Single i.v. ketamine augmentation of newly initiated escitalopram for major depression: results from a randomized, placebo-controlled 4-week study
| Autor: | Yongdong Hu, Si Zu, H F K Chiu, Guang Wang, Xin Rong Ma, Teng-Fei Tian, Y. Xue, Yu-Tao Xiang, Gabor S. Ungvari, J.X. Fang, Christoph U. Correll, Sha Sha, H. Shi, A.S. Wu |
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| Rok vydání: | 2015 |
| Předmět: |
Adult
Male China Adolescent Personality Inventory Kaplan-Meier Estimate Citalopram Young Mania Rating Scale Placebo Severity of Illness Index Drug Administration Schedule 03 medical and health sciences Young Adult 0302 clinical medicine Double-Blind Method Brief Psychiatric Rating Scale Outpatients medicine Escitalopram Humans Ketamine Applied Psychology Proportional Hazards Models Psychiatric Status Rating Scales Depressive Disorder Major Hamilton Rating Scale for Depression Middle Aged medicine.disease Antidepressive Agents 030227 psychiatry Psychiatry and Mental health Treatment Outcome Anesthesia Major depressive disorder Administration Intravenous Female Self Report Psychology 030217 neurology & neurosurgery medicine.drug |
| Zdroj: | Psychological medicine. 46(3) |
| ISSN: | 1469-8978 0033-2917 |
| Popis: | BackgroundWhile oral antidepressants reach efficacy after weeks, single-dose intravenous (i.v.) ketamine has rapid, yet time-limited antidepressant effects. We aimed to determine the efficacy and safety of single-dose i.v. ketamine augmentation of escitalopram in major depressive disorder (MDD).MethodThirty outpatients with severe MDD (17-item Hamilton Rating Scale for Depression total score ⩾24) were randomized to 4 weeks double-blind treatment with escitalopram 10 mg/day+single-dose i.v. ketamine (0.5 mg/kg over 40 min) or escitalopram 10 mg/day + placebo (0.9% i.v. saline). Depressive symptoms were measured using the Montgomery–Asberg Depression Rating Scale (MADRS) and the Quick Inventory of Depressive Symptomatology – Self-Report (QIDS-SR). Suicidal ideation was evaluated with the QIDS-SR item 12. Adverse psychopathological effects were measured with the Brief Psychiatric Rating Scale (BPRS)-positive symptoms, Young Mania Rating Scale (YMRS) and Clinician Administered Dissociative States Scale (CADSS). Patients were assessed at baseline, 1, 2, 4, 24 and 72 h and 7, 14, 21 and 28 days. Time to response (⩾50% MADRS score reduction) was the primary outcome.ResultsBy 4 weeks, more escitalopram + ketamine-treated than escitalopram + placebo-treated patients responded (92.3% v. 57.1%, p = 0.04) and remitted (76.9% v. 14.3%, p = 0.001), with significantly shorter time to response [hazard ratio (HR) 0.04, 95% confidence interval (CI) 0.01–0.22, p < 0.001] and remission (HR 0.11, 95% CI 0.02–0.63, p = 0.01). Compared to escitalopram + placebo, escitalopram + ketamine was associated with significantly lower MADRS scores from 2 h to 2 weeks [(peak = 3 days–2 weeks; effect size (ES) = 1.08–1.18)], QIDS-SR scores from 2 h to 2 weeks (maximum ES = 1.27), and QIDS-SR suicidality from 2 to 72 h (maximum ES = 2.24). Only YMRS scores increased significantly with ketamine augmentation (1 and 2 h), without significant BPRS or CADSS elevation.ConclusionsSingle-dose i.v. ketamine augmentation of escitalopram was safe and effective in severe MDD, holding promise for speeding up early oral antidepressant efficacy. |
| Databáze: | OpenAIRE |
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