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Efficacy of low-dose ketamine infusion in anxious vs nonanxious depression: revisiting the Adjunctive Ketamine Study of Taiwanese Patients with Treatment-Resistant Depression

Published online by Cambridge University Press:  18 May 2020

Mu-Hong Chen Open the ORCID record for Mu-Hong Chen [Opens in a new window] ,
Wei-Chen Lin ,
Hui-Ju Wu ,
Ya-Mei Bai ,
Cheng-Ta Li ,
Shih-Jen Tsai ,
Chen-Jee Hong ,
Pei-Chi Tu ,
Chih-Ming Cheng  and
Tung-Ping Su
Mu-Hong Chen
Affiliation:
Division of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan Department of Psychiatry, Veterans General Hospital, Taipei, Taiwan Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
Wei-Chen Lin
Affiliation:
Division of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan Department of Psychiatry, Veterans General Hospital, Taipei, Taiwan Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
Hui-Ju Wu
Affiliation:
Department of Psychiatry, Veterans General Hospital, Taipei, Taiwan
Ya-Mei Bai
Affiliation:
Division of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan Department of Psychiatry, Veterans General Hospital, Taipei, Taiwan
Cheng-Ta Li
Affiliation:
Division of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan Department of Psychiatry, Veterans General Hospital, Taipei, Taiwan Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
Shih-Jen Tsai
Affiliation:
Division of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan Department of Psychiatry, Veterans General Hospital, Taipei, Taiwan Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
Chen-Jee Hong
Affiliation:
Division of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan Department of Psychiatry, Veterans General Hospital, Taipei, Taiwan Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
Pei-Chi Tu
Affiliation:
Division of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan Department of Psychiatry, Veterans General Hospital, Taipei, Taiwan Department of Medical Research, Veterans General Hospital, Taipei, Taiwan
Chih-Ming Cheng
Affiliation:
Division of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan Department of Psychiatry, Veterans General Hospital, Taipei, Taiwan Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
Tung-Ping Su*
Affiliation:
Division of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan Department of Psychiatry, Veterans General Hospital, Taipei, Taiwan Department of Medical Research, Veterans General Hospital, Taipei, Taiwan Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan Department of Psychiatry, Cheng Hsin General Hospital, Taipei, Taiwan
*
*Tung-Ping Su Email: tomsu0402@gmail.com
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Abstract

Background

The antidepressant effect of low-dose ketamine infusion on Taiwanese patients with anxious vs nonanxious treatment-resistant depression (ANX-TRD vs NANX-TRD) has remained unknown.

Methods

In total, 71 patients with TRD were randomized to three groups. Each group had participants who received saline infusions mixed with 0 (a normal saline infusion), 0.2, and 0.5 mg/kg of ketamine. Participants were followed up for 2 weeks. Anxious depression was defined as major depressive disorder with a total score of 7 or more on the 17-item Hamilton Depression Rating Scale Anxiety-Somatization factor. Generalized estimating equation models were used to investigate the effects of treatment (ketamine vs placebo) and depression type (ANX-TRD vs NANX-TRD) in the reduction of depressive symptoms during the follow-up period.

Results

Patients with ANX-TRD were less likely to respond to a single low-dose ketamine infusion than those with NANX-TRD. Among patients with NANX-TRD, low-dose ketamine infusion was significantly superior to placebo for reducing depressive symptoms. However, among patients with ANX-TRD, ketamine was not superior to placebo; nonetheless, approximately 30% of the patients responded to ketamine infusion compared to 13% who responded to the placebo.

Conclusions

Low-dose ketamine infusion was effective for Taiwanese patients with NANX-TRD but not so effective for those with ANX-TRD. A higher level of anxiety severity accompanying depression was related to greater depression severity. This may confound and reduce the antidepressant effect of ketamine infusion.

Keywords

Ketaminetreatment-resistant depressionanxious depression.
Type
Original Research
Information
CNS Spectrums , Volume 26 , Issue 4 , August 2021 , pp. 362 - 367
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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References

