Examining the impact of comorbid posttraumatic stress disorder on ketamine's real-world effectiveness in treatment-resistant depression.

Autor: Johnson DE; Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, ON, Canada; Mood Disorders Psychopharmacology Unit, Toronto Western Hospital - University Health Network, Toronto, ON, Canada., Rodrigues NB; Mood Disorders Psychopharmacology Unit, Toronto Western Hospital - University Health Network, Toronto, ON, Canada; Department of Psychology, Neuropsychology Track, University of Windsor, Windsor, ON, Canada., Weisz S; Mood Disorders Psychopharmacology Unit, Toronto Western Hospital - University Health Network, Toronto, ON, Canada., Chisamore N; Mood Disorders Psychopharmacology Unit, Toronto Western Hospital - University Health Network, Toronto, ON, Canada; Department of Pharmacology and Toxicology, Temerty Faculty of Medicine, University of Toronto, ON, Canada., Kaczmarek ES; Mood Disorders Psychopharmacology Unit, Toronto Western Hospital - University Health Network, Toronto, ON, Canada; Department of Pharmacology and Toxicology, Temerty Faculty of Medicine, University of Toronto, ON, Canada., Chen-Li DCJ; Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, ON, Canada; Mood Disorders Psychopharmacology Unit, Toronto Western Hospital - University Health Network, Toronto, ON, Canada., Doyle Z; Mood Disorders Psychopharmacology Unit, Toronto Western Hospital - University Health Network, Toronto, ON, Canada., Richardson JD; St. Joseph's Operational Stress Injury Clinic, St. Joseph's Health Care London, London, ON, Canada; MacDonald Franklin OSI Research and Innovation Centre, St. Joseph's Health Care London, London, ON, Canada; Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada., Mansur RB; Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, ON, Canada; Mood Disorders Psychopharmacology Unit, Toronto Western Hospital - University Health Network, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada., McIntyre RS; Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, ON, Canada; Mood Disorders Psychopharmacology Unit, Toronto Western Hospital - University Health Network, Toronto, ON, Canada; Department of Pharmacology and Toxicology, Temerty Faculty of Medicine, University of Toronto, ON, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada., Rosenblat JD; Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, ON, Canada; Mood Disorders Psychopharmacology Unit, Toronto Western Hospital - University Health Network, Toronto, ON, Canada; Department of Pharmacology and Toxicology, Temerty Faculty of Medicine, University of Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada. Electronic address: joshua.rosenblat@uhn.ca.
Jazyk: angličtina
Zdroj: European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology [Eur Neuropsychopharmacol] 2024 Dec 05; Vol. 91, pp. 69-77. Date of Electronic Publication: 2024 Dec 05.
DOI: 10.1016/j.euroneuro.2024.11.008
Abstrakt: Depression with comorbid posttraumatic stress disorder (PTSD) is associated with more severe symptoms and a reduced response to traditional treatments. Although ketamine shows promise as a rapid-acting antidepressant for treatment-resistant depression (TRD), its effectiveness in patients with comorbid PTSD remains underexplored. Therefore, we conducted a retrospective analysis of 134 patients from the Canadian Rapid Treatment Center of Excellence to compare the effectiveness of four ketamine infusions (0.5-0.75 mg/kg) in reducing symptoms of depression and PTSD in TRD patients with and without comorbid PTSD. A repeated-measures linear mixed model was used to evaluate the impact of comorbid PTSD on ketamine's antidepressant effectiveness, measured by the Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR16). Paired samples t-tests were used to assess changes in PTSD symptoms, measured by the PTSD Checklist for DSM-5 (PCL-5). We found a significant main effect of time on QIDS-SR16 scores, F(4, 209.32) = 36.67, p < 0.001, but no significant group-by-time interaction (p = 0.895), suggesting that comorbid PTSD did not impact the antidepressant effectiveness of ketamine. Significant improvements in PTSD symptoms were observed in overall PCL-5 scores, t(66) = 6.66, p < 0.001, and across all PCL-5 symptom clusters with moderate to large effect sizes. In a real-world sample of TRD patients, ketamine was effective in reducing symptoms of depression and PTSD, regardless of PTSD comorbidity. These findings highlight ketamine's potential as a novel intervention for a patient population that is frequently non-responders to conventional treatments. Future randomized controlled trials should explore mediating factors of improvement and long-term effects.
Competing Interests: Conflict of interest Dr. Joshua D Rosenblat has received research grant support from the Canadian Institute of Health Research (CIHR), Physician Services Inc (PSI) Foundation, Labatt Brain Health Network, Brain and Cognition Discovery Foundation (BCDF), Canadian Cancer Society, Canadian Psychiatric Association, Academic Scholars Award, American Psychiatric Association, American Society of Psychopharmacology, University of Toronto, University Health Network Centre for Mental Health, Joseph M. West Family Memorial Fund, Inagene and Timeposters Fellowship and industry funding for speaker/consultation/research fees from iGan, Boehringer Ingelheim, Braxia Health (Canadian Rapid Treatment Centre of Excellence), Braxia Scientific, Janssen, Allergan, Lundbeck, Sunovion and COMPASS. Dr. Roger McIntyre has received research grant support from Global Alliance for Chronic Diseases/Canadian Institutes of Health Research (CIHR)/National Natural Science Foundation of China's Mental Health Team Grant; speaker/consultation fees from Lundbeck, Janssen, Purdue, Pfizer, Otsuka, Takeda, Neurocrine, Sunovion, Bausch Health, Novo Nordisk, Kris, Sanofi, Eisai, Intra-Cellular, NewBridge Pharmaceuticals, Abbvie. Dr. Roger McIntyre is a CEO of Braxia Scientific Corp. All other authors report no financial interests or potential conflicts of interest.
(Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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