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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
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

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.

Type
Original Research
Copyright
© The Author(s), 2021. Published by Cambridge University Press

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