The relationship between subjective effects induced by a single dose of ketamine and treatment response in patients with major depressive disorder: A systematic review

Mathai, David S.; Meyer, Matthew J.; Storch, Eric A.; Kosten, Thomas R.

doi:10.1016/j.jad.2019.12.023

Cited by 57 publications

(42 citation statements)

References 54 publications

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“…Furthermore, there is evidence to support the idea that the subjective experience induced by these compounds is relevant for their therapeutic effect. To some degree, this also holds true for ketamine, which is nevertheless predominantly administered as a standalone pharmacotherapy [ 2 , 27 , 102 – 104 ]. In some instances, a single substance (e.g.…”

Section: Discussionmentioning

confidence: 99%

“…the serotonin-releasing drug 3,4-methyenedioxymethamphetamine [MDMA]), the atypical psychedelic ibogaine and dissociative anesthetics such as the N-methyl-d-aspartate (NMDA) antagonist ketamine. All these substances can induce alterations of conscious states, as well as a wide range of psychological, cognitive, emotional, and biological effects that may be relevant for their therapeutic action, when administered within a (psycho) therapeutic context [24][25][26][27][28].…”

Section: Key Pointsmentioning

confidence: 99%

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Psychedelic Treatments for Psychiatric Disorders: A Systematic Review and Thematic Synthesis of Patient Experiences in Qualitative Studies

et al. 2020

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Introduction Interest in the use of psychedelic substances for the treatment of mental disorders is increasing. Processes that may affect therapeutic change are not yet fully understood. Qualitative research methods are increasingly used to examine patient accounts; however, currently, no systematic review exists that synthesizes these findings in relation to the use of psychedelics for the treatment of mental disorders. Objective To provide an overview of salient themes in patient experiences of psychedelic treatments for mental disorders, presenting both common and diverging elements in patients' accounts, and elucidating how these affect the treatment process. Methods We systematically searched the PubMed, MEDLINE, PsycINFO, and Embase databases for English-language qualitative literature without time limitations. Inclusion criteria were qualitative research design; peer-reviewed studies; based on verbalized patient utterances; and a level of abstraction or analysis of the results. Thematic synthesis was used to analyze and synthesize results across studies. A critical appraisal of study quality and methodological rigor was conducted using the Critical Appraisal Skills Programme (CASP). Results Fifteen research articles, comprising 178 patient experiences, were included. Studies exhibited a broad heterogeneity in terms of substance, mental disorder, treatment context, and qualitative methodology. Substances included psilocybin, lysergic acid diethylamide (LSD), ibogaine, ayahuasca, ketamine and 3,4-methylenedioxymethamphetamine (MDMA). Disorders included anxiety, depression, eating disorders, post-traumatic stress disorder, and substance use disorders. While the included compounds were heterogeneous in pharmacology and treatment contexts, patients reported largely comparable experiences across disorders, which included phenomenological analogous effects, perspectives on the intervention, therapeutic processes and treatment outcomes. Comparable therapeutic processes included insights, altered self-perception, increased connectedness, transcendental experiences, and an expanded emotional spectrum, which patients reported contributed to clinically and personally relevant responses. Conclusions This review demonstrates how qualitative research of psychedelic treatments can contribute to distinguishing specific features of specific substances, and carry otherwise undiscovered implications for the treatment of specific psychiatric disorders.

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Section: Discussionmentioning

confidence: 99%

Section: Key Pointsmentioning

confidence: 99%

Psychedelic Treatments for Psychiatric Disorders: A Systematic Review and Thematic Synthesis of Patient Experiences in Qualitative Studies

et al. 2020

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“…In another study, "floating"-a depersonalization side effect (a type of dissociative side effect) did not mediate antidepressant response to ketamine assessed at 230 min post infusion and at day 1 27 . In addition, a systematic review of the eight published papers on this topic found that the relationship between dissociation and antidepressant effect was mixed; only three of the eight analyses observed a relationship between CADSS or other psychosis scores and antidepressant response 39 . Within the papers that reported a significant relationship, the explained variance of dissociative experiences for antidepressant response was 12-21% 39 .…”

Section: The Correlation Between Dissociation and Antidepressant Respmentioning

confidence: 99%

The role of dissociation in ketamine’s antidepressant effects

2020

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Ketamine produces immediate antidepressant effects and has inspired research into next-generation treatments. Ketamine also has short term dissociative effects, in which individuals report altered consciousness and perceptions of themselves and their environment. However, whether ketamine’s dissociative side effects are necessary for its antidepressant effects remains unclear. This perspective examines the relationship between dissociative effects and acute and longer-lasting antidepressant response to ketamine and other N-methyl-D-aspartate (NMDA) receptor antagonists. Presently, the literature does not support the conclusion that dissociation is necessary for antidepressant response to ketamine. However, further work is needed to explore the relationship between dissociation and antidepressant response at the molecular, biomarker, and psychological levels.

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“…12 Interestingly, ketamine and esketamine also have remarkable psychoactive effects, which might be related to their antidepressant properties. 13 The degree of dissociation, depersonalization, and derealization induced by ketamine also seems to be related to the degree of response in depressed patients. 14 While the novelty of this data clearly requires careful consideration of its implications, it suggests that esketamine might be a useful tool for the treatment of functional neurological disorders.…”

Section: Discussionmentioning

confidence: 99%

Improvement of functional neurological disorder after administration of esketamine nasal spray: a case report

Vendrell-Serres

Soto-Angona

Rodríguez‐Urrutia

et al. 2021

Therapeutic Advances in Psychopharmacology

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Functional neurological disorder (FND) is a complex neuropsychiatric condition characterized by the presence of neurological symptoms and signs (either motor or sensory) that cannot be explained by any known medical or mental disease. It is frequently presented with psychiatric comorbidities, such as major depression. Its prognosis is poor, with low improvement or recovery rates at 1 year after their onset, and no particular treatment has demonstrated significant efficacy in this regard. Here, we describe the management of a patient affected by treatment-resistant depression (TRD) and FND characterized by mixed paralysis (sensory and motor) in the left arm, and who was successfully treated with esketamine nasal spray, achieving remission in both disorders. The US Food and Drug Administration and the European Medicines Agency recently approved esketamine, the S-enantiomer of ketamine, for treatment of TRD. It is a fast-acting drug that provides a rapid-onset improvement of depressive symptoms. We have presented the first case, to our knowledge, of functional neurological symptoms being successfully treated with esketamine in a patient with comorbid TRD. While the novelty of this data implies a clear need for further research, it is suggested that esketamine might be a useful tool for the treatment of FND, acting through different theorized mechanisms that are in tune with recent advances in knowledge of the etiopathology of FND.

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The relationship between subjective effects induced by a single dose of ketamine and treatment response in patients with major depressive disorder: A systematic review

Cited by 57 publications

References 54 publications

Psychedelic Treatments for Psychiatric Disorders: A Systematic Review and Thematic Synthesis of Patient Experiences in Qualitative Studies

Psychedelic Treatments for Psychiatric Disorders: A Systematic Review and Thematic Synthesis of Patient Experiences in Qualitative Studies

The role of dissociation in ketamine’s antidepressant effects

Improvement of functional neurological disorder after administration of esketamine nasal spray: a case report

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