Predictors of Response to Ketamine in Treatment Resistant Major Depressive Disorder and Bipolar Disorder

Extant evidence indicates that ketamine exerts rapid antidepressant effects in treatment-resistant depressive (TRD) symptoms as a part of major depressive disorder (MDD) and bipolar disorder (BD). The identification of depressed sub-populations that are more likely to benefit from ketamine treatment...

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Bibliographic Details
Published in:International journal of environmental research and public health 2018-04, Vol.15 (4), p.771
Main Authors: Rong, Carola, Park, Caroline, Rosenblat, Joshua D, Subramaniapillai, Mehala, Zuckerman, Hannah, Fus, Dominika, Lee, Yena L, Pan, Zihang, Brietzke, Elisa, Mansur, Rodrigo B, Cha, Danielle S, Lui, Leanna M W, McIntyre, Roger S
Format: Article
Language:English
Subjects:
Abnormalities
Adiponectin
Alcoholic beverages
Antidepressants
Antidepressive Agents - therapeutic use
Bipolar disorder
Bipolar Disorder - drug therapy
Body mass
Body mass index
Body size
Brain-derived neurotrophic factor
Cognitive ability
Computational neuroscience
Cyanocobalamin
Depressive Disorder, Major - drug therapy
Depressive Disorder, Treatment-Resistant - drug therapy
Emotions
Excitatory Amino Acid Antagonists - therapeutic use
Genetic diversity
Genetics
Glutamine
Humans
Inflammation
Information processing
Ketamine
Ketamine - therapeutic use
Medical imaging
Mental depression
Neuroimaging
Neurology
Pretreatment
Psychiatry
Remission
Signal transduction
Sleep
Sociodemographics
Suicide
Treatment Outcome
Vitamin B12
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Summary:Extant evidence indicates that ketamine exerts rapid antidepressant effects in treatment-resistant depressive (TRD) symptoms as a part of major depressive disorder (MDD) and bipolar disorder (BD). The identification of depressed sub-populations that are more likely to benefit from ketamine treatment remains a priority. In keeping with this view, the present narrative review aims to identify the pretreatment predictors of response to ketamine in TRD as part of MDD and BD. Electronic search engines PubMed/MEDLINE, ClinicalTrials.gov, and Scopus were searched for relevant articles from inception to January 2018. The search term was cross-referenced with the terms , and and/or . Multiple baseline pretreatment predictors of response were identified, including clinical (i.e., Body Mass Index (BMI), history of suicide, family history of alcohol use disorder), peripheral biochemistry (i.e., adiponectin levels, vitamin B12 levels), polysomnography (abnormalities in delta sleep ratio), neurochemistry (i.e., glutamine/glutamate ratio), neuroimaging (i.e., anterior cingulate cortex activity), genetic variation (i.e., Val66Met BDNF allele), and cognitive functioning (i.e., processing speed). High BMI and a positive family history of alcohol use disorder were the most replicated predictors. A pheno-biotype of depression more, or less likely, to benefit with ketamine treatment is far from complete. Notwithstanding, metabolic-inflammatory alterations are emerging as possible pretreatment response predictors of depressive symptom improvement, most notably being cognitive impairment. Sophisticated data-driven computational methods that are iterative and agnostic are more likely to provide actionable baseline pretreatment predictive information.
ISSN:1660-4601
1661-7827
1660-4601
DOI:10.3390/ijerph15040771