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Yun JY, Choi SH, Park S, Yoo SY, Jang JH. Neural correlates of anhedonia in young adults with subthreshold depression: A graph theory approach for cortical-subcortical structural covariance. J Affect Disord 2024; 366:234-243. [PMID: 39216643 DOI: 10.1016/j.jad.2024.08.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 08/27/2024] [Accepted: 08/28/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Anhedonia is an enduring symptom of subthreshold depression (StD) and predict later onset of major depressive disorder (MDD). Brain structural covariance describes the inter-regional distribution of morphological changes compared to healthy controls (HC) and reflects brain maturation and disease progression. We investigated neural correlates of anhedonia from the structural covariance. METHODS T1-weighted brain magnetic resonance images were acquired from 79 young adults (26 StD, 30 MDD, and 23 HC). Intra-individual structural covariance networks of 68 cortical surface area (CSAs), 68 cortical thicknesses (CTs), and 14 subcortical volumes were constructed. Group-level hubs and principal edges were defined using the global and regional graph metrics, compared between groups, and examined for the association with anhedonia severity. RESULTS Global network metrics were comparable among the StD, MDD, and HC. StD exhibited lower centralities of left pallidal volume than HC. StD showed higher centralities than HC in the CSAs of right rostral anterior cingulate cortex (ACC) and pars triangularis, and in the CT of left pars orbitalis. Less anhedonia was associated with higher centralities of left pallidum and right amygdala, higher edge betweenness centralities in the structural covariance (EBSC) of left postcentral gyrus-parahippocampal gyrus and LIPL-right amygdala. More anhedonia was associated with higher centralities of left inferior parietal lobule (LIPL), left postcentral gyrus, left caudal ACC, and higher EBSC of LIPL-left postcentral gyrus, LIPL-right lateral occipital gyrus, and left caudal ACC-parahippocampal gyrus. LIMITATIONS This study has a cross-sectional design. CONCLUSIONS Structural covariance of brain morphologies within the salience and limbic networks, and among the salience-limbic-default mode-somatomotor-visual networks, are possible neural correlates of anhedonia in depression.
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Affiliation(s)
- Je-Yeon Yun
- Seoul National University Hospital, Seoul, Republic of Korea; Yeongeon Student Support Center, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Soo-Hee Choi
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Susan Park
- Department of Psychiatry, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - So Young Yoo
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Psychiatry, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea.
| | - Joon Hwan Jang
- Department of Psychiatry, Seoul National University Health Service Center, Seoul, Republic of Korea; Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Yun JY, Kim YK. Neural correlates of treatment response to ketamine for treatment-resistant depression: A systematic review of MRI-based studies. Psychiatry Res 2024; 340:116092. [PMID: 39116687 DOI: 10.1016/j.psychres.2024.116092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 06/26/2024] [Accepted: 07/20/2024] [Indexed: 08/10/2024]
Abstract
Treatment-resistant depression (TRD) is defined as patients diagnosed with depression having a history of failure with different antidepressants with an adequate dosage and treatment duration. The NMDA receptor antagonist ketamine rapidly reduces depressive symptoms in TRD. We examined neural correlates of treatment response to ketamine in TRD through a systematic review of brain magnetic resonance imaging (MRI) studies. A comprehensive search in PubMed was performed using "ketamine AND depression AND magnetic resonance." The time span for the database queries was "Start date: 2018/01/01; End date: 2024/05/31." Total 41 original articles comprising 1,396 TRD and 587 healthy controls (HC) were included. Diagnosis of depression was made using the Structured Clinical Interview for DSM Disorders (SCID), the Mini-International Neuropsychiatric Interview (MINI), and/or the clinical assessment by psychiatrists. Patients with affective psychotic disorders were excluded. Most studies applied ketamine [0.5mg/kg racemic ketamine and/or 0.25mg/kg S-ketamine] diluted in 60cc of normal saline via intravenous infusion over 40 min one time, four times, or six times spaced 2-3 days apart over 2 weeks. Clinical outcome was defined as either remission, response, and/or percentage changes of depressive symptoms. Brain MRI of the T2*-weighted imaging (resting-state or task performance), arterial spin labeling, diffusion weighted imaging, and T1-weighted imaging were acquired at baseline and mainly 1-3days after the ketamine administration. Only the study results replicated by ≥ 2 studies and were included in the default-mode, salience, fronto-parietal, subcortical, and limbic networks were regarded as meaningful. Putative brain-based markers of treatment response to ketamine in TRD were found in the structural/functional features of limbic (subgenual ACC, hippocampus, cingulum bundle-hippocampal portion; anhedonia/suicidal ideation), salience (dorsal ACC, insula, cingulum bundle-cingulate gyrus portion; thought rumination/suicidal ideation), fronto-parietal (dorsolateral prefrontal cortex, superior longitudinal fasciculus; anhedonia/suicidal ideation), default-mode (posterior cingulate cortex; thought rumination), and subcortical (striatum; anhedonia/thought rumination) networks. Brain features of limbic, salience, and fronto-parietal networks could be useful in predicting the TRD with better response to ketamine in relief of anhedonia, thought rumination, and suicidal ideation.
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Affiliation(s)
- Je-Yeon Yun
- Seoul National University Hospital, Seoul, Republic of Korea; Yeongeon Student Support Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yong-Ku Kim
- Department of Psychiatry, Korea University Ansan Hospital, College of Medicine, Republic of Korea.
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Petrucci ABC, Fernandes JVA, Reis IA, da Silva GHS, Recla BMF, de Mendonça JC, Pedro VCS, D'Assunção LEN, Valiengo LDCL. Ketamine versus electroconvulsive therapy for major depressive episode: An updated systematic review and non-inferiority meta-analysis. Psychiatry Res 2024; 339:115994. [PMID: 38865906 DOI: 10.1016/j.psychres.2024.115994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 05/12/2024] [Accepted: 05/28/2024] [Indexed: 06/14/2024]
Abstract
We conducted a systematic review and meta-analysis to investigate the comparative effectiveness of ketamine versus electroconvulsive therapy (ECT) for the treatment of major depressive episodes (MDEs). PubMed, EMBASE and Cochrane Library databases were systematically searched for randomized controlled trials (RCTs) comparing ketamine and ECT for MDE. The primary outcome was response rate, for which we prespecified a non-inferiority margin of -0.1, based on the largest and most recent RCT. Response was defined as a reduction of at least 50 % in the depression scale score. Six RCTs met the inclusion criteria, comprising 655 patients. In the overall population, ketamine was not non-inferior to ECT in response rate (RD -0.10; 95 % CI -0.26 to 0.05; p = 0.198; I2 = 72 %). The ECT group had a higher reduction in depression scores, but without difference in remission and relapse rates. Regarding safety outcomes, ketamine had better posttreatment cognition scores and reduced muscle pain rate compared with ECT, albeit with an increased rate of dissociative symptoms. In a subanalysis with only inpatients, ketamine was inferior to ECT in response rate (RD -0.15; 95 % CI -0.27 to -0.03; p = 0.014; I2 = 25 %), remission, and change in depression scores. These findings support the use of ECT over ketamine for inpatients. Further RCTs are warranted to clarify the comparative effect of these treatments for outpatients.
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Affiliation(s)
- Arthur Bezerra Cavalcanti Petrucci
- Center of Medical Sciences, Federal University of Paraíba, University City, n/a, President Castelo Branco III. Complex, João Pessoa, Paraíba, Brazil
| | - João Vitor Andrade Fernandes
- Center of Medical Sciences, Federal University of Paraíba, University City, n/a, President Castelo Branco III. Complex, João Pessoa, Paraíba, Brazil
| | - Isabelle Albuquerque Reis
- Center of Medical Sciences, Federal University of Paraíba, University City, n/a, President Castelo Branco III. Complex, João Pessoa, Paraíba, Brazil
| | | | - Brenda Maria Folli Recla
- Multivix Vitória University Center, José Alves Street, 301, Goiabeiras, Vitória, Espírito Santo, Brazil
| | - Juliana Celga de Mendonça
- Multivix Vitória University Center, José Alves Street, 301, Goiabeiras, Vitória, Espírito Santo, Brazil
| | - Victória Carvalho Souto Pedro
- Center of Medical Sciences, Federal University of Paraíba, University City, n/a, President Castelo Branco III. Complex, João Pessoa, Paraíba, Brazil
| | - Luís Eduardo Negreiros D'Assunção
- Center of Medical Sciences, Federal University of Paraíba, University City, n/a, President Castelo Branco III. Complex, João Pessoa, Paraíba, Brazil
| | - Leandro da Costa Lane Valiengo
- Laboratory of Neurosciences (LIM-27), Institute of Psychiatry, University Hospital, University of São Paulo, Doctor Ovídio Pires de Campos Street, 785, Cerqueira César, São Paulo, São Paulo, Brazil.
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Kwaśny A, Kwaśna J, Wilkowska A, Szarmach J, Słupski J, Włodarczyk A, Cubała WJ. Ketamine treatment for anhedonia in unipolar and bipolar depression: a systematic review. Eur Neuropsychopharmacol 2024; 86:20-34. [PMID: 38917771 DOI: 10.1016/j.euroneuro.2024.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/16/2024] [Accepted: 04/21/2024] [Indexed: 06/27/2024]
Abstract
Ketamine, an N-methyl-D-aspartate receptor antagonist, is a racemic mixture of esketamine and arketamine used to treat unipolar and bipolar depression. Preliminary reports indicate that it may be beneficial for depressed patients reporting symptoms of anhedonia. In this systematic review we aim to assess and analyze the existing body of evidence regarding the therapeutic effects of ketamine on the domain of anhedonia. Electronic databases (PubMed, APA Psycinfo and Web of Science) were searched from inception to November 2023. Protocol was registered in PROSPERO under the identifier CRD42023476603. A total of twenty-two studies, including four randomized-controlled trials and eighteen open-label trials were included. All studies reported alleviation of anhedonia symptoms following ketamine or esketamine administration, regardless of the number of infusions. Several important limitations were included, first and foremost low number of placebo-controlled randomized-controlled trials. This review indicates a potential anti-anhedonic effect of ketamine in patients with depression. Several trials used neuroimaging techniques which confirm ketamine's effect on functional connectivity correlating with the improvement in anhedonia. Despite considerable variations in methodology and the specific brain regions investigated, these studies collectively point towards ketamine's neuroplastic effects in mitigating anhedonia.
