Fine-tuning neural excitation/inhibition for tailored ketamine use in treatment-resistant depression
Erik D. Fagerholm, Robert Leech, Steven C. R. Williams, Carlos A. Zarate Jr., Rosalyn J. Moran, Jessica R. Gilbert
arXiv Preprint Archive February 4, 2021 preprint
Study at a glance
AI-extracted from the abstract| Characteristics | Clinical trial with within-subject repeated measures |
|---|---|
| Sample size | 36 |
| Population | Unmedicated patients with treatment-resistant major depressive disorder and age-matched healthy controls |
| Interventions | Subanesthetic ketamine infusion placebo-saline infusion |
| Dose | subanesthetic |
| Topics | Depression Esketamine Ketamine |
| Keywords | Q-bio.qm Depression treatment Ketamine therapy Brain imaging |
| Key findings | Ketamine-induced shifts in neural dynamics toward the stable quadrant of the Poincaré diagram, driven by increased excitatory and inhibitory coupling, predicted depressive symptom improvement in a drug-specific manner. |
Abstract
The glutamatergic modulator ketamine has been shown to rapidly reduce depressive symptoms in patients with treatment-resistant major depressive disorder (TRD). Although its mechanisms of action are not fully understood, changes in cortical excitation/inhibition (E/I) following ketamine administration are well documented in animal models and could represent a potential biomarker of treatment response. Here, we analyse neuromagnetic virtual electrode timeseries collected from the primary somatosensory cortex in 18 unmedicated patients with TRD and in an equal number of age-matched healthy controls during a somatosensory 'airpuff' stimulation task. These two groups were scanned as part of a clinical trial of ketamine efficacy under three conditions: a) baseline; b) 6-9 hours following subanesthetic ketamine infusion; and c) 6-9 hours following placebo-saline infusion. We obtained estimates of E/I interaction strengths by using Dynamic Causal Modelling (DCM) on the timeseries, thereby allowing us to pinpoint, under each scanning condition, where each subject's dynamics lie within the Poincar\'e diagram - as defined in dynamical systems theory. We demonstrate that the Poincar\'e diagram offers classification capability for TRD patients, in that the further the patients' coordinates were shifted (by virtue of ketamine) toward the stable (top-left) quadrant of the Poincar\'e diagram, the more their depressive symptoms improved. The same relationship was not observed by virtue of a placebo effect - thereby verifying the drug-specific nature of the results. We show that the shift in neural dynamics required for symptom improvement necessitates an increase in both excitatory and inhibitory coupling. We present accompanying MATLAB code made available in a public repository, thereby allowing for future studies to assess individually-tailored treatments of TRD.
Comparable studies
Other non-randomized and open-label trials on ketamine for depression, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Rapid Resolution of Suicidal Ideation After a Single Infusion of anN-Methyl-D-Aspartate Antagonist in Patients With Treatment-Resistant Major Depressive Disorder Subjects with DSM-IV-diagnosed treatment-resistant major depressive disorder | 2010 | Open-label trial | n = 33 |
| Esketamine Nasal Spray Plus Oral Antidepressant in Patients With Treatment-Resistant Depression Adults (≥ 18 years) with treatment-resistant depression | 2020 | Phase 3, open-label, multicenter, long-term study | n = 802 |
| Intravenous arketamine for treatment-resistant depression: open-label pilot study Humans with treatment-resistant depression | 2020 | Open-label pilot trial | n = 7 |
| A Phase 2 Open Label Study of Efficacy, Safety, and Tolerability of SLS-002 (Intranasal Racemic Ketamine) in Adults with MDD at Imminent Risk of Suicide. Hospitalized patients with Major Depressive Disorder and acute suicidal ideation and... | 2024 | Open label study | n = 17 |
| Ketamine Safety and Tolerability in Clinical Trials for Treatment-Resistant Depression Participants with DSM-IV-defined major depressive disorder and treatment-resistant... | 2014 | Pooled analysis of three clinical trials | n = 97 |