Rapid decrease in depressive symptoms with an N-methyl-d-aspartate antagonist in ECT-resistant major depression.
Lobna Ibrahim, Nancy Diazgranados, David A. Luckenbaugh, Rodrigo Machado‐Vieira, Jacqueline Baumann, Alan G Mallinger, Carlos A. Zarate
Progress in neuro-psychopharmacology & biological psychiatry June 1, 2011 DOI: 10.1016/j.pnpbp.2011.03.019 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Observational cohort Open-label Peer reviewed |
|---|---|
| Sample size | 40 |
| Population | Patients with treatment-resistant major depressive disorder, including those who previously did not respond to ECT and those who had not received ECT |
| Intervention | Ketamine |
| Dose | 0.5 mg/kg |
| Duration | Single infusion, assessments up to 230 minutes after infusion |
| Measures | Montgomery-Asberg Depression Rating Scale (MADRS) |
| Topics | Depression |
| Key findings | Ketamine significantly improved depressive symptoms at 230 minutes in both ECT-resistant patients (moderate effect size, d=0.50) and non-ECT-exposed patients (large effect size, d=1.00), suggesting effectiveness in those who previously failed ECT. |
Abstract
Ketamine rapidly improves depressive symptoms in patients with treatment-resistant major depressive disorder (MDD) who do not respond to multiple standard antidepressants. However, it remains unknown whether ketamine is equally effective in patients with MDD who previously also did not respond to electroconvulsive therapy (ECT). This study compared 17 patients with treatment-resistant MDD who previously did not respond to ECT and 23 patients with treatment-resistant MDD who had not previously received ECT. All subjects received a single open-label infusion of ketamine (0.5 mg/kg). Patients were evaluated using the Montgomery-Asberg Depression Rating Scale (MADRS) at baseline (60 min before the infusion), as well as at 40, 80, 120, and 230 min after infusion. Depressive symptoms were significantly improved in the ECT-resistant group at 230 minutes with a moderate effect size (p < .001, d = 0.50, 95% C.I.: 0.21-0.80). At 230 minutes, the non-ECT exposed group showed significant improvement with a large effect size (p < .001, d=1.00, 95% C.I.: 0.71-1.29). Ketamine appears to improve depressive symptoms in patients with MDD who had previously not responded to ECT. These preliminary results encourage further investigation with a larger sample size to determine effectiveness compared to other treatment-resistant patients with MDD.