Ballard Elizabeth D, Wills Kathleen, Lally Níall, Richards Erica M, Luckenbaugh David A, Walls Tessa, Ameli Rezvan, Niciu Mark J, Brutsche Nancy E, Park Lawrence, Zarate Carlos A
Experimental Therapeutics & Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, 20892, USA.
Experimental Therapeutics & Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, 20892, USA.
J Affect Disord. 2017 Aug 15;218:195-200. doi: 10.1016/j.jad.2017.04.057. Epub 2017 Apr 25.
Identifying clinical correlates associated with reduced suicidal ideation may highlight new avenues for the treatment of suicidal thoughts. Anhedonia occurs across psychiatric diagnoses and has been associated with specific neural circuits in response to rapid-acting treatments, such as ketamine. This analysis sought to evaluate whether reductions in suicidal ideation after ketamine administration were related to reduced levels of anhedonia, independent of depressive symptoms.
This post-hoc analysis included treatment-resistant patients with either major depressive disorder (MDD) or bipolar disorder (BD) from several clinical trials of ketamine. Anhedonia was assessed using a subscale of the Beck Depression Inventory (BDI) and the Snaith-Hamilton Pleasure Scale (SHAPS). The outcome of interest was suicidal ideation, as measured by a subscale of the Scale for Suicide Ideation (SSI5), one day post-ketamine administration.
Anhedonia, as measured by the SHAPS, was associated with suicidal thoughts independent of depressive symptoms both before and after ketamine administration. One day post-ketamine administration, improvements on the SHAPS accounted for an additional 13% of the variance in suicidal thought reduction, beyond the influence of depressive symptoms. The BDI anhedonia subscale was not significantly associated with suicidal thoughts after adjusting for depressive symptoms.
Data were limited to patients experiencing a major depressive episode and may not be generalizable to patients experiencing an active suicidal crisis.
Suicidal thoughts may be related to symptoms of anhedonia independent of other depressive symptoms. These results have implications for the potential mechanisms of action of ketamine on suicidal thoughts.
识别与自杀意念减轻相关的临床关联因素可能会为自杀念头的治疗开辟新途径。快感缺乏在多种精神疾病诊断中都有出现，并且与特定神经回路有关，这些神经回路会对诸如氯胺酮等速效治疗产生反应。本分析旨在评估氯胺酮给药后自杀意念的减轻是否与快感缺乏水平的降低有关，而与抑郁症状无关。
这项事后分析纳入了来自几项氯胺酮临床试验的难治性重度抑郁症（MDD）或双相情感障碍（BD）患者。使用贝克抑郁量表（BDI）的一个子量表和斯奈斯 - 汉密尔顿快感量表（SHAPS）评估快感缺乏。感兴趣的结局是自杀意念，通过自杀意念量表（SSI5）的一个子量表在氯胺酮给药后一天进行测量。
通过SHAPS测量的快感缺乏在氯胺酮给药前后均与自杀念头相关，且与抑郁症状无关。氯胺酮给药后一天，SHAPS的改善在抑郁症状影响之外，又额外解释了自杀念头减轻中13%的变异。在调整抑郁症状后，BDI快感缺乏子量表与自杀念头无显著关联。
数据仅限于经历重度抑郁发作的患者，可能不适用于处于活跃自杀危机中的患者。
自杀念头可能与快感缺乏症状有关，而与其他抑郁症状无关。这些结果对氯胺酮治疗自杀念头的潜在作用机制具有启示意义。
