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Effectiveness of intravenous ketamine in mood disorder patients with a history of neurostimulation

Published online by Cambridge University Press:  10 December 2020

Nelson B. Rodrigues ,
Ashley Siegel ,
Orly Lipsitz Open the ORCID record for Orly Lipsitz [Opens in a new window] ,
Danielle S. Cha ,
Hartej Gill ,
Flora Nasri ,
Kevin Simonson ,
Margarita Shekotikhina ,
Yena Lee Open the ORCID record for Yena Lee [Opens in a new window]  and
Mehala Subramaniapillai
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Nelson B. Rodrigues
Affiliation:
Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, Toronto, Ontario, Canada Canadian Rapid Treatment Center of Excellence, Mississauga, Ontario, Canada
Ashley Siegel
Affiliation:
Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, Toronto, Ontario, Canada Canadian Rapid Treatment Center of Excellence, Mississauga, Ontario, Canada
Orly Lipsitz
Affiliation:
Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, Toronto, Ontario, Canada Canadian Rapid Treatment Center of Excellence, Mississauga, Ontario, Canada
Danielle S. Cha
Affiliation:
Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, Toronto, Ontario, Canada
Hartej Gill
Affiliation:
Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, Toronto, Ontario, Canada Canadian Rapid Treatment Center of Excellence, Mississauga, Ontario, Canada
Flora Nasri
Affiliation:
Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, Toronto, Ontario, Canada
Kevin Simonson
Affiliation:
Department of Psychiatry, University of California, Riverside, California, USA
Margarita Shekotikhina
Affiliation:
Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
Yena Lee
Affiliation:
Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, Toronto, Ontario, Canada Canadian Rapid Treatment Center of Excellence, Mississauga, Ontario, Canada
Mehala Subramaniapillai
Affiliation:
Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, Toronto, Ontario, Canada Canadian Rapid Treatment Center of Excellence, Mississauga, Ontario, Canada
Kevin Kratiuk
Affiliation:
Canadian Rapid Treatment Center of Excellence, Mississauga, Ontario, Canada
Kangguang Lin
Affiliation:
Department of Affective Disorder, The Affiliated Brain Hospital of Guangzhou Medical University, (Guangzhou Huiai Hospital), Guangzhou Medical University, Guangzhou, China Laboratory of Emotion and Cognition, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou Medical University, Guangzhou, China
Roger Ho
Affiliation:
Department of Psychological Medicine, National University of Singapore, Singapore
Rodrigo B. Mansur
Affiliation:
Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, Toronto, Ontario, Canada Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
Roger S. McIntyre*
Affiliation:
Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, Toronto, Ontario, Canada Canadian Rapid Treatment Center of Excellence, Mississauga, Ontario, Canada Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
Joshua D. Rosenblat
Affiliation:
Mood Disorders Psychopharmacology Unit, Poul Hansen Family Centre for Depression, University Health Network, Toronto, Ontario, Canada Canadian Rapid Treatment Center of Excellence, Mississauga, Ontario, Canada Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
*
*Author for correspondence: Roger S. McIntyre, Email: roger.mcintyre@uhn.ca
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Abstract

Background

Patients unsuccessfully treated by neurostimulation may represent a highly intractable subgroup of depression. While the efficacy of intravenous (IV) ketamine has been established in patients with treatment-resistant depression (TRD), there is an interest to evaluate its effectiveness in a subpopulation with a history of neurostimulation.

Methods

This retrospective, posthoc analysis compared the effects of four infusions of IV ketamine in 135 (x̄ = 44 ± 15.4 years of age) neurostimulation-naïve patients to 103 (x̄ = 47 ± 13.9 years of age) patients with a history of neurostimulation. The primary outcome evaluated changes in depression severity, measured by the Quick Inventory for Depression Symptomatology-Self Report 16-Item (QIDS-SR16). Secondary outcomes evaluated suicidal ideation (SI), anxiety severity, measured by the Generalized Anxiety Disorder 7-Item (GAD-7), and consummatory anhedonia, measured by the Snaith–Hamilton Pleasure Scale (SHAPS).

