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Neuroimaging-Derived Biomarkers of the Antidepressant Effects of Ketamine

Artemis Zavaliangos-Petropulu, Noor B. Al-Sharif, Brandon Taraku, Amber M Leaver, Ashish K Sahib, Randall Espinoza, Katherine L Narr

Biological Psychiatry: Cognitive Neuroscience and Neuroimaging November 25, 2022 DOI: 10.1016/j.bpsc.2022.11.005 (opens in new tab)

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Study at a glance

AI-extracted from the abstract
Characteristics Review Peer reviewed
Population Patients with unipolar or bipolar depression
Intervention Ketamine
Topics Default mode network Depression Ketamine Neuroplasticity Esketamine
Keywords Antidepressant Suicidal ideation Magnetic resonance imaging Functional neuroimaging Depression economics Poison control Cognition Hippocampus Injury prevention Radiology
Citations 27
Key findings Converging evidence supports that ketamine leads to neuroplasticity in structural and functional brain networks that contribute to or are relevant to its antidepressant effects.

Abstract

Major depressive disorder is a highly prevalent psychiatric disorder. Despite an extensive range of treatment options, about a third of patients still struggle to respond to available therapies. In the last 20 years, ketamine has gained considerable attention in the psychiatric field as a promising treatment of depression, particularly in patients who are treatment resistant or at high risk for suicide. At a subanesthetic dose, ketamine produces a rapid and pronounced reduction in depressive symptoms and suicidal ideation, and serial treatment appears to produce a greater and more sustained therapeutic response. However, the mechanism driving ketamine's antidepressant effects is not yet well understood. Biomarker discovery may advance knowledge of ketamine's antidepressant action, which could in turn translate to more personalized and effective treatment strategies. At the brain systems level, neuroimaging can be used to identify functional pathways and networks contributing to ketamine's therapeutic effects by studying how it alters brain structure, function, connectivity, and metabolism. In this review, we summarize and appraise recent work in this area, including 51 articles that use resting-state and task-based functional magnetic resonance imaging, arterial spin labeling, positron emission tomography, structural magnetic resonance imaging, diffusion magnetic resonance imaging, or magnetic resonance spectroscopy to study brain and clinical changes 24 hours or longer after ketamine treatment in populations with unipolar or bipolar depression. Though individual studies have included relatively small samples, used different methodological approaches, and reported disparate regional findings, converging evidence supports that ketamine leads to neuroplasticity in structural and functional brain networks that contribute to or are relevant to its antidepressant effects.

Comparable studies

Other narrative reviews on ketamine for depression, most cited first.

Study Year Design Participants
Synthesizing the Evidence for Ketamine and Esketamine in Treatment-Resistant Depression: An International Expert Opinion on the Available Evidence and Implementation Adults with treatment-resistant depression 2021 Review
Ketamine: a paradigm shift for depression research and treatment 2019 Review
Rapid‐acting antidepressant ketamine, its metabolites and other candidates: A historical overview and future perspective 2019 Review
Ketamine: A tale of two enantiomers 2020 Review
Molecular mechanisms underlying the antidepressant actions of arketamine: beyond the NMDA receptor 2021 Review

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Default mode network Depression Ketamine Neuroplasticity Esketamine

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