Does pre-treatment functioning influence response to intravenous ketamine in adults with treatment-resistant depression?

Jun 24, 2021

Contributor: Roger S McIntyre,Orly Lipsitz,Leanna M W Lui,Nelson B Rodrigues,Yena Lee,Roger C Ho,Mehala Subramaniapillai,Hartej Gill,Danielle S Cha,Kangguang Lin,Kayla M Teopiz,Flora Nasri,Rodrigo B Mansur,Kevin Kratiuk,Joshua D Rosenblat

Does pre-treatment functioning influence response to intravenous ketamine in adults with treatment-resistant depression?

The efficacy of monoamine-based antidepressants in adults with major depressive disorder (MDD) is attenuated in persons with greater pre-treatment functional impairment. Herein, we investigated whether pre-treatment functioning in outpatients with treatment-resistant depression (TRD) moderates response to intravenous (IV) ketamine.
Adults (N= 326; M = 45) with DSM-5-defined MDD or bipolar disorder and TRD received repeat-dose IV ketamine at a community-based clinic. Function was evaluated with the Sheehan Disability Scale (SDS), using total scores as well as scores on the subdomains of workplace/school, social life, and family life/home responsibilities. The primary dependent measure was change in depressive symptoms from pre-treatment to post-infusion 4, as measured by the Quick Inventory for Depressive Symptomatology-Self Report-16.
Total functional disability, as well as the subdomains of social life and family life/home responsibilities, significantly moderated response to IV ketamine (p = .003; p = .008; p = .008). Follow-up simple slopes analyses indicated a significant improvement in depressive symptoms across the functional domain spectrum (ps mean functional impairment within the sample) was associated with a greater change in depressive symptoms. Workplace function did not significantly moderate response to IV ketamine (p = .307), suggesting that individuals with significantly impaired workplace functioning may expect a similar response to ketamine as those with less workplace impairment.
Symptomatic benefit with IV ketamine was observed in patients with TRD and significant pre-treatment functional impairment. The foregoing result has implications for mechanism of action, cost-effectiveness, and patient selection in adults with TRD receiving IV ketamine.

Copyright © 2021 Elsevier B.V. All rights reserved.

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About The Expert

Roger S McIntyre

Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada. Electronic address: roger.mcintyre@uhn.ca.

Orly Lipsitz

Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada.

Leanna M W Lui

Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada.

Nelson B Rodrigues

Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada.

Yena Lee

Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada.

Roger C Ho

Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore; Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, Singapore.

Mehala Subramaniapillai

Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada.

Hartej Gill

Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada.

Danielle S Cha

Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; School of Medicine, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.

Kangguang Lin

Department of Affective Disorder, the Affiliated Brain Hospital of Guangzhou Medical University, (Guangzhou Huiai Hospital), Guangzhou Medical University, Guangzhou, China; Laboratory of Emotion and Cognition, the Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou Medical University, Guangzhou, China.

Kayla M Teopiz

Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada.

Flora Nasri

Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada.

Rodrigo B Mansur

Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada.

Kevin Kratiuk

Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada; Department of Physical Pharmacy, Poznan University of Medical Sciences, Poznan, Poland.

Joshua D Rosenblat

Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada.

References

PubMed