The Impact of Childhood Maltreatment on Intravenous Ketamine Outcomes for Adult Patients with Treatment-Resistant Depression
Brittany O’brien, Marijn Lijffijt, Allison Wells, Alan C. Swann, Sanjay J. Mathew
Pharmaceuticals September 11, 2019 DOI: 10.3390/ph12030133 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Observational cohort Peer reviewed |
|---|---|
| Sample size | 115 |
| Population | Patients with treatment-resistant depression receiving intravenous ketamine at a community outpatient clinic |
| Intervention | Ketamine |
| Measures | Quick Inventory of Depressive Symptoms–Self Report (QIDS-SR), Childhood Trauma Questionnaire (CTQ) |
| Topics | Depression Esketamine Ketamine |
| Key findings | Clinically significant childhood sexual abuse, physical abuse, and higher cumulative maltreatment load were associated with better treatment response to single and repeated ketamine infusions, and higher load was associated with higher remission rates after repeated infusions. The authors propose ketamine may be more effective in treatment-resistant depression patients with greater childhood trauma burden, unlike conventional antidepressants. |
Abstract
Childhood maltreatment is associated with a poor treatment response to conventional antidepressants and increased risk for treatment-resistant depression (TRD). The N-methyl-D-aspartate receptor (NDMAR) antagonist ketamine has been shown to rapidly improve symptoms of depression in patients with TRD. It is unknown if childhood maltreatment could influence ketamine’s treatment response. We examined the relationship between childhood maltreatment using the Childhood Trauma Questionnaire (CTQ) and treatment response using the Quick Inventory of Depressive Symptoms–Self Report (QIDS-SR) in TRD patients receiving intravenous ketamine at a community outpatient clinic. We evaluated treatment response after a single infusion (n = 115) and a course of repeated infusions (n = 63). Repeated measures general linear models and Bayes factor (BF) showed significant decreases in QIDS-SR after the first and second infusions, which plateaued after the third infusion. Clinically significant childhood sexual abuse, physical abuse, and cumulative clinically significant maltreatment on multiple domains (maltreatment load) were associated with better treatment response to a single and repeated infusions. After repeated infusions, higher load was also associated with a higher remission rate. In contrast to conventional antidepressants, ketamine could be more effective in TRD patients with more childhood trauma burden, perhaps due to ketamine’s proposed ability to block trauma-associated behavioral sensitization.