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Affiliation(s)
- Aleksander Kwaśny
- Department of Psychiatry, Faculty of Medicine, Medical University of Gdańsk, 80-214 Gdańsk, Poland.
| | - Julia Kwaśna
- Department of Psychiatry, Faculty of Medicine, Medical University of Gdańsk, 80-214 Gdańsk, Poland
| | - Alina Wilkowska
- Department of Psychiatry, Faculty of Medicine, Medical University of Gdańsk, 80-214 Gdańsk, Poland
| | - Joanna Szarmach
- Department of Psychiatry, Faculty of Medicine, Medical University of Gdańsk, 80-214 Gdańsk, Poland
| | - Jakub Słupski
- Department of Psychiatry, Faculty of Medicine, Medical University of Gdańsk, 80-214 Gdańsk, Poland
| | - Adam Włodarczyk
- Department of Psychiatry, Faculty of Medicine, Medical University of Gdańsk, 80-214 Gdańsk, Poland
| | - Wiesław Jerzy Cubała
- Department of Psychiatry, Faculty of Medicine, Medical University of Gdańsk, 80-214 Gdańsk, Poland
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Davis LL, Hamner MB. Post-traumatic stress disorder: the role of the amygdala and potential therapeutic interventions - a review. Front Psychiatry 2024; 15:1356563. [PMID: 38903645 PMCID: PMC11187309 DOI: 10.3389/fpsyt.2024.1356563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 05/16/2024] [Indexed: 06/22/2024] Open
Abstract
Introduction Post-traumatic stress disorder (PTSD) is a psychiatric disorder triggered by exposure to a life-threatening or sexually violent traumatic event, and is characterized by symptoms involving intrusive re-experiencing, persistent avoidance of associated stimuli, emotional and cognitive disturbances, and hyperarousal for long periods after the trauma has occurred. These debilitating symptoms induce occupational and social impairments that contribute to a significant clinical burden for PTSD patients, and substantial socioeconomic costs, reaching approximately $20,000 dollars per individual with PTSD each year in the US. Despite increased translational research focus in the field of PTSD, the development of novel, effective pharmacotherapies for its treatment remains an important unmet clinical need. Observations In this review, we summarize the evidence implicating dysfunctional activity of the amygdala in the pathophysiology of PTSD. We identify the transient receptor potential canonical (TRPC) ion channels as promising drug targets given their distribution in the amygdala, and evidence from animal studies demonstrating their role in fear response modulation. We discuss the evidence-based pharmacotherapy and psychotherapy treatment approaches for PTSD. Discussion In view of the prevalence and economic burden associated with PTSD, further investigation is warranted into novel treatment approaches based on our knowledge of the involvement of brain circuitry and the role of the amygdala in PTSD, as well as the potential added value of combined pharmacotherapy and psychotherapy to better manage PTSD symptoms.
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Affiliation(s)
- Lori L. Davis
- Mental Health Service, Birmingham VA Health Care System, Birmingham, AL, United States
- Department of Psychiatry, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, United States
- Department of Psychiatry, University of Alabama College of Community Health Science, Tuscaloosa, AL, United States
| | - Mark B. Hamner
- Department of Veterans Affairs, Ralph H. Johnson VA Medical Center, Charleston, SC, United States
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
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Martens MAG, Zghoul T, Watson E, Rieger SW, Capitão LP, Harmer CJ. Acute neural effects of the mood stabiliser lamotrigine on emotional processing in healthy volunteers: a randomised control trial. Transl Psychiatry 2024; 14:211. [PMID: 38802372 PMCID: PMC11130123 DOI: 10.1038/s41398-024-02944-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 05/14/2024] [Accepted: 05/17/2024] [Indexed: 05/29/2024] Open
Abstract
Lamotrigine is an effective mood stabiliser, largely used for the management and prevention of depression in bipolar disorder. The neuropsychological mechanisms by which lamotrigine acts to relieve symptoms as well as its neural effects on emotional processing remain unclear. The primary objective of this current study was to investigate the impact of an acute dose of lamotrigine on the neural response to a well-characterised fMRI task probing implicit emotional processing relevant to negative bias. 31 healthy participants were administered either a single dose of lamotrigine (300 mg, n = 14) or placebo (n = 17) in a randomized, double-blind design. Inside the 3 T MRI scanner, participants completed a covert emotional faces gender discrimination task. Brain activations showing significant group differences were identified using voxel-wise general linear model (GLM) nonparametric permutation testing, with threshold free cluster enhancement (TFCE) and a family wise error (FWE)-corrected cluster significance threshold of p < 0.05. Participants receiving lamotrigine were more accurate at identifying the gender of fearful (but not happy or angry) faces. A network of regions associated with emotional processing, including amygdala, insula, and the anterior cingulate cortex (ACC), was significantly less activated in the lamotrigine group compared to the placebo group across emotional facial expressions. A single dose of lamotrigine reduced activation in limbic areas in response to faces with both positive and negative expressions, suggesting a valence-independent effect. However, at a behavioural level lamotrigine appeared to reduce the distracting effect of fear on face discrimination. Such effects may be relevant to the mood stabilisation effects of lamotrigine.
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Affiliation(s)
- Marieke A G Martens
- Department of Psychiatry, University of Oxford, Oxford, UK.
- Oxford Health NHS Foundation Trust, Oxford, UK.
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK.
| | - Tarek Zghoul
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Evelyn Watson
- Department of Psychiatry, University of Oxford, Oxford, UK
- Institute of Sport Exercise and Health, Faculty of Medical Sciences, University College London, London, UK
- Institute of Cognitive Neuroscience, Faculty of Brain Sciences, University College London, London, UK
| | - Sebastian W Rieger
- Department of Psychiatry, University of Oxford, Oxford, UK
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
| | - Liliana P Capitão
- Psychology Research Centre (CIPsi), School of Psychology, University of Minho, Braga, Portugal
| | - Catherine J Harmer
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
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Gauer LE, Cavalcanti S, Simoes Moreira DDA, Teixeira G, Quevedo J. Author reply to letter to the editor regarding "Efficacy and adverse effects of ketamine versus electroconvulsive therapy for major depressive disorder: A systematic review and meta-analysis.". J Affect Disord 2024; 350:379-381. [PMID: 38199401 DOI: 10.1016/j.jad.2023.12.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024]
Affiliation(s)
| | - Stefanie Cavalcanti
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth Houston), Houston, TX, USA; Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth Houston), Houston, TX, USA
| | | | | | - João Quevedo
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth Houston), Houston, TX, USA; Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth Houston), Houston, TX, USA; Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX, USA; Translational Psychiatry Laboratory, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil.
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Fan S, Zhang J, Wu Y, Yu Y, Zheng H, Guo YY, Ji Y, Pang X, Tian Y. Changed brain entropy and functional connectivity patterns induced by electroconvulsive therapy in majoy depression disorder. Psychiatry Res Neuroimaging 2024; 339:111788. [PMID: 38335560 DOI: 10.1016/j.pscychresns.2024.111788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 12/09/2023] [Accepted: 01/08/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE Our objective is to innovatively integrate both linear and nonlinear characteristics of brain signals in Electroconvulsive Therapy (ECT) research, with the goal of uncovering deeper insights into the pathogenesis of Major Depressive Disorder (MDD) and identifying novel targets for other physical intervention therapies. METHODS We measured brain entropy (BEN) in 42 MDD patients and 42 matched healthy controls (HC) using rs-fMRI data. Brain regions that differed significantly in patients with MDD before and after ECT were extracted. Then, we use these brain regions as seed points to investigate the differences in whole-brain resting-state functional connectivity (RSFC) patterns before and after ECT. RESULTS Compared to HCs, patients had higher BEN levels in the right precuneus (PCUN.R) and right angular gyrus (ANG.R). After ECT, patients had lower BEN levels in the PCUN.R and ANG.R. Compared with before ECT, patients showed significantly increased RSFC after ECT between the PCUN.R and right middle temporal gyrus and ANG.R. Significantly increased RSFC was observed between the ANG.R and right middle frontal gyrus and right supramarginal gyrus after ECT. CONCLUSION Combining the linear and nonlinear characteristics of brain signals can effectively explore the pathogenesis of depression and provide new targets for ECT.
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Affiliation(s)
- Siyu Fan
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei. 230022, PR China
| | - Jiahua Zhang
- The College of Mental Health and Psychological Sciences, Anhui Medical University, Hefei 230032, PR China
| | - Yue Wu
- Department of Psychology and Sleep Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei,. 230601, PR China
| | - Yue Yu
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei. 230022, PR China
| | - Hao Zheng
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei. 230022, PR China
| | - Yuan Yuan Guo
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei. 230022, PR China
| | - Yang Ji
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei. 230022, PR China
| | - Xiaonan Pang
- Department of Neurology, the Second Affiliated Hospital of Anhui Medical University, Hefei 230601, PR China.
| | - Yanghua Tian
- The College of Mental Health and Psychological Sciences, Anhui Medical University, Hefei 230032, PR China; Department of Neurology, the Second Affiliated Hospital of Anhui Medical University, Hefei 230601, PR China; Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, 230032, PR China; Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei, 230088, PR China; Department of Psychology and Sleep Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei,. 230601, PR China.
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Rengasamy M, Mathew S, Howland R, Griffo A, Panny B, Price R. Neural connectivity moderators and mechanisms of ketamine treatment among treatment-resistant depressed patients: a randomized controlled trial. EBioMedicine 2024; 99:104902. [PMID: 38141395 PMCID: PMC10788398 DOI: 10.1016/j.ebiom.2023.104902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 11/18/2023] [Accepted: 11/20/2023] [Indexed: 12/25/2023] Open
Abstract
BACKGROUND Intravenous (IV) ketamine has emerged as a rapid and effective treatment for TRD. However, the specific neural mechanisms of ketamine's effects in humans remains unclear. Although neuroplasticity is implicated as a mechanism of action in animal models, relatively few randomized controlled trials (RCTs) in TRD patients have examined ketamine's impact on functional connectivity, a posited functional marker of neuroplasticity-particularly in the context of a mood-induction paradigm (termed miFC). METHODS 152 adults with TRD (63% female; 37% male) were randomly allocated to receive a single infusion of ketamine or saline in a 2:1 ratio. We examined changes in connectivity (from baseline to 24-h post-infusion) that differed by treatment, and whether clinical treatment response at 24-h post-infusion was uniquely related (among patients allocated to ketamine relative to saline) to (1) pre-treatment connectivity and (2) changes in connectivity. We examined both miFC and rsFC, using prefrontal cortex and limbic seed regions. We also conducted a multiverse analysis to examine findings most robust against analytic decisions. FINDINGS Across both miFC and rsFC, ketamine was associated with greater in prefrontal/limbic connectivity compared to saline, and lower baseline connectivity of limbic and prefrontal regions predicted greater treatment response in patients receiving ketamine. Greater connectivity increases in participants receiving ketamine was uniquely related to greater treatment response. In addition, certain findings were identified as being reproducible against different analytic decisions in multiverse analyses. INTERPRETATION Our findings identify specific neural connectivity patterns impacted by ketamine and were uniquely related to outcomes following ketamine (relative to saline). These findings generally support prominent neuroplasticity models of ketamine's therapeutic efficacy. These findings lay new groundwork for understanding how to enhance and optimize ketamine treatments and develop novel rapid-acting treatments for depression. FUNDING This research was supported by NIH grant R01MH113857 and by the Clinical and Translational Sciences Institute at the University of Pittsburgh (UL1-TR-001857).
