Effectiveness of intravenous ketamine in mood disorder patients with a history of neurostimulation
Nelson B Rodrigues, Ashley N. Siegel, Orly Lipsitz, Danielle S. Cha, Hartej Gill, Flora Nasri, Kevin Simonson, Margarita Shekotikhina, Yena Lee, Mehala Subramaniapillai, Kevin Kratiuk, Kangguang Lin, Roger Ho, Rodrigo B. Mansur, Roger S McIntyre, Joshua D. Rosenblat
CNS Spectrums December 10, 2020 DOI: 10.1017/s1092852920002187 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Retrospective post-hoc analysis Peer reviewed |
|---|---|
| Sample size | 238 |
| Population | Adults with treatment-resistant depression (TRD) from a community-based sample |
| Intervention | Intravenous (IV) ketamine |
| Duration | Four infusions |
| Topics | Anxiety Depression Ketamine Esketamine |
| Keywords | Anhedonia Neurostimulation Depression economics Mood Antidepressant Anesthesia Clinical global impression |
| Citations | 17 |
| Key points | IV ketamine infusions significantly reduced depression severity, suicidal ideation, anxiety, and anhedonia in both neurostimulation-naïve patients and those with a history of neurostimulation, with no between-group differences. |
Abstract
Background: Patients unsuccessfully treated by neurostimulation may represent a highly intractable subgroup of depression. While the efficacy of intravenous (IV) ketamine has been established in patients with treatment-resistant depression (TRD), there is an interest to evaluate its effectiveness in a subpopulation with a history of neurostimulation.
Methods: This retrospective, posthoc analysis compared the effects of four infusions of IV ketamine in 135 (x̄ = 44 ± 15.4 years of age) neurostimulation-naïve patients to 103 (x̄ = 47 ± 13.9 years of age) patients with a history of neurostimulation. The primary outcome evaluated changes in depression severity, measured by the Quick Inventory for Depression Symptomatology-Self Report 16-Item (QIDS-SR16). Secondary outcomes evaluated suicidal ideation (SI), anxiety severity, measured by the Generalized Anxiety Disorder 7-Item (GAD-7), and consummatory anhedonia, measured by the Snaith-Hamilton Pleasure Scale (SHAPS).
Results: Following four infusions, both cohorts reported a significant reduction in QIDS-SR16 Total Score (F (4, 648) = 73.4, P < .001), SI (F (4, 642) = 28.6, P < .001), GAD-7 (F (2, 265) = 53.8, P < .001), and SHAPS (F (2, 302) = 45.9, P < .001). No between-group differences emerged. Overall, the neurostimulation-naïve group had a mean reduction in QIDS-SR16 Total Score of 6.4 (standard deviation [SD] = 5.3), whereas the history of neurostimulation patients reported a 4.3 (SD = 5.3) point reduction.
Conclusion: IV ketamine was effective in reducing symptoms of depression, SI, anxiety, and anhedonia in both cohorts in this large, well-characterized community-based sample of adults with TRD.
Comparable studies
Other observational and cohort studies on ketamine for anxiety, most cited first.