Hypersomnia as a predictor of response to intravenous ketamine/intranasal esketamine in treatment resistant depression.
Liliana Patarroyo-Rodriguez, Vanessa M. Pazdernik, Jennifer L. Vande Voort, Simon Kung, Balwinder Singh
Journal of Affective Disorders 2024 DOI: 10.1016/j.jad.2024.01.003 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Observational study Peer reviewed |
|---|---|
| Sample size | 52 |
| Population | Patients with treatment-resistant depression |
| Interventions | Intravenous ketamine Intranasal esketamine |
| Topics | Depression Esketamine Ketamine |
| Citations | 12 |
| Key findings | Patients with treatment-resistant depression who have baseline hypersomnia or atypical depression features show greater reductions in depressive symptoms and higher response rates after treatment with ketamine or esketamine. |
Abstract
Background: Sleep disturbances are highly prevalent in depressive episodes and are linked to higher mood severity and suicidal behaviors. Slow wave sleep (SWS) and REM sleep are compromised in depression. Current evidence suggests that rapid antidepressant effects of intravenous (IV) ketamine in patients with treatment-resistant depression (TRD) is mediated by its effects on SWS and REM sleep. Sleep phenotypes may help predict ketamine response.
Method: In this observational study, we investigated differences in rates of response among sleep phenotypes defined by QIDS-SR in a cohort of patients with TRD (n = 52) treated with IV ketamine or intranasal (IN) esketamine. Also, we explored an atypical depression phenotype and its association between response and change in QIDS-SR following the treatment with IV ketamine/IN esketamine.
Results: 94 % of patients reported sleep difficulties and 62 % reported more than one sleep phenotype with middle and early insomnia being the most prevalent. Individuals with baseline hypersomnia showed higher response rates and more pronounced improvements on their QIDS-SR score. Additionally, 15 % of patients presented with an atypical depression phenotype; the majority of whom achieved response and had higher reductions on QIDS-SR. A trend towards faster response was identified for hypersomnia and atypical depression phenotypes.
Limitations: Observational study design and lack of a placebo group.
Conclusions: Our data indicate that patients with TRD who have baseline hypersomnia and atypical depression features experienced a more substantial reduction in depressive symptoms and are more likely to achieve response with ketamine/esketamine. This could serve as a future predictor for clinical response.
Comparable studies
Other observational and cohort studies on esketamine for depression, most cited first.