Can Quetiapine Prolong the Antidepressant Effect of Ketamine?: A 5-Year Follow-up Study
In a 5-year follow-up of 16 treatment‑resistant patients given intravenous ketamine alongside stable antidepressants, the five patients receiving quetiapine had a significantly longer time to relapse (mean 965.8 vs 80.5 days) and three remained in remission at 5 years. These results suggest that adjunctive quetiapine may substantially prolong the antidepressant effect of ketamine.
Authors
- Amiaz, R.
- Saporta, R.
- Noy, A.
Published
Abstract
Purpose
Ketamine, a noncompetitive, high-affinity antagonist of the N-methyl-d-aspartate-type glutamate receptor, has a rapid effect in patients with treatment-resistant disorder, but many patients who respond to intravenous ketamine relapse within several days. The objective of this study was to examine the long-term outcome of patients' mood 5 years after ketamine treatment.
Methods
Sixteen electroconvulsive therapy referrals received at least 1 intravenous ketamine treatment in addition to their stable antidepressant medications. Depression was evaluated using the Inventory of Depressive Symptomatology–Clinician-Rated, Hamilton Rating Scales for Depression, and Montgomery-Åsberg Depression Rating Scale. Anxiety was measured using the Hamilton Rating Scale.
Results
Of 16 patients treated, 6 achieved complete remission, 3 partially responded, and 7 did not respond. At baseline, all patients were treated with antidepressants, 14 patients were also treated with neuroleptics, of whom 5 patients were treated with quetiapine. The time to relapse in the 5 patients taking quetiapine was significantly longer than in patients who were taking other neuroleptics (965.83 ± 824.68 vs 80.5 ± 114.3, Z = 7.001, P = 0.0001). At the 5-year follow-up, 3 of the patients taking quetiapine maintained their remission. Overall levels of depression and anxiety at all times were improved in comparison to baseline.
Conclusions
Our follow-up results suggest that the combination of quetiapine and ketamine can prolong time to relapse after ketamine treatment in patients with treatment-resistant disorder.
Research Summary of 'Can Quetiapine Prolong the Antidepressant Effect of Ketamine?: A 5-Year Follow-up Study'
Introduction
Major depressive disorder (MDD) remains a leading cause of disability and a substantial proportion of patients do not achieve remission with first- and second-line treatments. Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist with additional dopaminergic and μ-opioid activity, has demonstrated rapid antidepressant effects in treatment-resistant patients, but these benefits are often short-lived, with many responders relapsing within days. Previous efforts to sustain ketamine's benefit using sequential treatments such as lamotrigine and riluzole have not shown efficacy, leaving relapse prevention after ketamine as an important clinical challenge. This study is a post hoc analysis aimed at examining whether concomitant use of quetiapine, an atypical antipsychotic with recognised antidepressant and mood-stabilising properties, is associated with prolonged antidepressant effects following ketamine treatment. Amiaz and colleagues report clinical outcomes up to 5 years after an initial course of intravenous ketamine infusions in a small cohort of electroconvulsive therapy (ECT) referrals, focusing on time to relapse and long-term mood and anxiety measures when quetiapine was part of baseline medication regimens.
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Study Details
- Study Typeindividual
- Journal
- Compound
- Topics
- APA Citation
Amiaz, R., Saporta, R., Noy, A., Berkenstadt, H., & Weiser, M. (2021). Can Quetiapine Prolong the Antidepressant Effect of Ketamine?: A 5-Year Follow-up Study. Journal of Clinical Psychopharmacology, 41(6), 673-675. https://doi.org/10.1097/jcp.0000000000001489
References (5)
Papers cited by this study that are also in Blossom
Murrough, J. W., Iosifescu, D. V., Chang, L. C. et al. · American Journal of Psychiatry (2013)
Murrough, J. W., Wan, L., Levitch, C. F. et al. · Journal of Clinical Psychiatry (2015)
Schwartz, J., Murrough, J. W., Iosifescu, D. V. · Evidence-Based Mental Health (2016)
Berman, R. M., Cappiello, A., Anand, A. et al. · Biological Psychiatry (2000)
Fond, G., Loundou, A., Macgregor, A. et al. · Psychopharmacology (2014)
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