Regulation of neural responses to emotion perception by ketamine in individuals with treatment-resistant major depressive disorder
Charney, D. S., Collins, K. A., DeWilde, K. E., Fields, J., Iosifescu, D. V., Mathew, S. J., Murrough, J. W., Phillips, M. L., Tang, C. Y., Wong, E.
This open-label between-subjects fMRI study (n=38) investigated the antidepressant effects of ketamine (35mg/70kg) with regard to changes in the neural correlates of emotional processing, 24 hours after infusion, in patients with major depression (n=18) compared to baseline measures from healthy volunteers (n=20). They found that ketamine rapidly increases brain responses to positive emotion, which correlated with increased connectivity of the right caudate during and improvement in depression severity.
Abstract
Introduction: The glutamate N-methyl-D-aspartate receptor antagonist ketamine has demonstrated antidepressant effects in individuals with treatment-resistant major depressive disorder (TRD) within 24 h of a single dose.Methods: The current study utilized functional magnetic resonance imaging (fMRI) and two separate emotion perception tasks to examine the neural effects of ketamine in patients with TRD. One task used happy and neutral facial expressions; the other used sad and neutral facial expressions. Twenty patients with TRD free of concomitant antidepressant medication underwent fMRI at baseline and 24 h following administration of a single intravenous dose of ketamine (0.5 mg kg−1). Adequate data were available for 18 patients for each task. Twenty age- and sex-matched healthy volunteers were scanned at one time point for baseline comparison. Whole-brain, voxel-wise analyses were conducted controlling for a family-wise error rate (FWE) of P<0.05.Results: Compared with healthy volunteers, TRD patients showed reduced neural responses to positive faces within the right caudate. Following ketamine, neural responses to positive faces were selectively increased within a similar region of right caudate. Connectivity analyses showed that greater connectivity of the right caudate during positive emotion perception was associated with improvement in depression severity following ketamine. No main effect of group was observed for the sad faces task.Discussion: Our results indicate that ketamine specifically enhances neural responses to positive emotion within the right caudate in depressed individuals in a pattern that appears to reverse baseline deficits and that connectivity of this region may be important for the antidepressant effects of ketamine.