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Affiliation(s)
- Manivel Rengasamy
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Sanjay Mathew
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA; Michael E. Debakey VA Medical Center, Houston, TX, USA; The Menninger Clinic, Houston, TX, USA
| | - Robert Howland
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Angela Griffo
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Benjamin Panny
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rebecca Price
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA; Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
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10
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Costi S. Ketamine for Major Depressive Disorder. Curr Top Behav Neurosci 2024; 66:131-147. [PMID: 37922100 DOI: 10.1007/7854_2023_453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2023]
Abstract
Major Depressive Disorder (MDD) is a leading cause of disability worldwide. Conventional antidepressant treatment is characterised by a significant time to onset of therapeutic action (approximately 2 weeks) and fails to achieve a stable remission of symptoms in one-third of subjects with MDD. In the last 20 years the discovery of antidepressant effects of the N-methyl-d-aspartate (NMDA) receptor antagonist ketamine as a rapid acting (within hours) and sustained (up to 7 days) antidepressant has represented a major paradigm shift in the field.The present chapter reviews the pharmacology, safety, and efficacy of ketamine as a novel therapeutic agent for MDD and specifically for subjects who did not respond to conventional antidepressant (treatment resistant depression). The impact of ketamine on suicidal ideation, the availability of brain biomarkers of ketamine treatment response and the association of ketamine and psychotherapy are considered.
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Affiliation(s)
- Sara Costi
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK.
- Oxford Health Foundation Trust, Warneford Hospital, Oxford, UK.
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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11
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Zavaliangos-Petropulu A, McClintock SM, Joshi SH, Taraku B, Al-Sharif NB, Espinoza RT, Narr KL. Hippocampal subfield volumes in treatment resistant depression and serial ketamine treatment. Front Psychiatry 2023; 14:1227879. [PMID: 37876623 PMCID: PMC10590913 DOI: 10.3389/fpsyt.2023.1227879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/11/2023] [Indexed: 10/26/2023] Open
Abstract
Introduction Subanesthetic ketamine is a rapidly acting antidepressant that has also been found to improve neurocognitive performance in adult patients with treatment resistant depression (TRD). Provisional evidence suggests that ketamine may induce change in hippocampal volume and that larger pre-treatment volumes might be related to positive clinical outcomes. Here, we examine the effects of serial ketamine treatment on hippocampal subfield volumes and relationships between pre-treatment subfield volumes and changes in depressive symptoms and neurocognitive performance. Methods Patients with TRD (N = 66; 31M/35F; age = 39.5 ± 11.1 years) received four ketamine infusions (0.5 mg/kg) over 2 weeks. Structural MRI scans, the National Institutes of Health Toolbox (NIHT) Cognition Battery, and Hamilton Depression Rating Scale (HDRS) were collected at baseline, 24 h after the first and fourth ketamine infusion, and 5 weeks post-treatment. The same data was collected for 32 age and sex matched healthy controls (HC; 17M/15F; age = 35.03 ± 12.2 years) at one timepoint. Subfield (CA1/CA3/CA4/subiculum/molecular layer/GC-ML-DG) volumes corrected for whole hippocampal volume were compared across time, between treatment remitters/non-remitters, and patients and HCs using linear regression models. Relationships between pre-treatment subfield volumes and clinical and cognitive outcomes were also tested. All analyses included Bonferroni correction. Results Patients had smaller pre-treatment left CA4 (p = 0.004) and GC.ML.DG (p = 0.004) volumes compared to HC, but subfield volumes remained stable following ketamine treatment (all p > 0.05). Pre-treatment or change in hippocampal subfield volumes over time showed no variation by remission status nor correlated with depressive symptoms (p > 0.05). Pre-treatment left CA4 was negatively correlated with improved processing speed after single (p = 0.0003) and serial ketamine infusion (p = 0.005). Left GC.ML.DG also negatively correlated with improved processing speed after single infusion (p = 0.001). Right pre-treatment CA3 positively correlated with changes in list sorting working memory at follow-up (p = 0.0007). Discussion These results provide new evidence to suggest that hippocampal subfield volumes at baseline may present a biomarker for neurocognitive improvement following ketamine treatment in TRD. In contrast, pre-treatment subfield volumes and changes in subfield volumes showed negligible relationships with ketamine-related improvements in depressive symptoms.
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Affiliation(s)
- Artemis Zavaliangos-Petropulu
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
| | - Shawn M. McClintock
- Division of Psychology, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, United States
| | - Shantanu H. Joshi
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
| | - Brandon Taraku
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
| | - Noor B. Al-Sharif
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
| | - Randall T. Espinoza
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
| | - Katherine L. Narr
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
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12
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Domke AK, Hempel M, Hartling C, Stippl A, Carstens L, Gruzman R, Herrera Melendez AL, Bajbouj M, Gärtner M, Grimm S. Functional connectivity changes between amygdala and prefrontal cortex after ECT are associated with improvement in distinct depressive symptoms. Eur Arch Psychiatry Clin Neurosci 2023; 273:1489-1499. [PMID: 36715751 PMCID: PMC10465635 DOI: 10.1007/s00406-023-01552-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 01/09/2023] [Indexed: 01/31/2023]
Abstract
Electroconvulsive therapy (ECT) is one of the most effective treatments for treatment-resistant depression. However, the underlying mechanisms of action are not yet fully understood. The investigation of depression-specific networks using resting-state fMRI and the relation to differential symptom improvement might be an innovative approach providing new insights into the underlying processes. In this naturalistic study, we investigated the relationship between changes in resting-state functional connectivity (rsFC) and symptom improvement after ECT in 21 patients with treatment-resistant depression. We investigated rsFC before and after ECT and focused our analyses on FC changes directly related to symptom reduction and on FC at baseline to identify neural targets that might predict individual clinical responses to ECT. Additional analyses were performed to identify the direct relationship between rsFC change and symptom dimensions such as sadness, negative thoughts, detachment, and neurovegetative symptoms. An increase in rsFC between the left amygdala and left dorsolateral prefrontal cortex (DLPFC) after ECT was related to overall symptom reduction (Bonferroni-corrected p = 0.033) as well as to a reduction in specific symptoms such as sadness (r = 0.524, uncorrected p = 0.014), negative thoughts (r = 0.700, Bonferroni-corrected p = 0.002) and detachment (r = 0.663, p = 0.004), but not in neurovegetative symptoms. Furthermore, high baseline rsFC between the left amygdala and the right frontal pole (FP) predicted treatment outcome (uncorrected p = 0.039). We conclude that changes in FC in regions of the limbic-prefrontal network are associated with symptom improvement, particularly in affective and cognitive dimensions. Frontal-limbic connectivity has the potential to predict symptom improvement after ECT. Further research combining functional imaging biomarkers and a symptom-based approach might be promising.
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Affiliation(s)
- Ann-Kathrin Domke
- Department of Psychiatry, Centre for Affective Neuroscience (CAN), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany.
| | - Moritz Hempel
- Department of Psychology, MSB Medical School Berlin, Rüdesheimer Straße 50, 14197, Berlin, Germany
| | - Corinna Hartling
- Department of Psychiatry, Centre for Affective Neuroscience (CAN), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Anna Stippl
- Department of Psychiatry, Centre for Affective Neuroscience (CAN), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Luisa Carstens
- Department of Psychology, MSB Medical School Berlin, Rüdesheimer Straße 50, 14197, Berlin, Germany
| | - Rebecca Gruzman
- Department of Psychology, MSB Medical School Berlin, Rüdesheimer Straße 50, 14197, Berlin, Germany
| | - Ana Lucia Herrera Melendez
- Department of Psychiatry, Centre for Affective Neuroscience (CAN), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Malek Bajbouj
- Department of Psychiatry, Centre for Affective Neuroscience (CAN), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Matti Gärtner
- Department of Psychiatry, Centre for Affective Neuroscience (CAN), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
- Department of Psychology, MSB Medical School Berlin, Rüdesheimer Straße 50, 14197, Berlin, Germany
| | - Simone Grimm
- Department of Psychiatry, Centre for Affective Neuroscience (CAN), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
- Department of Psychology, MSB Medical School Berlin, Rüdesheimer Straße 50, 14197, Berlin, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland
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13
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Medeiros GC, Matheson M, Demo I, Reid MJ, Matheson S, Twose C, Smith GS, Gould TD, Zarate CA, Barrett FS, Goes FS. Brain-based correlates of antidepressant response to ketamine: a comprehensive systematic review of neuroimaging studies. Lancet Psychiatry 2023; 10:790-800. [PMID: 37625426 DOI: 10.1016/s2215-0366(23)00183-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/28/2023] [Accepted: 05/12/2023] [Indexed: 08/27/2023]
Abstract
Ketamine is an effective antidepressant, but there is substantial variability in patient response and the precise mechanism of action is unclear. Neuroimaging can provide predictive and mechanistic insights, but findings are limited by small sample sizes. This systematic review covers neuroimaging studies investigating baseline (pre-treatment) and longitudinal (post-treatment) biomarkers of responses to ketamine. All modalities were included. We performed searches of five electronic databases (from inception to April 26, 2022). 69 studies were included (with 1751 participants). There was substantial methodological heterogeneity and no well replicated biomarker. However, we found convergence across some significant results, particularly in longitudinal biomarkers. Response to ketamine was associated with post-treatment increases in gamma power in frontoparietal regions in electrophysiological studies, post-treatment increases in functional connectivity within the prefrontal cortex, and post-treatment increases in the functional activation of the striatum. Although a well replicated neuroimaging biomarker of ketamine response was not identified, there are biomarkers that warrant further investigation.
