Ketamine in neuropsychiatric disorders: an update

Neuropsychopharmacology, Journal Year: 2023, Volume and Issue: 49(1), P. 23 - 40

Published: June 20, 2023

Language: Английский

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International pooled patient-level meta-analysis of ketamine infusion for depression: In search of clinical moderators

Molecular Psychiatry, Journal Year: 2022, Volume and Issue: 27(12), P. 5096 - 5112

Published: Sept. 7, 2022

Abstract Depression is disabling and highly prevalent. Intravenous (IV) ketamine displays rapid-onset antidepressant properties, but little known regarding which patients are most likely to benefit, limiting personalized prescriptions. We identified randomized controlled trials of IV that recruited individuals with a relevant psychiatric diagnosis (e.g., unipolar or bipolar depression; post-traumatic stress disorder), included one more control arms, did not provide any other study-administered treatment in conjunction (although clinically prescribed concurrent treatments were allowable), assessed outcome using either the Montgomery-Åsberg Rating Scale Hamilton for (HRSD-17). Individual patient-level data at least was obtained from 17 25 eligible [pooled n = 809]. Rates participant-level availability across 33 moderators solicited these studies ranged 10.8% 100% (median 55.6%). After harmonization, available 40% dataset tested sequentially, as well data-driven, combined moderator approach. Robust main effects on acute [~24-hours; β *(95% CI) 0.58 (0.44, 0.72); p < 0.0001] post-acute [~7 days; 0.38 (0.23, 0.54); depression severity observed. Two study-level emerged significant: (relative placebo) larger required higher degree previous resistance federal regulatory agency-approved medications (≥2 failed trials) study entry; used crossover design. A comprehensive data-driven search statistically significant, modest uninformative, (effect size r ≤ 0.29, small-medium effect). Ketamine robustly reduces depressive symptoms heterogeneous range patients, benefit relative placebo even greater resistant prior medications. In this largest effort date apply precision medicine approaches treatment, no clinical demographic features detected could be guide decisions. Review Registration: PROSPERO Identifier: CRD42021235630

Language: Английский

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Antidepressant mechanisms of ketamine: a review of actions with relevance to treatment-resistance and neuroprogression

Frontiers in Neuroscience, Journal Year: 2023, Volume and Issue: 17

Published: Aug. 8, 2023

Concurrent with recent insights into the neuroprogressive nature of depression, ketamine shows promise in interfering several factors, and has been suggested to reverse neuropathological patterns seen depression. These come at a time great need for novel approaches, as prevalence is rising current treatment options remain inadequate large number people. The rapidly growing literature on ketamine's antidepressant potential yielded multiple proposed mechanisms action, many which have implications recently elucidated aspects depressive pathology. This review aims provide reader an understanding pathology how act it. Literature was identified through PubMed Google Scholar, reference lists retrieved articles. When reviewing evidence pathology, picture emerges four elements interacting each other facilitate progressive worsening, namely stress, inflammation, neurotoxicity neurodegeneration. Ketamine acts all these levels rapid potent reductions symptoms. Converging suggests that works increase stress resilience stress-induced dysfunction, modulate systemic inflammation neuroinflammation, attenuate neurotoxic processes glial synaptogenesis rather than Still, much remains be revealed about research lacking durability effect. findings discussed herein calls more longitudinal approaches when determining efficacy its relation could relevant considerations clinical implementation.

Language: Английский

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Reconsidering “dissociation” as a predictor of antidepressant efficacy for esketamine

Psychopharmacology, Journal Year: 2023, Volume and Issue: 240(4), P. 827 - 836

Published: Feb. 2, 2023

Language: Английский

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Therapeutic mechanisms of psychedelics and entactogens

Neuropsychopharmacology, Journal Year: 2023, Volume and Issue: 49(1), P. 104 - 118

Published: July 24, 2023

Language: Английский

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Demographic and clinical predictors of response and remission in the treatment of major depressive disorder with ketamine and esketamine: A systematic review

Psychiatry Research, Journal Year: 2025, Volume and Issue: 345, P. 116355 - 116355

Published: Jan. 5, 2025

Accumulating evidence supports the efficacy of (es)ketamine in treatment major depressive disorder (MDD), particularly treatment-resistant depression (TRD). Yet around 50% individuals with TRD do not respond to (es)ketamine. Elucidating predictors response and remission could improve outcomes at individual level by defining subpopulations that are most likely benefit from This systematic review outlines predictive value demographic clinical characteristics for MDD. A literature search was performed retrieve studies investigating association between baseline likelihood achieving following Forty-four variables, episode, resistance, psychiatric comorbidities, symptomatology, suicidal risk/attempts, family/personal history, medication use, somatic personality traits, neurocognitive performance were included. The variables limited either no significant relationship or inconsistent results. Findings provide preliminary support a positive anhedonia, sleep disturbances, childhood physical abuse, obesity, openness, better episodic memory, visual learning, poorer performance, slower processing speed, lower attention, as well negative melancholic depression, benzodiazepine metabolic syndrome. However, these have been investigated number warrant replication. These findings suggest represents promising prospect who present often considered difficult treat.

