Ketamine produces rapid antidepressant effects in a subset of patients with treatment-resistant depression, yet neuroimaging findings have been difficult to integrate because studies differ in imaging modality, analytic approach, task context, and post-infusion timing. To address this, we conducted a multimodal synthesis of functional magnetic resonance imaging (fMRI) and positron emission...
Treatment-resistant depression (TRD) affects approximately 30% of major depressive disorder(MDD) cases and represents a major unmet clinical need. Ketamine produces rapid antidepressanteffects in TRD, but response is variable and no validated biomarker predicts who will respond.Multiple independent studies have now shown that baseline EEG features -- particularly vigilancestage distribution and...
Interleukin-6 (IL-6) has been implicated as a potential predictor of ketamine response in treatment-resistant depression (TRD). Esketamine, the S-enantiomer of ketamine, produces rapid antidepressant effects and offers improved safety and intranasal administration. To examine whether baseline IL-6 predicts treatment response to esketamine in individuals with TRD. Fourteen adults with TRD...
Background Paclitaxel (PTX), a broad-spectrum anti-tumor drug, is extensively employed as a first-line chemotherapy for solid tumors, including lung and breast cancers. However, it induces chemotherapy-related pain and anxiety in over 53% of patients. S-ketamine, the S-enantiomer of ketamine, exerts rapid antidepressant effects. In this study, we established a PTX model to examine the effects...
Background Ketamine is a rapid-acting antidepressant that produces acute dissociative symptoms. In routine care, the respective contributions of therapeutic expectations and dissociative symptoms to antidepressant response, and the directionality of their associations with depressive symptom change, remain poorly characterized.
Reserveer ketamine of esketamine voor patiënten bij wie twee tot vier adequate antidepressieve behandelingen onvoldoende effect hebben gehad. Weeg ook de ernst mee; bij milde gevallen is dit doorgaans niet geïndiceerd. Overweeg esketamine bij acute suïcidaliteit bij therapieresistente depressie, ondanks de negatieve studieresultaten. De placebogroepen ontvingen uitstekende intramurale...
Wanneer een patiënt terugvalt na het afbouwen van ketamine of esketamine, overweeg dan een herstart van een inductiekuur (tweemaal per week gedurende enkele weken, vervolgens geleidelijk spreiden). Bij ketamine of esketamine treden dysfore reacties op bij ongeveer 1 op de 200-300 behandelingen. Veel hiervan verdwijnen met ondersteunende zorg alleen; andere vereisen een kortwerkend...
Na het voltooien van deze activiteit dienen deelnemers in staat te zijn om: Geschikte kandidaten voor ketamine of esketamine te identificeren op basis van eerdere behandelmislukkingen, ernst van de aandoening, middelengebruiksgeschiedenis en relevante contra-indicaties. Strategieën te beschrijven voor onderhoudsdosering, afbouw en het omgaan met snelle terugval na het staken van ketamine of...
Reserve ketamine or esketamine for patients who have failed two to four adequate antidepressant trials. Weigh severity too; mild cases may not warrant it. Consider esketamine for acute suicidality in TRD despite the negative trial results. Placebo groups received excellent inpatient standard of care and improved substantially, masking the drug's benefit. Avoid ketamine and esketamine in active...
After completing this activity, participants should be able to: Identify appropriate candidates for ketamine or esketamine based on prior treatment failures, severity, substance use history, and relevant contraindications. Describe strategies for maintenance dosing, tapering, and managing rapid relapse after discontinuation of ketamine or esketamine. Apply clinic-based approaches to managing...