Clinical predictors of antidepressant response to ketamine in unipolar treatment-resistant depression
L.C. Del Sant, E. Magalhães, Ana C. Lucchese, H.N. Palhares Alves, Luciana M. Sarin, José A. Del-Porto, A.L. Tavares de Lacerda
European Psychiatry April 1, 2017 DOI: 10.1016/j.eurpsy.2017.01.704 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Systematic review Peer reviewed |
|---|---|
| Population | Patients with unipolar treatment-resistant depression |
| Intervention | Ketamine |
| Topics | Depression Esketamine Ketamine |
| Key findings | The authors report that several clinical characteristics predict ketamine response in treatment-resistant depression: positive family history of alcohol abuse, higher BMI, and negative history of suicide attempt were associated with greater improvement; greater dissociation during infusion and rapid response to the first infusion predicted better outcomes; and anxious depression or lower attention performance also predicted response. They conclude that future studies are needed to confirm reliable predictors for individualized treatment. |
Abstract
Introduction: The non-competitive N-methyl-d-aspartate glutamate receptor antagonist ketamine has been shown to have rapid antidepressant effects in treatment-resistant depression (TRD). However, only a few studies have investigated which clinical characteristics predict a response to ketamine.
Objectives: To assess sociodemographic variables and clinical markers that predict response to ketamine in unipolar TRD patients.
Methods: Searches of Pubmed, NCBI and Google Scholar were conducted for clinical trials and systematic reviews, through October 2016, using the keywords: ketamine, N-methyl-d-aspartate receptor antagonist, rapid-acting antidepressant, depression, treatment-resistant depression, clinical predictors.
Results: Findings support the following clinical predictors: – sociodemographic variables: positive family history of alcohol abuse disorder in first-degree relative (increased antidepressant response and fewer depressive symptoms for up to 4 weeks post-infusions), higher BMI (improvement in depression severity at 230 minutes and one day post-infusion), negative history of suicide attempt (greater improvement at day 7); – infusion-associated events: greater dissociation during infusion (better antidepressant response at 230 minutes and one week post-infusion); rapid response to first infusion (sustained response to subsequent infusions in one-third responders for up to 83 days); – symptomatology: anxious depression (fewer depression symptoms at day one up to 25 associated with longer time to relapse); neurocognitive performance (lower attention) predicts change in severity of depressive symptoms over six infusions.
Conclusions: Findings suggest that specific clinical characteristics are predictors of ketamine response in TRD. Future studies confirming reliable predictors will assist clinicians to implement efficacious and individualized treatment for TRD patients. Disclosure of interest: The authors have not supplied their declaration of competing interest.
Comparable studies
Other systematic reviews and meta-analyses on ketamine for depression, most cited first.