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Affiliation(s)
- Gustavo C Medeiros
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Malcolm Matheson
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Isabella Demo
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew J Reid
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Claire Twose
- Welch Medical Library, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gwenn S Smith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Todd D Gould
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Pharmacology, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Anatomy and Neurobiology, University of Maryland School of Medicine, Baltimore, MD, USA; Veterans Affairs Maryland Health Care System, Baltimore, MD, USA
| | - Carlos A Zarate
- Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, NIMH-NIH, Bethesda, MD, USA
| | - Frederick S Barrett
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neuroscience, Department of Psychological and Brain Sciences, and Center for Psychedelic and Consciousness Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Fernando S Goes
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Sen ZD, Chand T, Danyeli LV, Kumar VJ, Colic L, Li M, Yemisken M, Javaheripour N, Refisch A, Opel N, Macharadze T, Kretzschmar M, Ozkan E, Deliano M, Walter M. The effect of ketamine on affective modulation of the startle reflex and its resting-state brain correlates. Sci Rep 2023; 13:13323. [PMID: 37587171 PMCID: PMC10432502 DOI: 10.1038/s41598-023-40099-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 08/04/2023] [Indexed: 08/18/2023] Open
Abstract
Ketamine is a rapid-acting antidepressant that also influences neural reactivity to affective stimuli. However, the effect of ketamine on behavioral affective reactivity is yet to be elucidated. The affect-modulated startle reflex paradigm (AMSR) allows examining the valence-specific aspects of behavioral affective reactivity. We hypothesized that ketamine alters the modulation of the startle reflex during processing of unpleasant and pleasant stimuli and weakens the resting-state functional connectivity (rsFC) within the modulatory pathway, namely between the centromedial nucleus of the amygdala and nucleus reticularis pontis caudalis. In a randomized, double-blind, placebo-controlled, cross-over study, thirty-two healthy male participants underwent ultra-high field resting-state functional magnetic resonance imaging at 7 T before and 24 h after placebo and S-ketamine infusions. Participants completed the AMSR task at baseline and one day after each infusion. In contrast to our hypothesis, ketamine infusion did not impact startle potentiation during processing of unpleasant stimuli but resulted in diminished startle attenuation during processing of pleasant stimuli. This diminishment significantly correlated with end-of-infusion plasma levels of ketamine and norketamine. Furthermore, ketamine induced a decrease in rsFC within the modulatory startle reflex pathway. The results of this first study on the effect of ketamine on the AMSR suggest that ketamine might attenuate the motivational significance of pleasant stimuli in healthy participants one day after infusion.
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Affiliation(s)
- Zümrüt Duygu Sen
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07743, Jena, Germany
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany
- Department of Psychiatry and Psychotherapy, University Tübingen, Tübingen, Germany
- German Center for Mental Health (DZPG), Halle-Jena-Magdeburg Site, Jena, Germany
| | - Tara Chand
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07743, Jena, Germany
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany
- Department of Clinical Psychology, Friedrich Schiller University Jena, Am Steiger 3-1, 07743, Jena, Germany
- Jindal Institute of Behavioural Sciences, O. P. Jindal Global University (Sonipat), Haryana, India
| | - Lena Vera Danyeli
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07743, Jena, Germany
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany
- Department of Psychiatry and Psychotherapy, University Tübingen, Tübingen, Germany
| | | | - Lejla Colic
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07743, Jena, Germany
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany
- German Center for Mental Health (DZPG), Halle-Jena-Magdeburg Site, Jena, Germany
| | - Meng Li
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07743, Jena, Germany
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany
- German Center for Mental Health (DZPG), Halle-Jena-Magdeburg Site, Jena, Germany
| | - Merve Yemisken
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany
| | - Nooshin Javaheripour
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07743, Jena, Germany
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany
| | - Alexander Refisch
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07743, Jena, Germany
| | - Nils Opel
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07743, Jena, Germany
- German Center for Mental Health (DZPG), Halle-Jena-Magdeburg Site, Jena, Germany
| | - Tamar Macharadze
- Department of Anesthesiology and Intensive Care Medicine, Medical Faculty, Otto-Von-Guericke-Universität Magdeburg, Magdeburg, Germany
- Department Systems Physiology of Learning, Leibniz Institute for Neurobiology, Magdeburg, Germany
- Center for Behavioral Brain Sciences, Magdeburg, Germany
| | - Moritz Kretzschmar
- Department of Anesthesiology and Intensive Care Medicine, Medical Faculty, Otto-Von-Guericke-Universität Magdeburg, Magdeburg, Germany
| | - Esra Ozkan
- Koç University Research Center for Translational Medicine, Istanbul, Turkey
| | - Matthias Deliano
- Center for Behavioral Brain Sciences, Magdeburg, Germany.
- Leibniz Institute for Neurobiology, Magdeburg, Combinatorial NeuroImaging Core Facility, Brenneckestraße 6, 39118, Magdeburg, Germany.
| | - Martin Walter
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07743, Jena, Germany.
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany.
- Department of Psychiatry and Psychotherapy, University Tübingen, Tübingen, Germany.
- German Center for Mental Health (DZPG), Halle-Jena-Magdeburg Site, Jena, Germany.
- Max Planck Institute for Biological Cybernetics, Tübingen, Germany.
- Center for Behavioral Brain Sciences, Magdeburg, Germany.
- Leibniz Institute for Neurobiology, Magdeburg, Germany.
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15
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Kotoula V, Evans JW, Punturieri CE, Zarate CA. Review: The use of functional magnetic resonance imaging (fMRI) in clinical trials and experimental research studies for depression. FRONTIERS IN NEUROIMAGING 2023; 2:1110258. [PMID: 37554642 PMCID: PMC10406217 DOI: 10.3389/fnimg.2023.1110258] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 06/12/2023] [Indexed: 08/10/2023]
Abstract
Functional magnetic resonance imaging (fMRI) is a non-invasive technique that can be used to examine neural responses with and without the use of a functional task. Indeed, fMRI has been used in clinical trials and pharmacological research studies. In mental health, it has been used to identify brain areas linked to specific symptoms but also has the potential to help identify possible treatment targets. Despite fMRI's many advantages, such findings are rarely the primary outcome measure in clinical trials or research studies. This article reviews fMRI studies in depression that sought to assess the efficacy and mechanism of action of compounds with antidepressant effects. Our search results focused on selective serotonin reuptake inhibitors (SSRIs), the most commonly prescribed treatments for depression and ketamine, a fast-acting antidepressant treatment. Normalization of amygdala hyperactivity in response to negative emotional stimuli was found to underlie successful treatment response to SSRIs as well as ketamine, indicating a potential common pathway for both conventional and fast-acting antidepressants. Ketamine's rapid antidepressant effects make it a particularly useful compound for studying depression with fMRI; its effects on brain activity and connectivity trended toward normalizing the increases and decreases in brain activity and connectivity associated with depression. These findings highlight the considerable promise of fMRI as a tool for identifying treatment targets in depression. However, additional studies with improved methodology and study design are needed before fMRI findings can be translated into meaningful clinical trial outcomes.
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Kotoula V, Evans JW, Punturieri C, Johnson SC, Zarate CA. Functional MRI markers for treatment-resistant depression: Insights and challenges. PROGRESS IN BRAIN RESEARCH 2023; 278:117-148. [PMID: 37414490 PMCID: PMC10501192 DOI: 10.1016/bs.pbr.2023.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
Imaging studies of treatment-resistant depression (TRD) have examined brain activity, structure, and metabolite concentrations to identify critical areas of investigation in TRD as well as potential targets for treatment interventions. This chapter provides an overview of the main findings of studies using three imaging modalities: structural magnetic resonance imaging (MRI), functional MRI (fMRI), and magnetic resonance spectroscopy (MRS). Decreased connectivity and metabolite concentrations in frontal brain areas appear to characterize TRD, although results are not consistent across studies. Treatment interventions, including rapid-acting antidepressants and transcranial magnetic stimulation (TMS), have shown some efficacy in reversing these changes while alleviating depressive symptoms. However, comparatively few TRD imaging studies have been conducted, and these studies often have relatively small sample sizes or employ different methods to examine a variety of brain areas, making it difficult to draw firm conclusions from imaging studies about the pathophysiology of TRD. Larger studies with more unified hypotheses, as well as data sharing, could help TRD research and spur better characterization of the illness, providing critical new targets for treatment intervention.
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Affiliation(s)
- Vasileia Kotoula
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD, United States.
| | - Jennifer W Evans
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD, United States
| | - Claire Punturieri
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD, United States
| | - Sara C Johnson
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD, United States
| | - Carlos A Zarate
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD, United States
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17
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de A Simoes Moreira D, Gauer LE, Teixeira G, Fonseca da Silva AC, Cavalcanti S, Quevedo J. Efficacy and adverse effects of ketamine versus electroconvulsive therapy for major depressive disorder: A systematic review and meta-analysis. J Affect Disord 2023; 330:227-238. [PMID: 36907464 PMCID: PMC10497186 DOI: 10.1016/j.jad.2023.02.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 02/26/2023] [Accepted: 02/28/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND ECT is considered the fastest and most effective treatment for TRD. Ketamine seems to be an attractive alternative due to its rapid-onset antidepressant effects and impact on suicidal thoughts. This study aimed to compare efficacy and tolerability of ECT and ketamine for different depression outcomes (PROSPERO/CRD42022349220). METHODS We searched MEDLINE, Web of Science, Embase, PsycINFO, Google Scholar, Cochrane Library and trial registries, which were the ClinicalTrials.gov and the World Health Organization's International Clinical Trials Registry Platform, without restrictions on publication date. SELECTION CRITERIA randomized controlled trials or cohorts comparing ketamine versus ECT in patients with TRD. RESULTS Eight studies met the inclusion criteria (of 2875 retrieved). Random-effects models comparing ketamine and ECT regarding the following outcomes were conducted: a) reduction of depressive symptoms severity through scales, g = -0.12, p = 0.68; b) response to therapy, RR = 0.89, p = 0.51; c) reported side-effects: dissociative symptoms, RR = 5.41, p = 0.06; nausea, RR = 0.73, p = 0.47; muscle pain, RR = 0.25, p = 0.02; and headache, RR = 0.39, p = 0.08. Influential & subgroup analyses were performed. LIMITATIONS Methodological issues with high risk of bias in some of the source material, reduced number of eligible studies with high in-between heterogeneity and small sample sizes. CONCLUSION Our study showed no evidence to support the superiority of ketamine over ECT for severity of depressive symptoms and response to therapy. Regarding side effects, there was a statistically significant decreased risk of muscle pain in patients treated with ketamine compared to ECT.
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Affiliation(s)
| | | | | | | | - Stefanie Cavalcanti
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth Houston), Houston, TX, USA; Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth Houston), Houston, TX, USA
| | - João Quevedo
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth Houston), Houston, TX, USA; Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth Houston), Houston, TX, USA; Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX, USA; Translational Psychiatry Laboratory, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil.
