Effect of Baseline Anxious Depression on Initial and Sustained Antidepressant Response to Ketamine
Dawn F. Ionescu, David A. Luckenbaugh, Mark J. Niciu, Erica M. Richards, Elizabeth E. Slonena, Jennifer L. Vande Voort, Nancy E. Brutsché, Carlos A. Zarate
The Journal of Clinical Psychiatry September 25, 2014 DOI: 10.4088/jcp.14m09049 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Post hoc analysis of a single-arm open-label trial Peer reviewed |
|---|---|
| Sample size | 26 |
| Population | Inpatients with treatment-resistant major depressive disorder |
| Intervention | Ketamine |
| Dose | 0.5 mg/kg over 40 minutes |
| Duration | Single infusion, 28-day follow-up |
| Topics | Anxiety Depression Esketamine Ketamine |
| Keywords | Depression economics Antidepressant Somatization Rating scale Cognition |
| Citations | 111 |
| Registration | NCT00088699 |
| Key findings | Patients with anxious depression had significantly fewer depressive symptoms and later relapse after ketamine infusion compared to those with nonanxious depression. |
Abstract
Objective: Patients with anxious depression are typically more difficult to treat with monoaminergic antidepressants compared to those with nonanxious depression. Although novel research has shown that the N-methyl-D-aspartate (NMDA) receptor antagonist ketamine has rapidly acting, relatively sustained effects in treating depression, we predicted that, consistent with the existent literature on traditional antidepressants, patients with anxious depression would have a poorer antidepressant response.
Method: Twenty-six inpatients with treatment-resistant major depressive disorder (MDD) (DSM-IV criteria) received a single infusion of ketamine (0.5 mg/kg over 40 minutes) from January 2006-March 2013 and were followed for 28 days. A post hoc analysis compared treatment response and relapse using the Montgomery-Asberg Depression Rating Scale (MADRS) in patients with anxious versus nonanxious depression. Anxious depression was defined as MDD plus a Hamilton Depression Rating Scale anxiety/somatization factor score ≥ 7.
Results: Both anxious and nonanxious depressed patients responded positively to ketamine. A linear mixed model controlling for baseline with the MADRS revealed a significant group main effect (P = .03) and group-by-time interaction (P = .01). Post hoc tests indicated that patients with anxious depression had significantly fewer depression symptoms compared to those with nonanxious depression at days 1 through 5, 9 through 12, 15 through 17, and 25, with no significant group differences in dissociative (P = .62) or psychotic (P = .41) side effects. Regarding responders, patients with anxious depression relapsed significantly later than those with nonanxious depression (median ± SE = 19.0 ± 17.9 vs 1.0 ± 0.0 days to relapse, respectively; χ² = 9.30; P = .002).
Conclusions: Unexpectedly, patients with anxious depression responded better to ketamine than those with nonanxious depression, with longer time to relapse and no side effect differences. This finding gives promise for the role of novel glutamatergic medications for the treatment of those with anxious depression, a traditionally difficult-to-treat subgroup of depressed patients.
Trial Registration: ClinicalTrials.gov identifier: NCT00088699.
In the evidence
This study is part of the evidence base for a synthesis in the library. Here is how each one recorded it.
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Patients with anxious depression had significantly fewer depressive symptoms and later relapse after ketamine infusion compared to those with nonanxious depression.
Synthesized
Comparable studies
Other non-randomized and open-label trials on ketamine for anxiety, most cited first.