD.Conclusions and RelevanceResults of this trial showed the prophylactic effect of intraoperative esketamine infusion on the incidence of PSD in patients who underwent gynecological laparoscopic surgery. Further studies are needed to confirm these results.Trial RegistrationChinese Clinical Trial Registry Identifier: ChiCTR2100048587

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Section: Introductionmentioning

confidence: 99%

Effect of Intraoperative Esketamine Infusion on Postoperative Sleep Disturbance After Gynecological Laparoscopy

et al. 2022

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“…New treatments for BD are being studied, and most target disparate effector systems, mainly related to molecular targets in neuroplasticity, neurotrophic factors, inflammation, stress, mitochondrial function, and related metabolic pathways [46][47][48]. Clinical trials have demonstrated the efficacy of adjunctive inflammatory modulation with celecoxib in treatment-resistant bipolar depression, showing that add-on celecoxib reduces treatment resistance and enhances antidepressant response in patients with treatment-resistant bipolar depression [49,50].…”

Section: Discussionmentioning

confidence: 99%

Advances in the pathophysiology of bipolar disorder

Wartchow

Cordeiro

Scaini

2022

Current Opinion in Psychiatry

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Purpose of reviewDue to bipolar disorder clinical heterogeneity, a plethora of studies have provided new genetic, epigenetic, molecular, and cellular findings associated with its pathophysiology. Recent findingsGenome-wide association studies and epigenetic evidence points to genotype--phenotype interactions associated with inflammation, oxidative stress, abnormalities in signaling pathways, hypothalamic-pituitary--adrenal axis, and circadian rhythm linked to mitochondrial dysfunction in bipolar disorder. Although the literature is constantly increasing, most of the genetic variants proposed as biomarkers remain to be validated by independent groups and use bigger samples and longitudinal approaches to enhance their power and predictive ability.

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“…Therefore, in this study, we used the PSQI questionnaire to assess the postoperative sleep quality of patients undergoing MRM within 30 days. Mingqia Wang et al [41] found that repeated injections of ketamine increased blood levels of BDNF. Karen Schmitt et al [42] noted that BDNF promote the rapid induction of the N3 phase of sleep, so the BDNF is considered to have a substantial correlation with sleep homeostasis.…”

Section: Discussionmentioning

confidence: 99%

Effect of perioperative continuous infusion of S-ketamine on the quality of postoperative recovery of patients undergoing modified radical mastectomy: a randomized controlled trial

Zhang

Yuan

Wang

et al. 2022

Preprint

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Background: Patients undergoing modified radical mastectomy (MRM) often suffer some postoperative adverse events such as acute pain, mental abnormalities, and sleep disorders. This study aim to explore the effect of esketamine as the sole intraoperative analgesic on the quality of postoperative recovery in patients undergoing MRM.Methods: Ninety-eight female patients scheduled for elective MRM were randomly divided into two groups: the esketamine group (group E) or remifentanil group (group R). In group E, anesthesia was induced with etomidate, midazolam, esketamine, and rocuronium, and maintained with intravenous propofol and esketamine. In group R, anesthesia was induced with etomidate, midazolam, rocuronium, and remifentanil, and maintained with propofol and remifentanil. The scores of the Quality of Recovery (QoR-40) questionnaire, and Pittsburgh Sleep Quality Index (PSQI) were evaluated at 1 d, 3 d, 7 d, and 30 d after surgery as primary outcome and main secondary outcome respectively. Other secondary outcomes including intraoperative hemodynamics, postoperative inflammatory indicator, and the incidence of adverse events (e.g., vomiting and dizziness) during hospitalization were also recorded.Main Results: QoR-40 total scores in group E were higher than group R at 1 d [160.71±9.811 VS 146.94±7.375, P＜0.001], 3 d [168.45±9.670 VS 152.90±8.089, P＜0.001], 7 d [180.06±7.367 VS 175.20±6.334, P=0.001] postoperatively. The PSQI scores in group E were lower than group R at 1 d [14.18±1.740 VS 17.20±1.87, P＜0.001], 3 d [11.82±1.799 VS 16.31±2.133, P＜0.001], 7 d [7.71±1.814 VS 9.65±1.832, P＜0.001] after surgery. Conclusion: Our research shows that esketamine has a certain effect on improving the quality of short-term recovery after MRM.Clinical Trials Registration: Clinical Trials gov: ChiCTR2200056576. registered February 8th, 2022, http://www.chictr.org.cn/index.aspx.

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Sleep improvement is associated with the antidepressant efficacy of repeated-dose ketamine and serum BDNF levels: a post-hoc analysis

Cited by 19 publications

References 52 publications

Effect of Intraoperative Esketamine Infusion on Postoperative Sleep Disturbance After Gynecological Laparoscopy

Effect of Intraoperative Esketamine Infusion on Postoperative Sleep Disturbance After Gynecological Laparoscopy

Advances in the pathophysiology of bipolar disorder

Effect of perioperative continuous infusion of S-ketamine on the quality of postoperative recovery of patients undergoing modified radical mastectomy: a randomized controlled trial

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