Modulation of amygdala reactivity following rapidly acting interventions for major depression.
Joana R Loureiro, Amber M Leaver, Megha M Vasavada, Ashish K Sahib, Antoni Kubicki, Shantanu Joshi, Roger P Woods, Benjamin Wade, Eliza Congdon, Randall Espinoza, Katherine L Narr
Human Brain Mapping May 1, 2020 DOI: 10.1002/hbm.24895 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Naturalistic study Peer reviewed |
|---|---|
| Sample size | 44 |
| Population | Patients with major depressive disorder unresponsive to standard treatments |
| Interventions | Electroconvulsive therapy Ketamine |
| Dose | 0.5 mg/kg |
| Topics | Depression Ketamine |
| Keywords | Ect Amygdala Emotion processing Tfmri |
| Citations | 65 |
| Key points | Both ECT and ketamine reduce amygdala reactivity to emotional faces, with treatment-specific changes in the dorsolateral prefrontal cortex and insula, and correlations between brain activity changes and symptom improvement in anxiety and anhedonia. |
Abstract
Electroconvulsive therapy (ECT) and ketamine treatment both induce rapidly acting antidepressant effects in patients with major depressive disorder unresponsive to standard treatments, yet their specific impact on emotion processing is unknown. Here, we examined the neural underpinnings of emotion processing within and across patients (N = 44) receiving either ECT (N = 17, mean age: 36.8, 11.0 SD) or repeated subanesthetic (0.5 mg/kg) intravenous ketamine therapy (N = 27, mean age: 37.3, 10.8 SD) using a naturalistic study design. MRI and clinical data were collected before (TP1) and after treatment (TP2); healthy controls (N = 31, mean age: 34.5, 13.5 SD) completed one MRI session (TP1). An fMRI face-matching task probed negative- and positive-valence systems. Whole-brain analysis, comparing neurofunctional changes within and across treatment groups, targeted brain regions involved in emotional facial processing, and included regions-of-interest analysis of amygdala responsivity. Main findings revealed a decrease in amygdalar reactivity after both ECT and ketamine for positive and negative emotional face processing (p < .05 family wise-error (FWE) corrected). Subthreshold changes were observed between treatments within the dorsolateral prefrontal cortex and insula (p < .005, uncorrected). BOLD change for positive faces in the inferior parietal cortex significantly correlated with overall symptom improvement, and BOLD change in frontal regions correlated with anxiety for negative faces, and anhedonia for positive faces (p < .05 FWE corrected). Both serial ketamine and ECT treatment modulate amygdala response, while more subtle treatment-specific changes occur in the larger functional network. Findings point to both common and differential mechanistic upstream systems-level effects relating to fast-acting antidepressant response, and symptoms of anxiety and anhedonia, for the processing of emotionally valenced stimuli.
Comparable studies
Other observational and cohort studies on ketamine for depression, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Concomitant BDNF and sleep slow wave changes indicate ketamine-induced plasticity in major depressive disorder Patients with treatment-resistant major depressive disorder | 2012 | Observational cohort | n = 30 |
| Altered peripheral immune profiles in treatment-resistant depression: response to ketamine and prediction of treatment outcome Healthy controls and actively depressed patients with treatment-resistant depression... | 2017 | Observational cohort | n = 59 |
| Clinical Predictors of Ketamine Response in Treatment-Resistant Major Depression Treatment-resistant inpatients with DSM-IV-TR-diagnosed major depressive disorder or... | 2014 | Post hoc analysis of pooled data from four studies | n = 108 |
| An investigation of amino-acid neurotransmitters as potential predictors of clinical improvement to ketamine in depression Drug-free patients with major depressive disorder | 2011 | Observational cohort | n = 14 |
| Efficacy of ketamine therapy in the treatment of depression Drug-free/naïve men with severe depression, no history of psychotic disorder, head... | 2019 | Observational cohort | n = 25 |
Citations in the library
Cited by 25
- Ketamine and Serotonergic Psychedelics: Common Mechanisms Underlying the Effects of Rapid-Acting Antidepressants The International Journal of Neuropsychopharmacology November 16, 2020
- Rapid neuroplasticity changes and response to intravenous ketamine: a randomized controlled trial in treatment-resistant depression Translational Psychiatry May 9, 2023
- Depression treatment response to ketamine: sex-specific role of interleukin-8, but not other inflammatory markers Translational Psychiatry March 21, 2021
- Brain-based correlates of antidepressant response to ketamine: a comprehensive systematic review of neuroimaging studies. The Lancet Psychiatry October 1, 2023
- Intrinsic Connectivity Networks of Glutamate-Mediated Antidepressant Response: A Neuroimaging Review Frontiers in Psychiatry May 26, 2022
and 20 more in the library
Cites 10
- A Randomized Trial of an N-methyl-D-aspartate Antagonist in Treatment-Resistant Major Depression Archives of General Psychiatry August 1, 2006
- NMDAR inhibition-independent antidepressant actions of ketamine metabolites Nature April 24, 2016
- A Double-Blind, Randomized, Placebo-Controlled, Dose-Frequency Study of Intravenous Ketamine in Patients With Treatment-Resistant Depression American Journal of Psychiatry April 8, 2016
- Attenuation of Antidepressant Effects of Ketamine by Opioid Receptor Antagonism American Journal of Psychiatry August 29, 2018
- Do the dissociative side effects of ketamine mediate its antidepressant effects? Journal of Affective Disorders February 18, 2014
and 5 more in the library