Results

Following four infusions, both cohorts reported a significant reduction in QIDS-SR16 Total Score (F (4, 648) = 73.4, P < .001), SI (F (4, 642) = 28.6, P < .001), GAD-7 (F (2, 265) = 53.8, P < .001), and SHAPS (F (2, 302) = 45.9, P < .001). No between-group differences emerged. Overall, the neurostimulation-naïve group had a mean reduction in QIDS-SR16 Total Score of 6.4 (standard deviation [SD] = 5.3), whereas the history of neurostimulation patients reported a 4.3 (SD = 5.3) point reduction.

Conclusion

IV ketamine was effective in reducing symptoms of depression, SI, anxiety, and anhedonia in both cohorts in this large, well-characterized community-based sample of adults with TRD.

Keywords

Bipolar disorderelectroconvulsive therapy (ECT)ketaminemajor depressive disorderrTMStreatment resistant depression
Type
Original Research
Information
CNS Spectrums , Volume 27 , Issue 3 , June 2022 , pp. 315 - 321
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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References

Sinyor, M, Schaffer, A, Levitt, A. The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Trial: a review. Can J Psychiatry. 2010;55(3):126–135. doi:10.1177/070674371005500303.CrossRefGoogle ScholarPubMed
Rush, AJ, Trivedi, MH, Wisniewski, SR, et al. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR* D report. Am J Psychiatry. 2006;163(11):1905–1917.CrossRefGoogle ScholarPubMed
Sachs, GS, Nierenberg, AA, JR, C, et al. Effectiveness of adjunctive antidepressant treatment for bipolar depression. N Engl J Med. 2007;356(17):1711–1722.CrossRefGoogle ScholarPubMed
Milev, RV, Giacobbe, P, Kennedy, SH, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: section 4. Neurostimulation treatments. Can J Psychiatry. 2016;61(9):561–575.CrossRefGoogle ScholarPubMed
Health Quality Ontario. Repetitive Transcranial Magnetic Stimulation for Treatment-Resistant Depression: a systematic review and meta-analysis of randomized controlled trials. Ont Health Technol Assess Ser. 2016;16(5):1–66.Google Scholar
Kellner, CH, Fink, M, Knapp, R, et al. Relief of expressed suicidal intent by ECT: a consortium for research in ECT study. Am J Psychiatry. 2005;162(5):977–982.CrossRefGoogle Scholar
Zarate, CA Jr, Rothschild, A, Fletcher, KE, Madrid, A, Zapatel, J. Clinical predictors of acute response with quetiapine in psychotic mood disorders. J Clin Psychiatry. 2000;61(3):185–189.CrossRefGoogle ScholarPubMed
Thase, ME, Rush, AJ. When at first you don’t succeed: sequential strategies for antidepressant nonresponders. J Clin Psychiatry. 1997;58(suppl 13):23–29.Google ScholarPubMed
Bourgon, LN, Kellner, CH. Relapse of depression after ECT: a review. J ECT. 2000;16(1):19–31.CrossRefGoogle ScholarPubMed
Rodrigues, NB, Mithani, K, Meng, Y, Lipsman, N, Hamani, C. The emerging role of tractography in deep brain stimulation: basic principles and current applications. Brain Sci. 2018;8(2). doi:10.3390/brainsci8020023.CrossRefGoogle ScholarPubMed
Meng, Y, Suppiah, S, Mithani, K, Solomon, B, Schwartz, ML, Lipsman, N. Current and emerging brain applications of MR-guided focused ultrasound. J Ther Ultrasound. 2017;5(1):26. CrossRefGoogle ScholarPubMed
Coyle, CM, Laws, KR. The use of ketamine as an antidepressant: a systematic review and meta-analysis. Hum Psychopharm Clin. 2015;30(3):152–163.CrossRefGoogle ScholarPubMed
Phillips, JL, Norris, S, Talbot, J, et al. Single, repeated, and maintenance ketamine infusions for treatment-resistant depression: a randomized controlled trial. Am J Psychiatry. 2019;176(5):401–409.CrossRefGoogle ScholarPubMed
McIntyre, RS, Rodrigues, NB, Lee, Y, et al. The effectiveness of repeated intravenous ketamine on depressive symptoms, suicidal ideation and functional disability in adults with major depressive disorder and bipolar disorder: results from the Canadian Rapid Treatment Center of Excellence. J Affect Disord. 2020;274:903–910.CrossRefGoogle ScholarPubMed