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18
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Runia N, Bergfeld IO, de Kwaasteniet BP, Luigjes J, van Laarhoven J, Notten P, Beute G, van den Munckhof P, Schuurman R, Denys D, van Wingen GA. Deep brain stimulation normalizes amygdala responsivity in treatment-resistant depression. Mol Psychiatry 2023; 28:2500-2507. [PMID: 36991129 DOI: 10.1038/s41380-023-02030-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 02/28/2023] [Accepted: 03/07/2023] [Indexed: 03/31/2023]
Abstract
Deep brain stimulation (DBS) of the ventral anterior limb of the internal capsule (vALIC) is a promising intervention for treatment-resistant depression (TRD). However, the working mechanisms of vALIC DBS in TRD remain largely unexplored. As major depressive disorder has been associated with aberrant amygdala functioning, we investigated whether vALIC DBS affects amygdala responsivity and functional connectivity. To investigate the long-term effects of DBS, eleven patients with TRD performed an implicit emotional face-viewing paradigm during functional magnetic resonance imaging (fMRI) before DBS surgery and after DBS parameter optimization. Sixteen matched healthy controls performed the fMRI paradigm at two-time points to control for test-retest effects. To investigate the short-term effects of DBS de-activation after parameter optimization, thirteen patients additionally performed the fMRI paradigm after double-blind periods of active and sham stimulation. Results showed that TRD patients had decreased right amygdala responsivity compared to healthy controls at baseline. Long-term vALIC DBS normalized right amygdala responsivity, which was associated with faster reaction times. This effect was not dependent on emotional valence. Furthermore, active compared to sham DBS increased amygdala connectivity with sensorimotor and cingulate cortices, which was not significantly different between responders and non-responders. These results suggest that vALIC DBS restores amygdala responsivity and behavioral vigilance in TRD, which may contribute to the DBS-induced antidepressant effect.
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Affiliation(s)
- Nora Runia
- Amsterdam UMC location University of Amsterdam, Department of Psychiatry, Meibergdreef 9, Amsterdam, The Netherlands.
- Amsterdam Neuroscience, Amsterdam, The Netherlands.
| | - Isidoor O Bergfeld
- Amsterdam UMC location University of Amsterdam, Department of Psychiatry, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Bart P de Kwaasteniet
- Isala Hospital, Department of Radiology and Nuclear Medicine, Zwolle, The Netherlands
| | - Judy Luigjes
- Amsterdam UMC location University of Amsterdam, Department of Psychiatry, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Jan van Laarhoven
- Department of Psychiatry, ETZ, location Elisabeth, Tilburg, The Netherlands
| | - Peter Notten
- Department of Psychiatry, ETZ, location Elisabeth, Tilburg, The Netherlands
| | - Guus Beute
- Department of Neurosurgery, ETZ, location Elisabeth, Tilburg, The Netherlands
| | - Pepijn van den Munckhof
- Amsterdam UMC location University of Amsterdam, Department of Neurosurgery, Amsterdam, The Netherlands
| | - Rick Schuurman
- Amsterdam UMC location University of Amsterdam, Department of Neurosurgery, Amsterdam, The Netherlands
| | - Damiaan Denys
- Amsterdam UMC location University of Amsterdam, Department of Psychiatry, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Guido A van Wingen
- Amsterdam UMC location University of Amsterdam, Department of Psychiatry, Meibergdreef 9, Amsterdam, The Netherlands.
- Amsterdam Neuroscience, Amsterdam, The Netherlands.
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Finzi E. Botulinum Toxin Treatment for Depression: A New Paradigm for Psychiatry. Toxins (Basel) 2023; 15:336. [PMID: 37235370 PMCID: PMC10224294 DOI: 10.3390/toxins15050336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/10/2023] [Accepted: 05/13/2023] [Indexed: 05/28/2023] Open
Abstract
Multiple randomized double-blind placebo-controlled trials have shown that botulinum toxin A (BoNT/A), when injected into the frown musculature, is an antidepressant. This review outlines the conceptual narrative behind this treatment modality, starting with theory developed by Charles Darwin. We develop the concept of emotional proprioception and discuss how the muscles of facial expression play an important role in relaying valenced information to the brain's emotional neuroanatomical circuit. We review the role of facial frown musculature as the brain's barometer and transmitter of negatively valanced emotional information. The direct connections between the corrugator muscles and the amygdala are reviewed, and these provide a neuroanatomical circuit that is a logical target for treatment with BoNT/A. The centrality of amygdala dysfunction in the pathogenesis of many psychiatric disorders, and the evidence that BoNT/A modulates amygdala activity, provides the mechanistic link between BoNT/A and its antidepressant activity. Animal models of BoNT/A's antidepressant effects confirm the evolutionary conservation of this emotional circuit. The clinical and theoretical implications of this evidence, as it relates to the potential treatment of a broad range of psychiatric disorders by BoNT/A, is discussed. The ease of administration, long duration, and favorable side effect profile of this therapy is reviewed in the context of existing antidepressant treatments.
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Affiliation(s)
- Eric Finzi
- Healis Therapeutics, 4041 MacArthur Blvd Suite 400, Newport Beach, CA 92660, USA;
- Department of Psychiatry, George Washington School of Medicine & Health Sciences, Washington, DC 20037, USA
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20
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Kopelman J, Keller TA, Panny B, Griffo A, Degutis M, Spotts C, Cruz N, Bell E, Do-Nguyen K, Wallace ML, Mathew SJ, Howland RH, Price RB. Rapid neuroplasticity changes and response to intravenous ketamine: a randomized controlled trial in treatment-resistant depression. Transl Psychiatry 2023; 13:159. [PMID: 37160885 PMCID: PMC10170140 DOI: 10.1038/s41398-023-02451-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 04/17/2023] [Accepted: 04/25/2023] [Indexed: 05/11/2023] Open
Abstract
Intravenous ketamine is posited to rapidly reverse depression by rapidly enhancing neuroplasticity. In human patients, we quantified gray matter microstructural changes on a rapid (24-h) timescale within key regions where neuroplasticity enhancements post-ketamine have been implicated in animal models. In this study, 98 unipolar depressed adults who failed at least one antidepressant medication were randomized 2:1 to a single infusion of intravenous ketamine (0.5 mg/kg) or vehicle (saline) and completed diffusion tensor imaging (DTI) assessments at pre-infusion baseline and 24-h post-infusion. DTI mean diffusivity (DTI-MD), a putative marker of microstructural neuroplasticity in gray matter, was calculated for 7 regions of interest (left and right BA10, amygdala, and hippocampus; and ventral Anterior Cingulate Cortex) and compared to clinical response measured with the Montgomery-Asberg Depression Rating Scale (MADRS) and the Quick Inventory of Depressive Symptoms-Self-Report (QIDS-SR). Individual differences in DTI-MD change (greater decrease from baseline to 24-h post-infusion, indicative of more neuroplasticity enhancement) were associated with larger improvements in depression scores across several regions. In the left BA10 and left amygdala, these relationships were driven primarily by the ketamine group (group * DTI-MD interaction effects: p = 0.016-0.082). In the right BA10, these associations generalized to both infusion arms (p = 0.007). In the left and right hippocampus, on the MADRS only, interaction effects were observed in the opposite direction, such that DTI-MD change was inversely associated with depression change in the ketamine arm specifically (group * DTI-MD interaction effects: p = 0.032-0.06). The acute effects of ketamine on depression may be mediated, in part, by acute changes in neuroplasticity quantifiable with DTI.
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Affiliation(s)
- Jared Kopelman
- University of California San Diego School of Medicine, San Diego, CA, USA
| | | | - Benjamin Panny
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Angela Griffo
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Michelle Degutis
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Crystal Spotts
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Nicolas Cruz
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Elizabeth Bell
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Kevin Do-Nguyen
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Sanjay J Mathew
- Baylor College of Medicine and Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Robert H Howland
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Rebecca B Price
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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21
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Taraku B, Woods RP, Boucher M, Espinoza R, Jog M, Al-Sharif N, Narr KL, Zavaliangos-Petropulu A. Changes in white matter microstructure following serial ketamine infusions in treatment resistant depression. Hum Brain Mapp 2023; 44:2395-2406. [PMID: 36715291 PMCID: PMC10028677 DOI: 10.1002/hbm.26217] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/30/2022] [Accepted: 01/12/2023] [Indexed: 01/31/2023] Open
Abstract
Ketamine produces fast-acting antidepressant effects in treatment resistant depression (TRD). Though prior studies report ketamine-related changes in brain activity in TRD, understanding of ketamine's effect on white matter (WM) microstructure remains limited. We thus sought to examine WM neuroplasticity and associated clinical improvements following serial ketamine infusion (SKI) in TRD. TRD patients (N = 57, 49.12% female, mean age: 39.9) received four intravenous ketamine infusions (0.5 mg/kg) 2-3 days apart. Diffusion-weighted scans and clinical assessments (Hamilton Depression Rating Scale [HDRS-17]; Snaith Hamilton Pleasure Scale [SHAPS]) were collected at baseline and 24-h after SKI. WM measures including the neurite density index (NDI) and orientation dispersion index (ODI) from the neurite orientation dispersion and density imaging (NODDI) model, and fractional anisotropy (FA) from the diffusion tensor model were compared voxelwise pre- to post-SKI after using Tract-Based Spatial Statistics workflows to align WM tracts across subjects/time. Correlations between change in WM metrics and clinical measures were subsequently assessed. Following SKI, patients showed significant improvements in HDRS-17 (p-value = 1.8 E-17) and SHAPS (p-value = 1.97 E-10). NDI significantly decreased in occipitotemporal WM pathways (p < .05, FWER/TFCE corrected). ΔSHAPS significantly correlated with ΔNDI in the left internal capsule and left superior longitudinal fasciculus (r = -0.614, p-value = 6.24E-09). No significant changes in ODI or FA were observed. SKI leads to significant changes in the microstructural features of neurites within occipitotemporal tracts, and changes in neurite density within tracts connecting the basal ganglia, thalamus, and cortex relate to improvements in anhedonia. NODDI may be more sensitive for detecting ketamine-induced WM changes than DTI.
