Cognitive Behavior Therapy May Sustain Antidepressant Effects of Intravenous Ketamine in Treatment-Resistant Depression
Samuel T. Wilkinson, Dashaun Wright, Madonna K. Fasula, Lisa Fenton, Matthew Griepp, Robert Ostroff, Gerard Sanacora
Psychotherapy and Psychosomatics 2017 DOI: 10.1159/000457960 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Open-label trial Randomized Peer reviewed |
|---|---|
| Sample size | 16 |
| Population | Patients with treatment-resistant depression pursuing ketamine infusion therapy |
| Interventions | Cognitive behavioral therapy Intravenous ketamine |
| Dose | 0.5 mg/kg infused over 40 min |
| Duration | 10-week CBT course, 2-week ketamine course, 8-week follow-up after last ketamine exposure |
| Topics | Depression Esketamine Ketamine |
| Citations | 120 |
| Key findings | Cognitive behavioral therapy may sustain the antidepressant effects of ketamine in treatment-resistant depression, with 25% of ketamine responders relapsing by the end of CBT and a median time to relapse of 12 weeks. |
Abstract
Introduction: Ketamine has shown rapid though short-lived antidepressant effects. The possibility of concerning neurobiological changes following repeated exposure to the drug motivates the development of strategies that obviate or minimize the need for longer-term treatment with ketamine. In this open-label trial, we investigated whether cognitive behavioral therapy (CBT) can sustain or extend ketamine's antidepressant effects.
Methods: Patients who were pursuing ketamine infusion therapy for treatment-resistant depression were invited to participate in the study. If enrolled, the subjects initiated a 12-session, 10-week course of CBT concurrently with a short 4-treatment, 2-week course of intravenous ketamine (0.5 mg/kg infused over 40 min) provided under a standardized clinical protocol.
Results: Sixteen participants initiated the protocol, with 8 (50%) attaining a response to the ketamine and 7 (43.8%) achieving remission during the first 2 weeks of protocol. Among ketamine responders, the relapse rate at the end of the CBT course (8 weeks following the last ketamine exposure) was 25% (2/8). On longer-term follow-up, 5 of 8 subjects eventually relapsed, the median time to relapse being 12 weeks following ketamine exposure. Among ketamine remitters, 3 of 7 retained remission until at least 4 weeks following the last ketamine exposure, with 2 retaining remission through 8 weeks following ketamine exposure. Ketamine nonresponders did not appear to benefit from CBT.
Conclusions: CBT may sustain the antidepressant effects of ketamine in treatment-resistant depression. Well-powered randomized controlled trials are warranted to further investigate this treatment combination as a way to sustain ketamine's antidepressant effects.