Clinical predictors of ketamine response in treatment-resistant major depression.

The N-methyl-D-aspartate receptor antagonist ketamine has rapid antidepressant effects in treatment-resistant major depressive disorder (MDD) and bipolar depression. Clinical predictors may identify those more likely to benefit from ketamine within clinically heterogeneous populations.
Data were analyzed from 4 studies of treatment-resistant inpatients with DSM-IV-TR-diagnosed MDD or bipolar I or II depression. Patients who were currently experiencing a moderate-to-severe major depressive episode were enrolled between November 2004 and March 2013. All subjects received a single subanesthetic (0.5 mg/kg) ketamine infusion over 40 minutes. Patients were analyzed at the 230-minute postinfusion time point (n = 108), at day 1 (n = 82), and at day 7 (n = 71). Univariate Pearson correlations were performed for each variable with percent change from baseline in the 17-item Hamilton Depression Rating Scale (HDRS). Multivariate linear regression was then conducted for statistically significant predictors (P ≤ .05, 2-tailed).
Higher body mass index correlated with greater HDRS improvement at 230 minutes (standardized β = -0.30, P = .004) and at day 1 (standardized β = -0.37, P = .001), but not at day 7 (standardized β = -0.18, P = .10). Family history of an alcohol use disorder in a first-degree relative was associated with greater HDRS improvement at day 1 (standardized β = -0.27, P = .014) and day 7 (standardized β = -0.41, P < .001). No prior history of suicide attempt(s) was associated with greater improvement only at day 7 (standardized β = 0.28, P = .01). The overall statistical model explained 13%, 23%, and 36% of HDRS percent change variance at 230 minutes, day 1, and day 7, respectively.
Despite its post hoc nature, this study identified several clinical correlates of ketamine's rapid and durable antidepressant effects. Further investigation of these relationships is critical for individualized treatment of depression.
AuthorsMark J Niciu, David A Luckenbaugh, Dawn F Ionescu, Sara Guevara, Rodrigo Machado-Vieira, Erica M Richards, Nancy E Brutsche, Neal M Nolan, Carlos A Zarate Jr
JournalThe Journal of clinical psychiatry (J Clin Psychiatry) Vol. 75 Issue 5 Pg. e417-23 (May 2014) ISSN: 1555-2101 [Electronic] United States
PMID24922494 (Publication Type: Clinical Trial, Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
Copyright© Copyright 2014 Physicians Postgraduate Press, Inc.
Chemical References
  • Excitatory Amino Acid Antagonists
  • Receptors, N-Methyl-D-Aspartate
  • Ketamine
  • Adult
  • Bipolar Disorder (drug therapy)
  • Body Mass Index
  • Depressive Disorder, Major (drug therapy)
  • Depressive Disorder, Treatment-Resistant (drug therapy)
  • Excitatory Amino Acid Antagonists (administration & dosage, pharmacology)
  • Female
  • Follow-Up Studies
  • Humans
  • Infusions, Intravenous
  • Ketamine (administration & dosage, pharmacology)
  • Male
  • Middle Aged
  • Psychiatric Status Rating Scales
  • Receptors, N-Methyl-D-Aspartate (antagonists & inhibitors)
  • Severity of Illness Index
  • Time Factors
  • Treatment Outcome

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