Psychiatric Neurotherapeutics Program, McLean Hospital, 115 Mill St, Belmont, MA, 02478, USA.
Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
BMC Psychiatry. 2022 Feb 22;22(1):140. doi: 10.1186/s12888-022-03789-3.
Ketamine has emerged as a rapid-acting antidepressant in treatment-resistant depression (TRD) increasingly used in non-research, clinical settings. Few studies, however, have examined neurocognitive effects of repeated racemic ketamine infusion treatments in patients with TRD. In an effort to identify potential effects after serial infusions, we conducted a retrospective chart review to identify statistically significant changes in cognition in patient undergoing serial intravenous infusions; concomitantly, we examined baseline cognition as potential predictor of anti-depressant potential.
Twenty-two patients with TRD were examined after they finished the induction phase of 8-10 repeated intravenous ketamine infusions and completed the assessments of their depressive symptoms (measured by the 16-item Quick Inventory of Depressive Symptomatology-Self Report Scale: QIDS-SR16) and cognitive function (measured by the Montreal Cognitive Assessment: MoCA) before the first and the last ketamine treatments.
Repeated ketamine infusions administered through an escalating dose protocol with 8-10 infusion sessions produced a 47.2% reduction response in depression; there was no evidence of impairment as reflected in MoCA testing. There was a moderate association between baseline cognition and antidepressant response with a Pearson correlation of 0.453.
In this naturalistic sample of patients with TRD in our clinical service, repeated ketamine infusions significantly decreased depression symptoms without impairing cognitive performance. The baseline cognition may positively predict antidepressant responses of repeated ketamine treatment.
氯胺酮在治疗抵抗性抑郁症（TRD）中作为一种快速起效的抗抑郁药越来越多地被应用于非研究性、临床环境中。然而，很少有研究检查重复使用外消旋氯胺酮输注治疗对 TRD 患者的神经认知影响。为了确定连续输注后的潜在影响，我们进行了回顾性图表审查，以确定正在接受连续静脉输注的患者认知功能的统计学显著变化；同时，我们检查了基线认知作为抗抑郁潜力的潜在预测因子。
22 名 TRD 患者在完成 8-10 次重复静脉氯胺酮输注诱导阶段后接受检查，并在第一次和最后一次氯胺酮治疗前完成他们的抑郁症状评估（用 16 项抑郁症状快速自评量表：QIDS-SR16 测量）和认知功能评估（用蒙特利尔认知评估：MoCA 测量）。
通过递增剂量方案进行重复氯胺酮输注，共 8-10 次输注，产生了 47.2%的抑郁缓解反应；MoCA 测试没有显示认知损害的证据。基线认知与抗抑郁反应之间存在中度关联，皮尔逊相关系数为 0.453。
在我们临床服务中 TRD 患者的自然样本中，重复氯胺酮输注显著降低了抑郁症状，而没有损害认知表现。基线认知可能对重复氯胺酮治疗的抗抑郁反应产生积极预测。