Language: Английский

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At-home, sublingual ketamine telehealth is a safe and effective treatment for moderate to severe anxiety and depression: Findings from a large, prospective, open-label effectiveness trial

Journal of Affective Disorders, Journal Year: 2022, Volume and Issue: 314, P. 59 - 67

Published: July 7, 2022

At-home Ketamine-assisted therapy (KAT) with psychosocial support and remote monitoring through telehealth platforms addresses access barriers, including the COVID-19 pandemic. Large-scale evaluation of this approach is needed for questions regarding safety effectiveness depression anxiety.In prospective study, a large outpatient sample received KAT over four weeks provider. Symptoms were assessed using Patient Health Questionnaire (PHQ-9) depression, Generalized Anxiety Disorder scale (GAD-7) anxiety. Demographics, adverse events, patient-reported dissociation also analyzed. Symptom trajectories identified Growth Mixture Modeling, along outcome predictors.A 1247 completed treatment sufficient data, 62.8 % reported 50 or greater improvement on PHQ-9, d = 1.61, 62.9 GAD-7, 1.56. Remission rates 32.6 PHQ-9 31.3 0.9 deteriorating 0.6 GAD-7. Four patients left early due to side effects clinician disqualification, two more events. Three patient subpopulations emerged, characterized by Improvement (79.3 %), Chronic (11.4 Delayed (9.3 %) Endorsing at Session 2 was associated delayed symptom improvement, likely than other groups report 4.At-home response remission indicated rapid significant antidepressant anxiolytic effects. Rates consistent laboratory- clinic-administered ketamine treatment. screening maintained low levels Future research should assess durability

Language: Английский

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Evaluation of the Trajectory of Depression Severity With Ketamine and Esketamine Treatment in a Clinical Setting

JAMA Psychiatry, Journal Year: 2022, Volume and Issue: 79(7), P. 736 - 736

Published: May 11, 2022

Our website uses cookies to enhance your experience. By continuing use our site, or clicking "Continue," you are agreeing Cookie Policy | Continue JAMA Psychiatry HomeNew OnlineCurrent IssueFor Authors Podcast Publications Network Open Cardiology Dermatology Health Forum Internal Medicine Neurology Oncology Ophthalmology Otolaryngology–Head & Neck Surgery Pediatrics Archives of (1919-1959) JN Learning / CMESubscribeJobsInstitutions LibrariansReprints Permissions Terms Use Privacy Accessibility Statement 2023 American Medical Association. All Rights Reserved Search Archive Input Term Sign In Individual inCreate an Account Access through institution Purchase Options: Buy this article Rent Subscribe the journal

Language: Английский

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Ketamine-assisted psychotherapy in adolescents with multiple psychiatric diagnoses

Frontiers in Psychiatry, Journal Year: 2023, Volume and Issue: 14

Published: March 30, 2023

Ketamine-assisted psychotherapy is a promising new treatment for variety of mental disorders adolescence. There currently an adolescent health crisis, with high prevalence disorders, diagnostic complexity, and many adolescents failing to respond conventional treatments. While there strong evidence the use ketamine in adults treatment-refractory illnesses, research its early stages. (KAP) has been described results here we present first published cases KAP adolescents. The four include aged 14-19 at initiation treatment, each comorbid diagnoses including treatment-resistant depression, bipolar disorder, eating anxiety, panic, trauma-related symptoms. They initially received sublingual ketamine, followed by sessions intramuscular ketamine. Their courses varied, but had symptomatic functional improvements, was well-tolerated. Subjective patient reports are included. Rapid resolution symptomatology suffering often occurs within months as result application psychiatric care not inevitable. Family involvement process appears be essential success. development this modality may have singularly positive impact that will expand toolbox healing potency.

Language: Английский

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The effects of ketamine on symptoms of depression and anxiety in real-world care settings: A retrospective controlled analysis

Journal of Affective Disorders, Journal Year: 2023, Volume and Issue: 335, P. 484 - 492

Published: May 16, 2023

Ketamine intravenous therapy (KIT) appears effective for treating depression in controlled trials testing a short series of infusions. A rapidly proliferating number clinics offer KIT and anxiety, using protocols without strong evidence basis. Controlled comparison mood anxiety from real-world clinics, the stability outcomes, is lacking. We performed retrospective analysis on patients treated with ten community across US, between 08/2017‐03/2020. Depression symptoms were evaluated Quick Inventory Depressive Symptomatology-Self Report 16-item (QIDS) Generalized Anxiety Disorder 7-item (GAD-7) scales, respectively. Comparison data sets who did not undergo obtained previously published studies. Of 2758 treated, 714 836 met criteria induction maintenance Patients exhibited significant concordant reduction both after (Cohen's d = -1.17 -1.56, respectively). Compared to two external datasets KIT-naive depressed or starting standard antidepressant therapy, experienced significantly greater at eight weeks -1.03 -0.62 Furthermore, we identified subpopulation late-responders. During maintenance, up year post-induction, increases minimal. Due nature analyses, interpreting this dataset limited by incomplete patient information sample attrition. treatment elicited robust symptomatic relief that remained stable one follow-up.

Language: Английский

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