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Roxas N, Ahuja C, Isom J, Wilkinson ST, Capurso N. A Potential Case of Acute Ketamine Withdrawal: Clinical Implications for the Treatment of Refractory Depression. Am J Psychiatry 2021; 178:588-591. [PMID: 34270337 DOI: 10.1176/appi.ajp.2020.20101480] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Nichole Roxas
- Department of Psychiatry, Yale University School of Medicine, New Haven, Conn
| | - Chaarushi Ahuja
- Department of Psychiatry, Yale University School of Medicine, New Haven, Conn
| | - Jessica Isom
- Department of Psychiatry, Yale University School of Medicine, New Haven, Conn
| | - Samuel T Wilkinson
- Department of Psychiatry, Yale University School of Medicine, New Haven, Conn
| | - Noah Capurso
- Department of Psychiatry, Yale University School of Medicine, New Haven, Conn
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Andrashko V, Novak T, Brunovsky M, Klirova M, Sos P, Horacek J. The Antidepressant Effect of Ketamine Is Dampened by Concomitant Benzodiazepine Medication. Front Psychiatry 2020; 11:844. [PMID: 33005153 PMCID: PMC7485124 DOI: 10.3389/fpsyt.2020.00844] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 08/03/2020] [Indexed: 11/29/2022] Open
Abstract
The rapid antidepressant effect of ketamine has become a breakthrough in the research and treatment of depression. Although predictive and modulating factors of the response to ketamine are broadly studied, little is known about optimal concurrent medication protocols. Concerning gamma-aminobutyric acid neurotransmission being a shared target for both ketamine and benzodiazepines (BZD), we evaluated the influence of BZD on the antidepressant effect of a single ketamine infusion in depressed patients. Data from 47 patients (27 females) with major depression (MADRS ≥ 20, ≥ 1 prior nonresponse to antidepressant treatment in current episode) who participated in two previous studies (EudraCT Number: 2009-010625-39 and 2013-000952-17) entered the analysis. All of the subjects were given an infusion of a subanesthetic dose of racemic ketamine (0.54 mg per kg) as an add-on medication to ongoing antidepressant treatment. Thirteen patients (28%) reached ≥ 50% reduction in MADRS within one week after ketamine administration. Nineteen (40%) patients took concomitant benzodiazepines on a daily basis. The doses of BZDs were significantly higher in nonresponders (p=0.007). ROC analysis distinguished responders from nonresponders by a criterion of >8mg of diazepam equivalent dose (DZ equivalent) with a sensitivity of 80% and a specificity of 85% (p<0.001). RM-ANOVA revealed a different time pattern of response to ketamine between the BZD+ (>8mg of DZ equivalent) and BZD- (≤8mg of DZ equivalent) groups, with a significantly worse outcome in BZD+ on day 3 (p=0.04) and day 7 (p=0.02). The results of the study indicate that concomitant benzodiazepine treatment in higher doses may attenuate ketamine's antidepressant effect. The pathophysiological, clinical and methodological implications of this finding should be considered in future research and ketamine treatment.
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Affiliation(s)
- Veronika Andrashko
- Clinical Research of Mental Disorders, National Institute of Mental Health, Klecany, Czechia.,Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Tomas Novak
- Clinical Research of Mental Disorders, National Institute of Mental Health, Klecany, Czechia.,Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Martin Brunovsky
- Clinical Research of Mental Disorders, National Institute of Mental Health, Klecany, Czechia.,Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Monika Klirova
- Clinical Research of Mental Disorders, National Institute of Mental Health, Klecany, Czechia.,Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Peter Sos
- Clinical Research of Mental Disorders, National Institute of Mental Health, Klecany, Czechia
| | - Jiri Horacek
- Clinical Research of Mental Disorders, National Institute of Mental Health, Klecany, Czechia.,Third Faculty of Medicine, Charles University, Prague, Czechia
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Dome P, Rihmer Z, Gonda X. Suicide Risk in Bipolar Disorder: A Brief Review. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E403. [PMID: 31344941 PMCID: PMC6723289 DOI: 10.3390/medicina55080403] [Citation(s) in RCA: 120] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/15/2019] [Accepted: 07/23/2019] [Indexed: 12/19/2022]
Abstract
Bipolar disorders (BDs) are prevalent mental health illnesses that affect about 1-5% of the total population, have a chronic course and are associated with a markedly elevated premature mortality. One of the contributors for the decreased life expectancy in BD is suicide. Accordingly, the rate of suicide among BD patients is approximately 10-30 times higher than the corresponding rate in the general population. Extant research found that up to 20% of (mostly untreated) BD subjects end their life by suicide, and 20-60% of them attempt suicide at least one in their lifetime. In our paper we briefly recapitulate the current knowledge on the epidemiological aspects of suicide in BD as well as factors associated with suicidal risk in BD. Furthermore, we also discuss concisely the possible means of suicide prevention in BD.
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Affiliation(s)
- Peter Dome
- Department of Psychiatry and Psychotherapy, Semmelweis University, Faculty of Medicine, 1125 Budapest, Hungary.
- National Institute of Psychiatry and Addictions, Laboratory for Suicide Research and Prevention, 1135 Budapest, Hungary.
| | - Zoltan Rihmer
- Department of Psychiatry and Psychotherapy, Semmelweis University, Faculty of Medicine, 1125 Budapest, Hungary
- National Institute of Psychiatry and Addictions, Laboratory for Suicide Research and Prevention, 1135 Budapest, Hungary
| | - Xenia Gonda
- Department of Psychiatry and Psychotherapy, Semmelweis University, Faculty of Medicine, 1125 Budapest, Hungary
- National Institute of Psychiatry and Addictions, Laboratory for Suicide Research and Prevention, 1135 Budapest, Hungary
- MTA-SE Neuropsychopharmacology, Neurochemistry Research Group, Hungarian Academy of Sciences, 1089 Budapest, Hungary
- NAP-2-SE New Antidepressant Target Research Group, Hungarian Brain Research Program, Semmelweis University, 1089 Budapest, Hungary
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Neuroscience-Informed Treatments. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2019; 17:50-51. [PMID: 31975961 PMCID: PMC6493151 DOI: 10.1176/appi.focus.17101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Cook IA. Emerging Therapies in Psychiatry. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2018; 16:241-242. [PMID: 31975917 DOI: 10.1176/appi.focus.20180014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ian A Cook
- Dr. Cook is Chief Translational Innovation Officer for the Semel Institute for Neuroscience and Human Behavior, and is a professor with the Department of Psychiatry and Biobehavioral Sciences of the David Geffen School of Medicine, and the Department of Bioengineering of the Henry Samueli School of Engineering and Applied Science at the University of California, Los Angeles. He is also with the Veterans Affairs Greater Los Angeles Healthcare System.,Dr. Cook reports that his active biomedical device patents are assigned to the University of California. In the past year, he has advised Arctica Health, Cerêve, and NeuroDetect, and UCLA has received research grant funding from NeoSync, Inc., for his work. He has been granted stock options in NeuroSigma, the licensee of some of his inventions, and he currently is on leave as its chief medical officer and senior vice president
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