The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.
Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China.
Acta Psychiatr Scand. 2019 Nov;140(5):446-457. doi: 10.1111/acps.13096. Epub 2019 Sep 20.
About half or more of treatment-resistant depressed patients do not respond to ketamine, and few clinical predictors to gauge the most likely antidepressant response have been proposed. We explored whether depression subtypes are associated with response to ketamine.
Ninety-seven participants with depression were administered six repeated-dose intravenous ketamine and assessed for depression (Montgomery-Åsberg Depression Rating Scale, MADRS), anxiety (Hamilton Anxiety Rating Scale, HAMA), and suicidal ideation (Beck Scale for Suicidal Ideation, SSI) at baseline, 24 h after each infusion, and 2 weeks after the whole treatment. Participants were classified by melancholic/anxious subtype. Individuals who met criteria for neither or both subtypes were classified separately, resulting in four mutually exclusive groups.
Patients with melancholic or melancholic-anxious features were less likely to respond (e.g., day 13, melancholic-anxious vs. anxious, OR 0.138, 95% CI 0.032-0.584, P = 0.007) or remit (e.g., day 26, melancholic vs. no subtype, OR 0.182, 95% CI 0.035-0.960, P = 0.045) and took longer to achieve response/remission than those with anxious or no subtype features. Faster HAMA score reductions were observed in patients with anxious or melancholic-anxious features, and faster SSI score reductions were observed among those with melancholic-anxious features.
Our study shows promising results for ketamine as a novel antidepressant preferentially for the treatment of non-melancholic or anxious depression.
约半数或更多的治疗抵抗性抑郁症患者对氯胺酮没有反应，并且很少有临床预测因子来评估最有可能的抗抑郁反应。我们探讨了抑郁亚型是否与氯胺酮反应相关。
97 名抑郁症患者接受了六次重复静脉注射氯胺酮，并在基线、每次输注后 24 小时以及整个治疗后 2 周评估了抑郁（蒙哥马利-阿斯伯格抑郁评定量表，MADRS）、焦虑（汉密尔顿焦虑量表，HAMA）和自杀意念（贝克自杀意念量表，SSI）。根据忧郁/焦虑亚型对参与者进行分类。不符合忧郁或焦虑亚型标准的个体单独分类，分为四个相互排斥的组。
具有忧郁或忧郁-焦虑特征的患者不太可能出现反应（例如，第 13 天，忧郁-焦虑与焦虑相比，OR 0.138，95%CI 0.032-0.584，P=0.007）或缓解（例如，第 26 天，忧郁与无亚型相比，OR 0.182，95%CI 0.035-0.960，P=0.045），且达到反应/缓解的时间长于具有焦虑或无亚型特征的患者。具有焦虑或忧郁-焦虑特征的患者的 HAMA 评分下降较快，而具有忧郁-焦虑特征的患者的 SSI 评分下降较快。
我们的研究结果表明氯胺酮作为一种新型抗抑郁药具有前景，尤其适用于治疗非忧郁或焦虑性抑郁症。
