Department of Psychiatry, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland.
Faculty of Psychology, SWPS University of Social Sciences and Humanities, Sopot, Poland.
Bipolar Disord. 2024 Jun;26(4):356-363. doi: 10.1111/bdi.13409. Epub 2024 Feb 4.
Bipolar depression is the major cause of morbidity in patients with bipolar disorder. It affects psychosocial functioning and markedly impairs occupational productivity. Anhedonia is one of the most debilitating symptoms of depression contributing to treatment resistance. It correlates with suicidality, low quality of life, social withdrawal, and poor treatment response. Currently, there is no approved treatment specifically targeting anhedonia. Emerging evidence suggests that ketamine possesses anti-anhedonic properties in individuals with depression.
The aim of this naturalistic open-label study was to investigate the effect of add-on ketamine treatment on anhedonia in treatment resistant bipolar depression.
Our main interest was the change in patient-reported (Snaith-Hamilton Pleasure Scale) and rater-based anhedonia measure (Montgomery-Åsberg Depression Rating Scale-anhedonia subscale). The secondary aim was to analyze the score change in three Inventory of Depressive Symptomatology-Self Report (IDS-SR) domains: mood/cognition, anxiety/somatic, and sleep. Patients underwent assessments at several time points, including baseline, after the third, fifth, and seventh ketamine infusions. Additionally, a follow-up assessment was conducted 1 week following the final ketamine administration.
We found improvement in anhedonia symptoms according to both patient-reported and rater-based measures. The improvement in IDS-SR domains was most prominent in anxiety/somatic factor and mood/cognition factor, improvement in sleep factor was not observed. No serious adverse events occurred.
Add-on ketamine seems to be a good choice for the treatment of anhedonia in treatment resistant bipolar depression. It also showed a good effect in reducing symptoms of anxiety in this group of patients. Considering unmet needs and the detrimental effect of anhedonia and anxiety, more studies are needed on ketamine treatment in resistant bipolar depression.
双相情感障碍的主要发病原因是抑郁，它影响社会心理功能，明显损害职业生产力。快感缺失是抑郁症最具致残性的症状之一，导致治疗抵抗。它与自杀意念、生活质量低、社会退缩和治疗反应差有关。目前，尚无专门针对快感缺失的批准治疗方法。新出现的证据表明，氯胺酮在抑郁症患者中具有抗快感缺失作用。
本自然主义、开放性标签研究旨在探讨附加氯胺酮治疗对治疗抵抗性双相抑郁快感缺失的疗效。
我们主要关注的是患者报告的（Snaith-Hamilton 快感量表）和评定者基于的快感缺失测量（蒙哥马利-阿斯伯格抑郁评定量表-快感缺失子量表）的变化。次要目的是分析三个抑郁症状自评量表-自我报告（IDS-SR）领域的评分变化：情绪/认知、焦虑/躯体和睡眠。患者在多个时间点进行评估，包括基线、第三次、第五次和第七次氯胺酮输注后，以及最后一次氯胺酮给药后 1 周进行随访评估。
我们发现，根据患者报告和评定者基于的测量，快感缺失症状有所改善。IDS-SR 领域的改善在焦虑/躯体因子和情绪/认知因子中最为明显，睡眠因子的改善未观察到。未发生严重不良事件。
附加氯胺酮似乎是治疗治疗抵抗性双相抑郁快感缺失的一个不错选择。它还在减少这组患者焦虑症状方面显示出良好的效果。考虑到未满足的需求以及快感缺失和焦虑的不利影响，需要更多关于氯胺酮治疗抵抗性双相抑郁的研究。
