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Features of dissociation differentially predict antidepressant response to ketamine in treatment-resistant depression.

Authors :
Niciu MJ
Shovestul BJ
Jaso BA
Farmer C
Luckenbaugh DA
Brutsche NE
Park LT
Ballard ED
Zarate CA Jr
Source :
Journal of affective disorders [J Affect Disord] 2018 May; Vol. 232, pp. 310-315. Date of Electronic Publication: 2018 Feb 17.
Publication Year :
2018

Abstract

Background: Ketamine induces rapid and robust antidepressant effects, and many patients also describe dissociation, which is associated with antidepressant response. This follow-up study investigated whether antidepressant efficacy is uniquely related to dissociative symptom clusters.<br />Methods: Treatment-resistant patients with major depressive disorder (MDD) or bipolar disorder (BD) (n = 126) drawn from three studies received a single subanesthetic (0.5 mg/kg) ketamine infusion. Dissociative effects were measured using the Clinician-Administered Dissociative States Scale (CADSS). Antidepressant response was measured using the 17-item Hamilton Depression Rating Scale (HAM-D). A confirmatory factor analysis established the validity of CADSS subscales (derealization, depersonalization, amnesia), and a general linear model with repeated measures was fitted to test whether subscale scores were associated with antidepressant response.<br />Results: Factor validity was supported, with a root mean square error of approximation of .06, a comparative fit index of .97, and a Tucker-Lewis index of .96. Across all studies and timepoints, the depersonalization subscale was positively related to HAM-D percent change. A significant effect of derealization on HAM-D percent change was observed at one timepoint (Day 7) in one study. The amnesia subscale was unrelated to HAM-D percent change.<br />Limitations: Possible inadequate blinding; combined MDD/BD datasets might have underrepresented ketamine's antidepressant efficacy; the possibility of Type I errors in secondary analyses.<br />Conclusions: From a psychometric perspective, researchers may elect to administer only the CADSS depersonalization subscale, given that it was most closely related to antidepressant response. From a neurobiological perspective, mechanistic similarities may exist between ketamine-induced depersonalization and antidepressant response, although off-target effects cannot be excluded.<br /> (Published by Elsevier B.V.)

Details

Language :
English
ISSN :
1573-2517
Volume :
232
Database :
MEDLINE
Journal :
Journal of affective disorders
Publication Type :
Academic Journal
Accession number :
29501990
Full Text :
https://doi.org/10.1016/j.jad.2018.02.049