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Affiliation(s)
- Brandon Taraku
- Department of Neurology, University of California Los Angeles, Los Angeles, California, USA
| | - Roger P Woods
- Department of Neurology, University of California Los Angeles, Los Angeles, California, USA
- Department of Psychiatry and Behavioral Sciences, University of California Los Angeles, Los Angeles, California, USA
| | - Michael Boucher
- Department of Psychiatry and Behavioral Sciences, University of California Los Angeles, Los Angeles, California, USA
| | - Randall Espinoza
- Department of Psychiatry and Behavioral Sciences, University of California Los Angeles, Los Angeles, California, USA
| | - Mayank Jog
- Department of Neurology, University of California Los Angeles, Los Angeles, California, USA
| | - Noor Al-Sharif
- Department of Neurology, University of California Los Angeles, Los Angeles, California, USA
| | - Katherine L Narr
- Department of Neurology, University of California Los Angeles, Los Angeles, California, USA
- Department of Psychiatry and Behavioral Sciences, University of California Los Angeles, Los Angeles, California, USA
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22
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Zavaliangos-Petropulu A, Al-Sharif NB, Taraku B, Leaver AM, Sahib AK, Espinoza RT, Narr KL. Neuroimaging-Derived Biomarkers of the Antidepressant Effects of Ketamine. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2023; 8:361-386. [PMID: 36775711 DOI: 10.1016/j.bpsc.2022.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/03/2022] [Accepted: 11/07/2022] [Indexed: 11/27/2022]
Abstract
Major depressive disorder is a highly prevalent psychiatric disorder. Despite an extensive range of treatment options, about a third of patients still struggle to respond to available therapies. In the last 20 years, ketamine has gained considerable attention in the psychiatric field as a promising treatment of depression, particularly in patients who are treatment resistant or at high risk for suicide. At a subanesthetic dose, ketamine produces a rapid and pronounced reduction in depressive symptoms and suicidal ideation, and serial treatment appears to produce a greater and more sustained therapeutic response. However, the mechanism driving ketamine's antidepressant effects is not yet well understood. Biomarker discovery may advance knowledge of ketamine's antidepressant action, which could in turn translate to more personalized and effective treatment strategies. At the brain systems level, neuroimaging can be used to identify functional pathways and networks contributing to ketamine's therapeutic effects by studying how it alters brain structure, function, connectivity, and metabolism. In this review, we summarize and appraise recent work in this area, including 51 articles that use resting-state and task-based functional magnetic resonance imaging, arterial spin labeling, positron emission tomography, structural magnetic resonance imaging, diffusion magnetic resonance imaging, or magnetic resonance spectroscopy to study brain and clinical changes 24 hours or longer after ketamine treatment in populations with unipolar or bipolar depression. Though individual studies have included relatively small samples, used different methodological approaches, and reported disparate regional findings, converging evidence supports that ketamine leads to neuroplasticity in structural and functional brain networks that contribute to or are relevant to its antidepressant effects.
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Affiliation(s)
- Artemis Zavaliangos-Petropulu
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
| | - Noor B Al-Sharif
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Brandon Taraku
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Amber M Leaver
- Department of Radiology, Northwestern University, Chicago, Illinois
| | - Ashish K Sahib
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Randall T Espinoza
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Katherine L Narr
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; Jane and Terry Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
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23
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Gruzman R, Hartling C, Domke AK, Stippl A, Carstens L, Bajbouj M, Gärtner M, Grimm S. Investigation of Neurofunctional Changes Over the Course of Electroconvulsive Therapy. Int J Neuropsychopharmacol 2022; 26:20-31. [PMID: 36173403 PMCID: PMC9850659 DOI: 10.1093/ijnp/pyac063] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/13/2022] [Accepted: 09/28/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is an effective treatment for patients suffering from depression. Yet the exact neurobiological mechanisms underlying the efficacy of ECT and indicators of who might respond best to it remain to be elucidated. Identifying neural markers that can inform about an individual's response to ECT would enable more optimal treatment strategies and increase clinical efficacy. METHODS Twenty-one acutely depressed inpatients completed an emotional working memory task during functional magnetic resonance imaging before and after receiving treatment with ECT. Neural activity was assessed in 5 key regions associated with the pathophysiology of depression: bilateral dorsolateral prefrontal cortex and pregenual, subgenual, and dorsal anterior cingulate cortex. Associations between brain activation and clinical improvement, as reflected by Montgomery-Åsberg Depression Rating Scale scores, were computed using linear regression models, t tests, and Pearson correlational analyses. RESULTS Significant neurobiological prognostic markers or changes in neural activity from pre- to post ECT did not emerge. CONCLUSIONS We could not confirm normalization effects and did not find significant neural markers related to treatment response. These results demonstrate that the search for reliable and clinically useful biomarkers for ECT treatment remains in its initial stages and still faces challenges.
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Affiliation(s)
- Rebecca Gruzman
- Correspondence: Rebecca Gruzman, MSc, MSB Medical School Berlin, Rüdesheimer Straße 50, 14197 Berlin, Germany ()
| | | | - Ann-Kathrin Domke
- Charité Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Berlin, Germany
| | - Anna Stippl
- Charité Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Berlin, Germany
| | | | - Malek Bajbouj
- Charité Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Berlin, Germany
| | - Matti Gärtner
- MSB Medical School Berlin, Berlin, Germany,Charité Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Berlin, Germany
| | - Simone Grimm
- MSB Medical School Berlin, Berlin, Germany,Charité Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Berlin, Germany,Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry, University of Zurich, Switzerland
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24
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Wade BSC, Loureiro J, Sahib A, Kubicki A, Joshi SH, Hellemann G, Espinoza RT, Woods RP, Congdon E, Narr KL. Anterior default mode network and posterior insular connectivity is predictive of depressive symptom reduction following serial ketamine infusion. Psychol Med 2022; 52:2376-2386. [PMID: 35578581 PMCID: PMC9527672 DOI: 10.1017/s0033291722001313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/20/2021] [Accepted: 04/19/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Ketamine is a rapidly-acting antidepressant treatment with robust response rates. Previous studies have reported that serial ketamine therapy modulates resting state functional connectivity in several large-scale networks, though it remains unknown whether variations in brain structure, function, and connectivity impact subsequent treatment success. We used a data-driven approach to determine whether pretreatment multimodal neuroimaging measures predict changes along symptom dimensions of depression following serial ketamine infusion. METHODS Patients with depression (n = 60) received structural, resting state functional, and diffusion MRI scans before treatment. Depressive symptoms were assessed using the 17-item Hamilton Depression Rating Scale (HDRS-17), the Inventory of Depressive Symptomatology (IDS-C), and the Rumination Response Scale (RRS) before and 24 h after patients received four (0.5 mg/kg) infusions of racemic ketamine over 2 weeks. Nineteen unaffected controls were assessed at similar timepoints. Random forest regression models predicted symptom changes using pretreatment multimodal neuroimaging and demographic measures. RESULTS Two HDRS-17 subscales, the HDRS-6 and core mood and anhedonia (CMA) symptoms, and the RRS: reflection (RRSR) scale were predicted significantly with 19, 27, and 1% variance explained, respectively. Increased right medial prefrontal cortex/anterior cingulate and posterior insula (PoI) and lower kurtosis of the superior longitudinal fasciculus predicted reduced HDRS-6 and CMA symptoms following treatment. RRSR change was predicted by global connectivity of the left posterior cingulate, left insula, and right superior parietal lobule. CONCLUSIONS Our findings support that connectivity of the anterior default mode network and PoI may serve as potential biomarkers of antidepressant outcomes for core depressive symptoms.
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Affiliation(s)
- Benjamin S. C. Wade
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California, Los Angeles, CA, USA
| | - Joana Loureiro
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California, Los Angeles, CA, USA
| | - Ashish Sahib
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California, Los Angeles, CA, USA
| | - Antoni Kubicki
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California, Los Angeles, CA, USA
| | - Shantanu H. Joshi
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California, Los Angeles, CA, USA
| | - Gerhard Hellemann
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, UCLA, Los Angeles, USA
| | - Randall T. Espinoza
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, UCLA, Los Angeles, USA
| | - Roger P. Woods
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, UCLA, Los Angeles, USA
| | - Eliza Congdon
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, UCLA, Los Angeles, USA
| | - Katherine L. Narr
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, UCLA, Los Angeles, USA
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25
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Kerr WT, Tatekawa H, Lee JK, Karimi AH, Sreenivasan SS, O'Neill J, Smith JM, Hickman LB, Savic I, Nasrullah N, Espinoza R, Narr K, Salamon N, Beimer NJ, Hadjiiski LM, Eliashiv DS, Stacey WC, Engel J, Feusner JD, Stern JM. Clinical MRI morphological analysis of functional seizures compared to seizure-naïve and psychiatric controls. Epilepsy Behav 2022; 134:108858. [PMID: 35933959 DOI: 10.1016/j.yebeh.2022.108858] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/26/2022] [Accepted: 07/15/2022] [Indexed: 11/15/2022]
Abstract
PURPOSE Functional seizures (FS), also known as psychogenic nonepileptic seizures (PNES), are physical manifestations of acute or chronic psychological distress. Functional and structural neuroimaging have identified objective signs of this disorder. We evaluated whether magnetic resonance imaging (MRI) morphometry differed between patients with FS and clinically relevant comparison populations. METHODS Quality-screened clinical-grade MRIs were acquired from 666 patients from 2006 to 2020. Morphometric features were quantified with FreeSurfer v6. Mixed-effects linear regression compared the volume, thickness, and surface area within 201 regions-of-interest for 90 patients with FS, compared to seizure-naïve patients with depression (n = 243), anxiety (n = 68), and obsessive-compulsive disorder (OCD, n = 41), respectively, and to other seizure-naïve controls with similar quality MRIs, accounting for the influence of multiple confounds including depression and anxiety based on chart review. These comparison populations were obtained through review of clinical records plus research studies obtained on similar scanners. RESULTS After Bonferroni-Holm correction, patients with FS compared with seizure-naïve controls exhibited thinner bilateral superior temporal cortex (left 0.053 mm, p = 0.014; right 0.071 mm, p = 0.00006), thicker left lateral occipital cortex (0.052 mm, p = 0.0035), and greater left cerebellar white-matter volume (1085 mm3, p = 0.0065). These findings were not accounted for by lower MRI quality in patients with FS. CONCLUSIONS These results reinforce prior indications of structural neuroimaging correlates of FS and, in particular, distinguish brain morphology in FS from that in depression, anxiety, and OCD. Future work may entail comparisons with other psychiatric disorders including bipolar and schizophrenia, as well as exploration of brain structural heterogeneity within FS.
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Affiliation(s)
- Wesley T Kerr
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Neurology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA.
| | - Hiroyuki Tatekawa
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - John K Lee
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Amir H Karimi
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Siddhika S Sreenivasan
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Joseph O'Neill
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA; Brain Research Institute, University of California Los Angeles, Los Angeles, CA, USA
| | - Jena M Smith
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - L Brian Hickman
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Ivanka Savic
- Department of Women's and Children's Health, Karolinska Institute and Neurology Clinic, Karolinksa University Hospital, Karolinska Universitetssjukhuset, Stockholm, Sweden
| | - Nilab Nasrullah
- Department of Women's and Children's Health, Karolinska Institute and Neurology Clinic, Karolinksa University Hospital, Karolinska Universitetssjukhuset, Stockholm, Sweden
| | - Randall Espinoza
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Katherine Narr
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Noriko Salamon
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Nicholas J Beimer
- Department of Neurology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Lubomir M Hadjiiski
- Department of Radiology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Dawn S Eliashiv
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - William C Stacey
- Department of Neurology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Jerome Engel
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA; Brain Research Institute, University of California Los Angeles, Los Angeles, CA, USA; Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jamie D Feusner
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA; Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - John M Stern
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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26
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The effect of ketamine on anhedonia: improvements in dimensions of anticipatory, consummatory, and motivation-related reward deficits. Psychopharmacology (Berl) 2022; 239:2011-2039. [PMID: 35292831 DOI: 10.1007/s00213-022-06105-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 02/23/2022] [Indexed: 10/18/2022]
Abstract
Anhedonia is a common, persistent, and disabling condition. However, available therapeutics primarily focus on the reduction of depressive and negative symptoms rather than amelioration of deficits in positive affect. As such, extant drug treatments remain largely ineffective in treating symptoms of anhedonia. Ketamine is a rapid-acting and novel therapeutic treatment for treatment-resistant depression, which has also been demonstrated to attenuate symptoms of anhedonia. However, the literature on the anti-anhedonic effects of ketamine is limited-especially within independent dimensions of this symptom domain. Herein, this review examined the impact of ketamine treatment on anhedonia and its dimensions on anticipatory, consummatory, and motivation-related reward deficits. Overall, the findings have shown a trend towards symptom reduction and/or improvements in anhedonia and their respective subdomains, in both human and preclinical studies, as well as its potential to provide additional benefit in reducing suicidality and improving quality-of-life. Although further research is required in understanding the long-term efficacy and mechanism, ketamine may provide an effective and rapid-acting therapeutic in an otherwise unmet domain.