Fava, M, Rush, AJ, Alpert, JE, et al. Difference in treatment outcome in outpatients with anxious versus nonanxious depression: a STAR*D report. Am J Psychiatry. 2008;165(3):342–351.CrossRefGoogle ScholarPubMed
Gaspersz, R, Nawijn, L, Lamers, F, Penninx, B. Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome. Curr Opin Psychiatry. 2018;31(1):17–25.CrossRefGoogle ScholarPubMed
Fava, M, Alpert, JE, Carmin, CN, et al. Clinical correlates and symptom patterns of anxious depression among patients with major depressive disorder in STAR*D. Psychol Med. 2004;34(7):1299–1308.CrossRefGoogle ScholarPubMed
Braund, TA, Palmer, DM, Williams, LM, Harris, AWF. Dimensions of anxiety in Major depressive disorder and their use in predicting antidepressant treatment outcome: an iSPOT-D report. Psychol Med. 2019 Apr 26:1–11. doi: 10.1017/S0033291719000941Google ScholarPubMed
Braund, TA, Palmer, DM, Williams, LM, Harris, AW. Characterising anxiety in major depressive disorder and its use in predicting antidepressant treatment outcome: an iSPOT-D report. Aust N Z J Psychiatry. 2019;58(8):782–793.CrossRefGoogle Scholar
Wiethoff, K, Bauer, M, Baghai, TC, et al. Prevalence and treatment outcome in anxious versus nonanxious depression: results from the German Algorithm Project. J Clin Psychiatry. 2010;71(8):1047–1054.CrossRefGoogle ScholarPubMed
Murrough, JW, Iosifescu, DV, Chang, LC, et al. Antidepressant efficacy of ketamine in treatment-resistant major depression: a two-site randomized controlled trial. Am J Psychiatry. 2013;170(10):1134–1142.CrossRefGoogle ScholarPubMed
Su, TP, Chen, MH, Li, CT, et al. Dose-related effects of adjunctive ketamine in Taiwanese patients with treatment-resistant depression. Neuropsychopharmacology. 2017;42(13):2482–2492.CrossRefGoogle ScholarPubMed
Salloum, NC, Fava, M, Freeman, MP, et al. Efficacy of intravenous ketamine treatment in anxious versus nonanxious unipolar treatment-resistant depression. Depression Anxiety. 2019;36(3):235–243.CrossRefGoogle ScholarPubMed
Ionescu, DF, Luckenbaugh, DA, Niciu, MJ, et al. Effect of baseline anxious depression on initial and sustained antidepressant response to ketamine. J Clin Psychiatry. 2014;75(9):e932–e938.CrossRefGoogle Scholar
Ionescu, DF, Luckenbaugh, DA, Niciu, MJ, Richards, EM, Zarate, CA Jr. A single infusion of ketamine improves depression scores in patients with anxious bipolar depression. Bipolar Disord. 2015;17(4):438–443.CrossRefGoogle ScholarPubMed
Li, CT, Chen, MH, Lin, WC, et al. The effects of low-dose ketamine on the prefrontal cortex and amygdala in treatment-resistant depression: a randomized controlled study. Hum Brain Mapp. 2016;37(3):1080–1090.CrossRefGoogle ScholarPubMed
Hamilton, M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23:56–62.CrossRefGoogle ScholarPubMed
Montgomery, SA, Rani, SJ, McAuley, R, Roy, D, Montgomery, DB. The antidepressant efficacy of zimelidine and maprotiline. Acta Psychiatr Scand Suppl. 1981;290:219–224.CrossRefGoogle ScholarPubMed
Cleary, P, Guy, W. Factor analysis of the Hamilton Depression Scale. Drugs Exp Clin Res. 1977;(1):115–120.Google Scholar
Jakubovski, E, Bloch, MH. Prognostic subgroups for citalopram response in the STAR*D trial. J Clin Psychiatry. 2014;75(7):738–747.CrossRefGoogle ScholarPubMed
Clarke, E, Clarke, P, Gill, S, Paterson, T, Hahn, L, Galletly, C. Efficacy of repetitive transcranial magnetic stimulation in the treatment of depression with comorbid anxiety disorders. J Affect Disord. 2019;252:435–439.CrossRefGoogle ScholarPubMed
Su, TP, Huang, CC, Wei, IH. Add-on rTMS for medication-resistant depression: a randomized, double-blind, sham-controlled trial in Chinese patients. J Clin Psychiatry. 2005;66(7):930–937.CrossRefGoogle ScholarPubMed
Glue, P, Medlicott, NJ, Harland, S, et al. Ketamine’s dose-related effects on anxiety symptoms in patients with treatment refractory anxiety disorders. J Psychopharmacol. 2017;31(10):1302–1305.CrossRefGoogle ScholarPubMed
Taylor, JH, Landeros-Weisenberger, A, Coughlin, C, et al. Ketamine for social anxiety disorder: a randomized, placebo-controlled crossover trial. Neuropsychopharmacology. 2018;43(2):325–333.CrossRefGoogle ScholarPubMed
Feder, A, Parides, MK, Murrough, JW, et al. Efficacy of intravenous ketamine for treatment of chronic posttraumatic stress disorder: a randomized clinical trial. JAMA psychiatry. 2014;71(6):681–688.CrossRefGoogle ScholarPubMed
Frye, MA, Blier, P, Tye, SJ. Concomitant benzodiazepine use attenuates ketamine response: implications for large scale study design and clinical development. J Clin Psychopharmacol. 2015;35(3):334–336.CrossRefGoogle ScholarPubMed
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