title: Neurocognitive performance and serial intravenous subanesthetic ketamine in treatment-resistant depression.
abstract: 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.
authors: Mental Health Service Line,Minneapolis VA Medical Center,Minneapolis, MN,USA.
authors: Paulo R
authors: PR
authors: Shiroma
authors: Mental Health Service Line,Minneapolis VA Medical Center,Minneapolis, MN,USA.
authors: C Sophia
authors: CS
authors: Albott
authors: Department of Psychiatry,University of Minnesota Medical School,Minneapolis, MN,USA.
authors: Brian
authors: B
authors: Johns
authors: Mental Health Service Line,Minneapolis VA Medical Center,Minneapolis, MN,USA.
authors: Paul
authors: P
authors: Thuras
authors: Department of Anesthesiology,Minneapolis VA Medical Center,Minneapolis, MN,USA.
authors: Joseph
authors: J
authors: Wels
authors: Mental Health Service Line,Minneapolis VA Medical Center,Minneapolis, MN,USA.
authors: Kelvin O
authors: KO
authors: Lim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000778:Anesthetics, Dissociative / Q000008:administration & dosage / Q000494:pharmacology*; D001288:Attention / Q000187:drug effects; D003071:Cognition / Q000187:drug effects*; D003863:Depression / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007649:Ketamine / Q000008:administration & dosage / Q000494:pharmacology*; D008297:Male; D008568:Memory / Q000187:drug effects; D008875:Middle Aged; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D016896:Treatment Outcome; D014706:Verbal Learning / Q000187:drug effects; D055815:Young Adult
chemical_list: D000778:Anesthetics, Dissociative; D007649:Ketamine