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27
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Willis DE, Goldstein PA. Targeting Affective Mood Disorders With Ketamine to Prevent Chronic Postsurgical Pain. FRONTIERS IN PAIN RESEARCH 2022; 3:872696. [PMID: 35832728 PMCID: PMC9271565 DOI: 10.3389/fpain.2022.872696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/06/2022] [Indexed: 12/02/2022] Open
Abstract
The phencyclidine-derivative ketamine [2-(2-chlorophenyl)-2-(methylamino)cyclohexan-1-one] was added to the World Health Organization's Model List of Essential Medicines in 1985 and is also on the Model List of Essential Medicines for Children due to its efficacy and safety as an intravenous anesthetic. In sub-anesthetic doses, ketamine is an effective analgesic for the treatment of acute pain (such as may occur in the perioperative setting). Additionally, ketamine may have efficacy in relieving some forms of chronic pain. In 2019, Janssen Pharmaceuticals received regulatory-approval in both the United States and Europe for use of the S-enantiomer of ketamine in adults living with treatment-resistant major depressive disorder. Pre-existing anxiety/depression and the severity of postoperative pain are risk factors for development of chronic postsurgical pain. An important question is whether short-term administration of ketamine can prevent the conversion of acute postsurgical pain to chronic postsurgical pain. Here, we have reviewed ketamine's effects on the biopsychological processes underlying pain perception and affective mood disorders, focusing on non-NMDA receptor-mediated effects, with an emphasis on results from human trials where available.
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Affiliation(s)
- Dianna E. Willis
- Burke Neurological Institute, White Plains, NY, United States
- Feil Family Brain and Mind Institute, Weill Cornell Medicine, New York, NY, United States
| | - Peter A. Goldstein
- Feil Family Brain and Mind Institute, Weill Cornell Medicine, New York, NY, United States
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, United States
- Department of Medicine, Weill Cornell Medicine, New York, NY, United States
- *Correspondence: Peter A. Goldstein
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28
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Pang Y, Wei Q, Zhao S, Li N, Li Z, Lu F, Pang J, Zhang R, Wang K, Chu C, Tian Y, Wang J. Enhanced default mode network functional connectivity links with electroconvulsive therapy response in major depressive disorder. J Affect Disord 2022; 306:47-54. [PMID: 35304230 DOI: 10.1016/j.jad.2022.03.035] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 01/16/2022] [Accepted: 03/10/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is an effective neuromodulatory treatment for major depressive disorder (MDD), especially for cases resistant to antidepressant drugs. While the precise mechanisms underlying ECT efficacy are still unclear, it is speculated that ECT modulates brain connectivity. The current study aimed to investigate the longitudinal effects of ECT on resting-state functional connectivity (FC) in MDD patients and test if baseline FC can be used to predict therapeutic response. METHOD Resting-state functional magnetic resonance imaging data were collected at baseline and following ECT from 33 MDD patients. Whole-brain multi-voxel pattern analysis (MVPA) and region of interest-wise FC analysis were employed to fully investigate ECT effects on brain connectivity. Linear support vector regression was further utilized to predict the improvement in depressive symptoms based on baseline connectivity. RESULTS MVPA revealed a significant ECT effect on FC in the default mode network (DMN), central executive network (CEN), sensorimotor network (SMN), and cerebellar posterior lobe. The FCs within the DMN and between DMN and CEN were enhanced in patients after ECT, and the changed FC between the medial prefrontal cortex and ventrolateral prefrontal cortex was negatively correlated with depressive symptom improvement. Moreover, baseline FC within the DMN and between the DMN and CEN could effectively predict the improvement of depressive symptoms. CONCLUSIONS The findings suggest that the FCs within the DMN and between DMN and CEN may be critical therapeutic targets for effective antidepressant treatment as well as neuromarkers for predicting treatment response.
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Affiliation(s)
- Yajing Pang
- School of Electrical Engineering, Zhengzhou University, Zhengzhou 450001, China
| | - Qiang Wei
- Department of Neurology, The First Hospital of Anhui Medical University, Hefei 230022, China
| | - Shanshan Zhao
- School of Electrical Engineering, Zhengzhou University, Zhengzhou 450001, China
| | - Nan Li
- School of Electrical Engineering, Zhengzhou University, Zhengzhou 450001, China
| | - Zhihui Li
- School of Electrical Engineering, Zhengzhou University, Zhengzhou 450001, China
| | - Fengmei Lu
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 610054, China
| | - Jianyue Pang
- Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Rui Zhang
- School of Electrical Engineering, Zhengzhou University, Zhengzhou 450001, China
| | - Kai Wang
- Department of Neurology, The First Hospital of Anhui Medical University, Hefei 230022, China
| | - Congying Chu
- Brainnetome Center, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China; China National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China.
| | - Yanghua Tian
- Department of Neurology, The First Hospital of Anhui Medical University, Hefei 230022, China.
| | - Jiaojian Wang
- State Key Laboratory of Primate Biomedical Research, Institute of Primate Translational Medicine, Kunming University of Science and Technology, Kunming 650500, China; Yunnan Key Laboratory of Primate Biomedical Research, Kunming, Yunnan, 650500, China.
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29
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Luciana M, Collins PF. Neuroplasticity, the Prefrontal Cortex, and Psychopathology-Related Deviations in Cognitive Control. Annu Rev Clin Psychol 2022; 18:443-469. [PMID: 35534121 DOI: 10.1146/annurev-clinpsy-081219-111203] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A basic survival need is the ability to respond to, and persevere in the midst of, experiential challenges. Mechanisms of neuroplasticity permit this responsivity via functional adaptations (flexibility), as well as more substantial structural modifications following chronic stress or injury. This review focuses on prefrontally based flexibility, expressed throughout large-scale neuronal networks through the actions of excitatory and inhibitory neurotransmitters and neuromodulators. With substance use disorders and stress-related internalizing disorders as exemplars, we review human behavioral and neuroimaging data, considering whether executive control, particularly cognitive flexibility, is impaired premorbidly, enduringly compromised with illness progression, or both. We conclude that deviations in control processes are consistently expressed in the context of active illness but operate through different mechanisms and with distinct longitudinal patterns in externalizing versus internalizing conditions.
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Affiliation(s)
- Monica Luciana
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota, USA; ,
| | - Paul F Collins
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota, USA; ,
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30
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Demchenko I, Tassone VK, Kennedy SH, Dunlop K, Bhat V. Intrinsic Connectivity Networks of Glutamate-Mediated Antidepressant Response: A Neuroimaging Review. Front Psychiatry 2022; 13:864902. [PMID: 35722550 PMCID: PMC9199367 DOI: 10.3389/fpsyt.2022.864902] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 04/12/2022] [Indexed: 11/23/2022] Open
Abstract
Conventional monoamine-based pharmacotherapy, considered the first-line treatment for major depressive disorder (MDD), has several challenges, including high rates of non-response. To address these challenges, preclinical and clinical studies have sought to characterize antidepressant response through monoamine-independent mechanisms. One striking example is glutamate, the brain's foremost excitatory neurotransmitter: since the 1990s, studies have consistently reported altered levels of glutamate in MDD, as well as antidepressant effects following molecular targeting of glutamatergic receptors. Therapeutically, this has led to advances in the discovery, testing, and clinical application of a wide array of glutamatergic agents, particularly ketamine. Notably, ketamine has been demonstrated to rapidly improve mood symptoms, unlike monoamine-based interventions, and the neurobiological basis behind this rapid antidepressant response is under active investigation. Advances in brain imaging techniques, including functional magnetic resonance imaging, magnetic resonance spectroscopy, and positron emission tomography, enable the identification of the brain network-based characteristics distinguishing rapid glutamatergic modulation from the effect of slow-acting conventional monoamine-based pharmacology. Here, we review brain imaging studies that examine brain connectivity features associated with rapid antidepressant response in MDD patients treated with glutamatergic pharmacotherapies in contrast with patients treated with slow-acting monoamine-based treatments. Trends in recent brain imaging literature suggest that the activity of brain regions is organized into coherent functionally distinct networks, termed intrinsic connectivity networks (ICNs). We provide an overview of major ICNs implicated in depression and explore how treatment response following glutamatergic modulation alters functional connectivity of limbic, cognitive, and executive nodes within ICNs, with well-characterized anti-anhedonic effects and the enhancement of "top-down" executive control. Alterations within and between the core ICNs could potentially exert downstream effects on the nodes within other brain networks of relevance to MDD that are structurally and functionally interconnected through glutamatergic synapses. Understanding similarities and differences in brain ICNs features underlying treatment response will positively impact the trajectory and outcomes for adults suffering from MDD and will facilitate the development of biomarkers to enable glutamate-based precision therapeutics.
