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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 and Biological Psychiatry June 1, 2011 DOI: 10.1016/j.pnpbp.2011.03.019 (opens in new tab)

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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.

Comparable studies

Other observational and cohort studies on depression, most cited first.

Study Year Design Participants
Metacognitive awareness and prevention of relapse in depression: Empirical evidence. Residually depressed patients and nondepressed controls; recovered depressed patients 2002 Observational cohort with intervention components
Psilocybin for treatment-resistant depression: fMRI-measured brain mechanisms. Patients with treatment-resistant depression 2017 Observational cohort n = 19
Antidepressant effects of a single dose of ayahuasca in patients with recurrent depression: a preliminary report Patients with a depressive disorder 2015 Observational study
Concomitant BDNF and sleep slow wave changes indicate ketamine-induced plasticity in major depressive disorder Patients with treatment-resistant major depressive disorder 2012 Observational cohort n = 30
Altered peripheral immune profiles in treatment-resistant depression: response to ketamine and prediction of treatment outcome Healthy controls and actively depressed patients with treatment-resistant depression... 2017 Observational cohort n = 59

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Depression Ketamine