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双相情感障碍中单剂量与双剂量静脉注射氯胺酮的比较:一项双盲对照临床试验

A Comparison between Single and Double-Dose Intravenous Ketamine Administration in Bipolar Mood Disorder: A Double-Blind Controlled Clinical Trial.

作者信息

Talaei Ali, Farid Hoseini Farhad, Mahdavi Meisam, Salehi Maryam, Karimani Asieh, Afzaljavan Fahimeh

机构信息

Psychiatry and Behavioral Science Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

Research Center for Patient Safety, Mashhad University of Medical Sciences, Mashhad, Iran.

出版信息

Iran J Psychiatry. 2023 Oct;18(4):396-405. doi: 10.18502/ijps.v18i4.13627.

Abstract

As glutamatergic system dysfunction is involved in bipolar depression pathophysiology, the glutamate receptor modulators such as Ketamine have been applied as complementary medication for mood stabilizers. While the treatment is currently just the intravenous injection of a single dose, and there is no robust conclusion on Ketamine effectiveness or its side effects in bipolar patients, this study aimed to consider single- and double-dose intravenous injections of Ketamine in bipolar patients compared to the placebo. In a randomized, double-blind controlled clinical trial, 30 patients diagnosed with bipolar I and II disorders according to DSM-IV-TR (SCID-I) were randomly divided into three groups: the first group received an intravenous injection of Ketamine (0.5 mg/kg) and placebo with a three-day interval, the second group received two doses of Ketamine (0.5 mg/kg) in the same interval, and the third group received two placebo injections. Patients were assessed for depression, anxiety, and mania at various time points, including before the injection, 60 minutes after the injection, on the first, third, fifth, seventh, and 14th day, as well as at the end of the first month using the Hamilton Depression Rating Scale, Beck Anxiety Inventory, and Young Mania Scale, respectively. Data were analyzed using ANOVA and Repeated measure tests. The mean age of patients was 36.8 ± 7.9 years, with 18 females (60%) and 12 (40%) males. Depression and anxiety showed significant differences in both the single- and double-dose Ketamine groups over time (P < 0.01). Moreover, mania displayed significant changes during the study time in the single- and double-dose Ketamine groups, as well as the in the control group. However, during the study time, there were no significant differences observed in depression, anxiety, and mania among the three groups (P = 0.198, P = 0.416, and P = 0.540, respectively). Patients did not indicate any side effects during the study. Intravenous Ketamine administration may relieve depressive manifestations in bipolar patients. The findings suggest that a double dose of Ketamine does not lead to greater improvement than a single dose.

摘要

由于谷氨酸能系统功能障碍参与双相抑郁的病理生理过程,氯胺酮等谷氨酸受体调节剂已被用作心境稳定剂的辅助药物。虽然目前的治疗只是单次静脉注射,且对于氯胺酮在双相情感障碍患者中的有效性或副作用尚无确凿结论,但本研究旨在比较双相情感障碍患者单次和双次静脉注射氯胺酮与安慰剂的效果。在一项随机、双盲对照临床试验中,根据DSM-IV-TR(SCID-I)诊断为双相I型和II型障碍的30名患者被随机分为三组:第一组在间隔三天的时间里接受一次氯胺酮(0.5mg/kg)静脉注射和一次安慰剂注射;第二组在相同间隔内接受两次氯胺酮(0.5mg/kg)注射;第三组接受两次安慰剂注射。分别使用汉密尔顿抑郁量表、贝克焦虑量表和杨氏躁狂量表,在注射前、注射后60分钟、第1、3、5、7和14天以及第一个月末的各个时间点对患者的抑郁、焦虑和躁狂症状进行评估。数据采用方差分析和重复测量检验进行分析。患者的平均年龄为36.8±7.9岁,其中女性18名(60%),男性12名(40%)。随着时间推移,单次和双次氯胺酮治疗组的抑郁和焦虑症状均有显著差异(P<0.01)。此外,在研究期间,单次和双次氯胺酮治疗组以及对照组的躁狂症状均有显著变化。然而,在研究期间,三组之间的抑郁、焦虑和躁狂症状均未观察到显著差异(分别为P = 0.198、P = 0.416和P = 0.540)。患者在研究期间未出现任何副作用。静脉注射氯胺酮可能缓解双相情感障碍患者的抑郁表现。研究结果表明,双倍剂量的氯胺酮并不比单剂量能带来更大改善。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c44e/10593997/a71e4837e956/IJPS-18-396-g001.jpg

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