aan het Rot, M, Collins, KA, Murrough, JW, et al. Safety and efficacy of repeated-dose intravenous ketamine for treatment-resistant depression. Biol Psychiatry. 2010;67(2):139–145.CrossRefGoogle ScholarPubMed
Wilkinson, ST, Ballard, ED, Bloch, MH, et al. The effect of a single dose of intravenous ketamine on suicidal ideation: a systematic review and individual participant data meta-analysis. Am J Psychiatry. 2018;175(2):150–158.CrossRefGoogle ScholarPubMed
Ibrahim, L, Diazgranados, N, Luckenbaugh, DA, et al. Rapid decrease in depressive symptoms with an N-methyl-d-aspartate antagonist in ECT-resistant major depression. Prog Neuropsychopharmacol Biol Psychiatry. 2011;35(4):1155–1159.CrossRefGoogle ScholarPubMed
Cusin, C, Ionescu, DF, Pavone, KJ, et al. Ketamine augmentation for outpatients with treatment-resistant depression: preliminary evidence for two-step intravenous dose escalation. Aust N Z J Psychiatry. 2017;51(1):55–64.CrossRefGoogle ScholarPubMed
Spitzer, RL, Kroenke, K, Williams, JBW, Löwe, B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–1097.CrossRefGoogle ScholarPubMed
Snaith, RP, Hamilton, M, Morley, S, Humayan, A, Hargreaves, D, Trigwell, P. A scale for the assessment of hedonic tone the Snaith–Hamilton Pleasure Scale. Br J Psychiatry. 1995;167(1):99–103.CrossRefGoogle ScholarPubMed
Rush, AJ, Trivedi, MH, Ibrahim, HM, et al. The 16-Item quick inventory of depressive symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression. Biol Psychiatry. 2003;54(5):573–583.CrossRefGoogle ScholarPubMed
Harris, PA, Taylor, R, Thielke, R, Payne, J, Gonzalez, N, Conde, JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–381.CrossRefGoogle ScholarPubMed
Harris, PA, Taylor, R, Minor, BL, et al. The REDCap Consortium: building an international community of software platform partners. J Biomed Inform. 2019;95:103208 CrossRefGoogle ScholarPubMed
Lu, BY, Agapoff, JR, Olson, D, et al. Effectiveness and safety of intravenous ketamine for severely depressed patients unable to receive electroconvulsive therapy due to medical risks. Prim Care Companion CNS Disord. 2020;22(3):19l02535. doi:10.4088/PCC.19l02535.CrossRefGoogle ScholarPubMed
Morris, LS, Costi, S, Tan, A, Stern, ER, Charney, DS, Murrough, JW. Ketamine normalizes subgenual cingulate cortex hyper-activity in depression. Neuropsychopharmacology. 2020;45:975–981. doi:10.1038/s41386-019-0591-5.CrossRefGoogle ScholarPubMed
Evans, JW, Szczepanik, J, Brutsché, N, Park, LT, Nugent, AC, Zarate, CA. Default mode connectivity in major depressive disorder measured up to 10 days after ketamine administration. Biol Psychiatry. 2018;84(8):582–590.CrossRefGoogle ScholarPubMed
Biedermann, S, Weber-Fahr, W, Zheng, L, et al. Increase of hippocampal glutamate after electroconvulsive treatment: a quantitative proton MR spectroscopy study at 9.4 T in an animal model of depression. World J Biol Psychiatry. 2012;13(6):447–457.CrossRefGoogle Scholar
Li, D-J, Wang, F-C, Chu, C-S, et al. Significant treatment effect of add-on ketamine anesthesia in electroconvulsive therapy in depressive patients: a meta-analysis. Eur Neuropsychopharmacol. 2017;27(1):29–41.CrossRefGoogle ScholarPubMed
Phillips, JL, Jaworska, N, Kamler, E, et al. A randomized, crossover comparison of ketamine and electroconvulsive therapy for treatment of major depressive episodes: a Canadian biomarker integration network in depression (CAN-BIND) study protocol. BMC Psychiatry. 2020;20(1):268 CrossRefGoogle ScholarPubMed
Drysdale, AT, Grosenick, L, Downar, J, et al. Resting-state connectivity biomarkers define neurophysiological subtypes of depression. Nat Med. 2017;23(1):28–38.CrossRefGoogle ScholarPubMed