Can we change depressive beliefs? Modulation of belief updating by ketamine in treatment resistant depression
Hugo Bottemanne, Orphée Morlaàs, Anne Claret, Philippe Fossati, Liane Schmidt
Study at a glance
AI-extracted from the abstract| Characteristics | Observational cohort |
|---|---|
| Sample size | 56 |
| Population | Treatment-resistant depression patients and healthy controls |
| Intervention | sub-anesthetic ketamine infusion |
| Duration | Single infusion, one-week follow-up |
| Topics | Depression Esketamine Ketamine |
| Citations | 4 |
| Key findings | A single ketamine infusion shifted belief-updating toward optimism in treatment-resistant depression patients, and this change mediated early clinical response. |
Abstract
Treatment resistant depression (TRD) is a tremendous health problem that has encouraged novel treatment strategies involving sub-anesthetic ketamine infusions. While ketamine induces rapid and sustained clinical improvement, its cognitive effects are less well known. Here we tested if ketamine alters the negative expectancies about the future that are insensitive to disconfirming information, and play a key role for the maintenance of depression. Twenty-six TRD patients performed a belief-updating task before and after ketamine treatment, and were compared to a group of thirty healthy controls. The task involved estimating likelihoods of experiencing adverse life events before and after receiving information about the actual occurrence of events in the general public. A computational reinforcement-learning (RL) model tested how much belief updating was explained by learning from positive (better than thought) and negative (worser than thought) estimation errors. Global clinical improvement was assessed by the Montgomery Asberg Depression scale (MADRS). Following a single ketamine infusion patients updated their beliefs about the future more after favorable, and less after unfavorable information, controlled for sequential testing effects by comparison to healthy controls. The emergence of optimism biases in belief updating was underpinned by asymmetric learning from positive rather than negative estimation errors, and formally mediated precocious clinical responsiveness at one week of treatment observed in 19% of the patients. These findings provide novel insight into the cognitive mechanisms of ketamine action in TRD, and through it open the window toward promising perspectives for augmented psychotherapy in mood disorder.
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 |