Cortical inhibition function is associated with baseline suicidal symptoms and post-ketamine suicidal symptom reduction among patients with treatment-resistant depression and strong suicidal ideation.
Mu-Hong Chen, T. Su, Li-Fen Chen, Cheng-Ta Li, Hui-Ju Wu, Wei-Chen Lin, S. Tsai, Ya-Mei Bai, Wei-Chung Mao, Pei-Chi Tu, J. Jeng, Wei-Chi Li
Journal of Psychiatric Research March 1, 2023 DOI: 10.1016/j.jpsychires.2023.03.010 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial Peer reviewed |
|---|---|
| Sample size | 64 |
| Population | 29 patients with treatment-resistant depression and strong suicidal ideation, plus 35 age- and sex-matched healthy controls |
| Interventions | Ketamine Midazolam |
| Dose | 0.5 mg/kg ketamine; 0.045 mg/kg midazolam |
| Duration | Assessments at baseline and 240 minutes after infusion |
| Measures | Intracortical facilitation (ICF), short-interval intracortical inhibition (SICI), long-interval intracortical inhibition (LICI) |
| Topics | Depression Esketamine Ketamine |
| Key findings | Patients with treatment-resistant depression and strong suicidal ideation had lower intracortical facilitation and higher short- and long-interval intracortical inhibition than healthy controls, indicating worse cortical excitatory and inhibitory function; higher baseline short-interval inhibition was associated with greater suicidal symptoms. A single 0.5 mg/kg ketamine infusion did not alter these measures at 240 minutes relative to midazolam, and baseline measures did not predict antidepressant or antisuicidal response, though decreased short-interval inhibition was related to reduced suicidal symptoms. |
Abstract
Background: Whether cortical excitation and inhibition functions differ between patients with treatment-resistant depression (TRD) and strong suicidal ideation (SI) and healthy subjects and whether 0.5 mg/kg ketamine infusion can modulate cortical excitation and inhibition functions among patients with TRD-SI remain unclear.
Methods: A total of 29 patients with TRD-SI and 35 age- and sex-matched healthy controls were assessed using paired-pulse transcranial magnetic stimulation. The patients were randomly assigned to receive either a single 0.5-mg/kg ketamine or 0.045-mg/kg midazolam infusion. Depressive and suicidal symptoms were assessed at baseline and 240 min after infusion. Intracortical facilitation (ICF), short-interval intracortical inhibition (SICI), and long-interval intracortical inhibition (LICI), all of which reflect cortical excitability and inhibition functions, were measured at the same time points.
Results: The patients with TRD-SI had lower ICF (p < 0.001) estimates (worse cortical excitatory function) and higher SICI (p = 0.032) and LICI (p < 0.001) estimates (worse cortical inhibitory function) compared with the control group. Higher SICI estimates at baseline were associated with greater baseline suicidal symptoms. No differences were found in the SICI, ICF, and LICI estimates at 240 min after the infusion between the two groups. Low-dose ketamine did not alter the cortical excitation and inhibition functions of the patients with TRD-SI. However, decreased SICI estimates (greater cortical inhibition function) were related to the reduction of suicidal symptoms.
Discussion: Dysfunction of cortical excitation and inhibition may play a crucial role in the pathomechanisms of TRD and suicidal symptoms. However, we found a lack of predictive ability of the baseline cortical excitation and inhibition parameters on the antidepressant and antisuicidal effect of low-dose ketamine infusion.
Comparable studies
Other randomized controlled trials on ketamine for depression, most cited first.