Ketamine-Induced Dissociative Symptoms Predict Antidepressant Response
Psychiatry Advisor gives and in-depth description of the chemical processes involved in Ketamine treatment, how they effect individuals over time and the high rates of success when used in conjunction with traditional methods.
Increased dissociative symptoms associated with ketamine infusion treatment can predict a greater antidepressant effect in individuals with major depressive disorder or bipolar disorder. In fact, specific properties of ketamine-induced dissociation (such as depersonalization and derealization) can uniquely predict the antidepressant response, according to a study published in the Journal of Affective Disorders.
This follow-up study expanded on previous research that explored the relationship between ketamine's dissociative side-effects and the antidepressant response in individuals with treatment-resistant depression. Furthermore, it validated the subdimensions of dissociation as unique predictors of depression improvement. Data were obtained for 126 patients from 3 previous studies and participants were identified as ketamine-bipolar (n=39), ketamine-riluzole (n=52), and ketamine-MOA (n=35); all patients experienced a major depressive episode lasting at least 2 weeks at screening and had failed to respond to other antidepressants.
Dissociative symptoms were assessed at baseline and again 40 minutes after the subanesthetic-dose of ketamine was administered. The 19-item Clinician-Administered Dissociative States Scale (CADSS) was used to evaluate dissociative symptoms, and study researchers proposed 3 subdimensions of dissociation: amnesia (2 items), depersonalization (5 items), and derealization (12 items). The depressive response was evaluated using the 17-item Hamilton Depression Rating Scale (HAM-D), in which a percent change in score was measured at 230 minutes, 1 day, and 7 days after ketamine infusion.
The antidepressant response (shown by a negative change in HAM-D scores) was predicted by a greater CADSS total score, along with the derealization and depersonalization subscales. Specifically, a relationship between the CADSS total score and a significant percent change in HAM-D score at Day 7 in the ketamine-MOA study was observed. The relationship was non-significant for both the ketamine-bipolar and ketamine-riluzole groups, and for all studies at the 230-minute time point. Similarly, the derealization subscale showed a significant effect on the Day-7 HAM-D score, but only in the ketamine-MOA group. However, across all studies and all time points, a greater depersonalization subscale predicted a significant percent change in HAM-D score. The amnesia subscale was non-significant.
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Niciu MJ, Shovestul BJ, Jaso BA, et al. Features of dissociation differently predict antidepressant response to ketamine in treatment-resistant depression. J Affect Disord. 2018; 232:310-315.