Trial PaperAnxiety DisordersDepressive DisordersSchizophreniaMajor Depressive Disorder (MDD)Bipolar DisorderKetamine

Antianhedonic effects of serial intravenous subanaesthetic ketamine in anxious versus nonanxious depression

This posthoc analysis explored the effects of six repeated ketamine infusions (0.5mg/kg) in participants with anxious depression (n = 92) and nonanxious depression (n = 43). Anxious depressed patients were associated with a relatively lower antianhedonic response (47.8 % versus 51.2 %, p > 0.05) and remission (17.4 % versus 27.9 %, p > 0.05) than their non-anxious counterparts. Across both groups, a significant reduction in anhedonic symptoms was observed from the first infusion to the last infusion and at a 2-week follow-up.

Authors

  • Yuping Ning
  • Wei Zheng

Published

Journal of Affective Disorders
individual Study

Abstract

Objectives

Patents with anxious depression have poor treatment outcomes compared to their non-anxious counterparts. Ketamine has a rapid and robust antianhedonic effect, independent of depressive symptoms. The difference in the antianhedonic effect of ketamine between patients with anxious versus nonanxious depression remains unknown.

Methods

One hundred thirty-five Chinese individuals with anxious depression (n = 92) and nonanxious depression (n = 43) received six intravenous infusions of ketamine (0.5 mg/kg). Post hoc analyses compared changes in anhedonic symptoms, as measured by the Montgomery-Åsberg Depression Rating Scale (MADRS), between patients with anxious depression (defined by a Hamilton Depression Rating Scale Anxiety-Somatization score ≥7) and nonanxious depression.

Results

In this study, 68.1 % of patients were found to have anxious depression. Anxious depressed patients were associated with a relatively lower antianhedonic response (47.8 % versus 51.2 %, p > 0.05) and remission (17.4 % versus 27.9 %, p > 0.05) than their non-anxious counterparts. When compared to baseline, a significant reduction in anhedonic symptoms was observed from the first infusion to the last infusion and 2-week follow-up in both groups (all p < 0.05). A linear mixed model did not find a significant group main effect on the MADRS anhedonia subscale scores (F = 0.5, p = 0.46).

Conclusion

This preliminary study shows that repeated intravenous infusions of ketamine rapidly ameliorate anhedonic symptoms in individuals experiencing anxious depression, but these individuals displayed a weaker antianhedonic response to ketamine than nonanxious depressed patients.

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Research Summary of 'Antianhedonic effects of serial intravenous subanaesthetic ketamine in anxious versus nonanxious depression'

Introduction

Anxious depression, defined as unipolar or bipolar depression with high levels of anxiety symptoms, is common and typically associated with more severe illness, poorer treatment outcomes and lower quality of life than nonanxious depression. Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, has attracted attention because it can produce rapid antidepressant, antisuicidal and antianhedonic effects that differ from conventional antidepressants. Previous studies comparing ketamine’s effects in anxious versus nonanxious depression have been inconsistent, and no drug specifically approved to target anhedonia exists despite its high prevalence in major depressive disorder (MDD) and bipolar disorder (BD). Zheng and colleagues conducted a post hoc analysis to determine whether baseline anxiety status modifies the antianhedonic response to repeated subanaesthetic intravenous ketamine. The study specifically tested the hypothesis that people with anxious depression would show a poorer reduction in anhedonic symptoms after six 0.5 mg/kg infusions (over 40 minutes) than those with nonanxious depression, using standard clinical scales to measure anxiety and anhedonia.

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Study Details

References (6)

Papers cited by this study that are also in Blossom

A single infusion of ketamine improves depression scores in patients with anxious bipolar depression

Ionescu, D. F., Luckenbaugh, D. A., Niciu, M. J. et al. · Bipolar Disorders (2014)

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Lally, N., Nugent, A. C., Luckenbaugh, D. A. et al. · Translational Psychiatry (2014)

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Salloum, N. C., Fava, M., Freeman, M. P. et al. · Depression and Anxiety (2018)

Comparative effectiveness of repeated ketamine infusions in treating anhedonia in bipolar and unipolar depression

Zheng, W., Gu, L. M., Sun, C. H. et al. · Journal of Affective Disorders (2022)

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