Neurocognitive performance and serial intravenous subanesthetic ketamine in treatment-resistant depression

Jun 26, 2014The international journal of neuropsychopharmacology

Brain function and repeated low-dose ketamine in hard-to-treat depression

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Abstract

Significant improvement was observed in visual memory, simple working memory, and complex working memory scores after six ketamine infusions.

The likelihood of response to ketamine infusions was greater in patients with lower attention at baseline.
Improvements in neurocognitive performance were linked to reductions in the severity of depressive symptoms.
No short-term neurocognitive impairment was detected after the completion of six infusions.
The study identified a potential baseline neurocognitive predictor for ketamine response among patients with treatment-resistant depression.
Changes in neurocognitive functioning post-infusion were not associated with the likelihood of relapse during follow-up.

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The N-methyl-D-aspartate glutamate receptor antagonist ketamine has demonstrated rapid antidepressant effects in treatment-resistant depression (TRD). However, evaluation of ketamine's neurocognitive aspects in TRD has started to be explored. This study aims to (1) examine baseline neurocognitive performance and change in severity of depressive symptoms through six ketamine infusions, (2) examine the neurocognitive effects after completion of serial infusions and whether changes were associated to relapse to depression. Six IV infusions of 0.5 mg/Kg ketamine over 40 min were conducted on a Monday-Wednesday-Friday schedule during a 12-d period on 15 patients with TRD followed by a 4-wk observational period. Neurocognitive functioning was assessed using the CogState battery at baseline and at each follow-up visit. Tasks were designed to test attention, memory (working, visual, and verbal), speed of processing, and set shifting. The likelihood of response through six infusions was greater among depressed subjects with lower attention at baseline (F(1,13)=5.59, p=0.034). Significant improvement was found in scores of visual memory (F(4,33.82)=5.12, p=0.002), simple working memory (F(4, 24.85)=3.29, p=0.027) and complex working memory (F(4, 32.76)=4.18, p=0.008) after the last ketamine infusion. However, neurocognitive changes were accounted for by improvement in the severity of depressive symptom. The acute neurocognitive effect after completion of repeated infusions was not associated with the likelihood of subsequent relapse during follow-up. Our findings suggest a potential baseline neurocognitive predictor of ketamine response and the apparently lack of short-term neurocognitive impairment after completion of six ketamine infusions in TRD.

Neurocognitive performance and serial intravenous subanesthetic ketamine in treatment-resistant depression

Abstract

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