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Affiliation(s)
- Ilya Demchenko
- Interventional Psychiatry Program, Mental Health and Addictions Service, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Center for Depression and Suicide Studies, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Vanessa K Tassone
- Interventional Psychiatry Program, Mental Health and Addictions Service, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Sidney H Kennedy
- Interventional Psychiatry Program, Mental Health and Addictions Service, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Center for Depression and Suicide Studies, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Keenan Research Center for Biomedical Science, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Katharine Dunlop
- Interventional Psychiatry Program, Mental Health and Addictions Service, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Center for Depression and Suicide Studies, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Keenan Research Center for Biomedical Science, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Venkat Bhat
- Interventional Psychiatry Program, Mental Health and Addictions Service, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Center for Depression and Suicide Studies, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Keenan Research Center for Biomedical Science, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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31
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Tozzi L, Anene ET, Gotlib IH, Wintermark M, Kerr AB, Wu H, Seok D, Narr KL, Sheline YI, Whitfield-Gabrieli S, Williams LM. Convergence, preliminary findings and future directions across the four human connectome projects investigating mood and anxiety disorders. Neuroimage 2021; 245:118694. [PMID: 34732328 PMCID: PMC8727513 DOI: 10.1016/j.neuroimage.2021.118694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/11/2021] [Accepted: 10/29/2021] [Indexed: 12/31/2022] Open
Abstract
In this paper we provide an overview of the rationale, methods, and preliminary results of the four Connectome Studies Related to Human Disease investigating mood and anxiety disorders. The first study, "Dimensional connectomics of anxious misery" (HCP-DAM), characterizes brain-symptom relations of a transdiagnostic sample of anxious misery disorders. The second study, "Human connectome Project for disordered emotional states" (HCP-DES), tests a hypothesis-driven model of brain circuit dysfunction in a sample of untreated young adults with symptoms of depression and anxiety. The third study, "Perturbation of the treatment resistant depression connectome by fast-acting therapies" (HCP-MDD), quantifies alterations of the structural and functional connectome as a result of three fast-acting interventions: electroconvulsive therapy, serial ketamine therapy, and total sleep deprivation. Finally, the fourth study, "Connectomes related to anxiety and depression in adolescents" (HCP-ADA), investigates developmental trajectories of subtypes of anxiety and depression in adolescence. The four projects use comparable and standardized Human Connectome Project magnetic resonance imaging (MRI) protocols, including structural MRI, diffusion-weighted MRI, and both task and resting state functional MRI. All four projects also conducted comprehensive and convergent clinical and neuropsychological assessments, including (but not limited to) demographic information, clinical diagnoses, symptoms of mood and anxiety disorders, negative and positive affect, cognitive function, and exposure to early life stress. The first round of analyses conducted in the four projects offered novel methods to investigate relations between functional connectomes and self-reports in large datasets, identified new functional correlates of symptoms of mood and anxiety disorders, characterized the trajectory of connectome-symptom profiles over time, and quantified the impact of novel treatments on aberrant connectivity. Taken together, the data obtained and reported by the four Connectome Studies Related to Human Disease investigating mood and anxiety disorders describe a rich constellation of convergent biological, clinical, and behavioral phenotypes that span the peak ages for the onset of emotional disorders. These data are being prepared for open sharing with the scientific community following screens for quality by the Connectome Coordinating Facility (CCF). The CCF also plans to release data from all projects that have been pre-processed using identical state-of-the-art pipelines. The resultant dataset will give researchers the opportunity to pool complementary data across the four projects to study circuit dysfunctions that may underlie mood and anxiety disorders, to map cohesive relations among circuits and symptoms, and to probe how these relations change as a function of age and acute interventions. This large and combined dataset may also be ideal for using data-driven analytic approaches to inform neurobiological targets for future clinical trials and interventions focused on clinical or behavioral outcomes.
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Affiliation(s)
- Leonardo Tozzi
- Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Esther T Anene
- Psychiatry, Neurology, Radiology, University of Pennsylvania, Philadelphia PA, USA
| | | | | | - Adam B Kerr
- Center for Cognitive and Neurobiological Imaging, Stanford University, CA, USA; Electrical Engineering, Stanford University, CA, USA
| | - Hua Wu
- Electrical Engineering, Stanford University, CA, USA
| | - Darsol Seok
- Department of Psychiatry, University of Pennsylvania, Philadelphia PA, USA
| | - Katherine L Narr
- Neurology, Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA
| | - Yvette I Sheline
- Neurology, Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA.
| | | | - Leanne M Williams
- Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA; Sierra-Pacific Mental Illness Research, Education, and Clinical Center (MIRECC) Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
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32
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Norbury A, Rutter SB, Collins AB, Costi S, Jha MK, Horn SR, Kautz M, Corniquel M, Collins KA, Glasgow AM, Brallier J, Shin LM, Charney DS, Murrough JW, Feder A. Neuroimaging correlates and predictors of response to repeated-dose intravenous ketamine in PTSD: preliminary evidence. Neuropsychopharmacology 2021; 46:2266-2277. [PMID: 34333555 PMCID: PMC8580962 DOI: 10.1038/s41386-021-01104-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/15/2021] [Accepted: 07/07/2021] [Indexed: 02/06/2023]
Abstract
Promising initial data indicate that the glutamate N-methyl-D-aspartate (NMDA) receptor antagonist ketamine may be beneficial in post-traumatic stress disorder (PTSD). Here, we explore the neural correlates of ketamine-related changes in PTSD symptoms, using a rich battery of functional imaging data (two emotion-processing tasks and one task-free scan), collected from a subset of participants of a randomized clinical trial of repeated-dose intravenous ketamine vs midazolam (total N = 21). In a pre-registered analysis, we tested whether changes in an a priori set of imaging measures from a target neural circuit were predictive of improvement in PTSD symptoms, using leave-one-out cross-validated elastic-net regression models (regions of interest in the target circuit consisted of the dorsal and rostral anterior cingulate cortex, ventromedial prefrontal cortex, anterior hippocampus, anterior insula, and amygdala). Improvements in PTSD severity were associated with increased functional connectivity between the ventromedial prefrontal cortex (vmPFC) and amygdala during emotional face-viewing (change score retained in model with minimum predictive error in left-out subjects, standardized regression coefficient [β] = 2.90). This effect was stronger in participants who received ketamine compared to midazolam (interaction β = 0.86), and persisted following inclusion of concomitant change in depressive symptoms in the analysis model (β = 0.69). Improvement following ketamine was also predicted by decreased dorsal anterior cingulate activity during emotional conflict regulation, and increased task-free connectivity between the vmPFC and anterior insula (βs = -2.82, 0.60). Exploratory follow-up analysis via dynamic causal modelling revealed that whilst improvement in PTSD symptoms following either drug was associated with decreased excitatory modulation of amygdala→vmPFC connectivity during emotional face-viewing, increased top-down inhibition of the amygdala by the vmPFC was only observed in participants who improved under ketamine. Individuals with low prefrontal inhibition of amygdala responses to faces at baseline also showed greater improvements following ketamine treatment. These preliminary findings suggest that, specifically under ketamine, improvements in PTSD symptoms are accompanied by normalization of hypofrontal control over amygdala responses to social signals of threat.
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Affiliation(s)
- Agnes Norbury
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sarah B Rutter
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Abigail B Collins
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sara Costi
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Manish K Jha
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sarah R Horn
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Marin Kautz
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Morgan Corniquel
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Katherine A Collins
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | - Andrew M Glasgow
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jess Brallier
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lisa M Shin
- Department of Psychology, Tufts University, Medford, MA, USA
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Dennis S Charney
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - James W Murrough
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Adriana Feder
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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33
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Loureiro JRA, Sahib AK, Vasavada M, Leaver A, Kubicki A, Wade B, Joshi S, Hellemann G, Congdon E, Woods RP, Espinoza R, Narr KL. Ketamine's modulation of cerebro-cerebellar circuitry during response inhibition in major depression. Neuroimage Clin 2021; 32:102792. [PMID: 34571429 PMCID: PMC8476854 DOI: 10.1016/j.nicl.2021.102792] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 12/01/2022]
Abstract
Ketamine modulates cerebellar connectivity during response inhibition in depression. Cerebellar–frontoparietal/sensory connectivity decreases in ketamine remitters. Cerebellar-frontoparietal/salience connectivity predicts treatment outcome. Cerebro-cerebellar loops serve as treatment biomarkers in major depression.
Patients with major depressive disorder (MDD) exhibit impaired control of cognitive and emotional systems, including deficient response selection and inhibition. Though these deficits are typically attributed to abnormal communication between macro-scale cortical networks, altered communication with the cerebellum also plays an important role. Yet, how the circuitry between the cerebellum and large-scale functional networks impact treatment outcome in MDD is not understood. We thus examined how ketamine, which elicits rapid therapeutic effects in MDD, modulates cerebro-cerebellar circuitry during response-inhibition using a functional imaging NoGo/Go task in MDD patients (N = 46, mean age: 39.2, 38.1% female) receiving four ketamine infusions, and healthy controls (N = 32, mean age:35.2, 71.4% female). We fitted psychophysiological-interaction (PPI) models for a functionally-derived cerebellar-seed and extracted average PPI in three target functional networks, frontoparietal (FPN), sensory-motor (SMN) and salience (SN) networks. Time and remission status were then evaluated for each of the networks and their network-nodes. Follow-up tests examined whether PPI-connectivity differed between patient remitter/non-remitters and controls. Results showed significant decreases in PPI-connectivity after ketamine between the cerebellum and FPN (p < 0.001) and SMN networks (p = 0.008) in remitters only (N = 20). However, ketamine-related changes in PPI-connectivity between the cerebellum and the SN (p = 0.003) did not vary with remitter status. Cerebellar-FPN, -SN PPI values at baseline were also associated with treatment outcome. Using novel methodology to quantify the functional coupling of cerebro-cerebellar circuitry during response-inhibition, our findings highlight that these loops play distinct roles in treatment response and could potentially serve as novel biomarkers for fast-acting antidepressant therapies in MDD.
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Affiliation(s)
- Joana R A Loureiro
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA.
| | - Ashish K Sahib
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | - Megha Vasavada
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Antoni Kubicki
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | - Benjamin Wade
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | - Shantanu Joshi
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | - Gerhard Hellemann
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Eliza Congdon
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Roger P Woods
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Randall Espinoza
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Katherine L Narr
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
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34
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Alario AA, Niciu MJ. Biomarkers of ketamine's antidepressant effect: a clinical review of genetics, functional connectivity, and neurophysiology. CHRONIC STRESS 2021; 5:24705470211014210. [PMID: 34159281 PMCID: PMC8186113 DOI: 10.1177/24705470211014210] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/13/2021] [Indexed: 12/17/2022]
Abstract
Major depressive disorder (MDD) is one of the leading causes of morbidity and all-cause mortality (including suicide) worldwide, and, unfortunately, first-line monoaminergic antidepressants and evidence-based psychotherapies are not effective for all patients. Subanesthetic doses of the N-methyl-D-aspartate receptor antagonists and glutamate modulators ketamine and S-ketamine have rapid and robust antidepressant efficacy in such treatment-resistant depressed patients (TRD). Yet, as with all antidepressant treatments including electroconvulsive therapy (ECT), not all TRD patients adequately respond, and we are presently unable to a priori predict who will respond or not respond to ketamine. Therefore, antidepressant treatment response biomarkers to ketamine have been a major focus of research for over a decade. In this article, we review the evidence in support of treatment response biomarkers, with a particular focus on genetics, functional magnetic resonance imaging, and neurophysiological studies, i.e. electroencephalography and magnetoencephalography. The studies outlined here lay the groundwork for replication and dissemination.
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Affiliation(s)
- Alexandra A Alario
- Department of Psychiatry and Iowa Neuroscience Institute, University of Iowa Health Care, Iowa City, IA, USA
| | - Mark J Niciu
- Department of Psychiatry and Iowa Neuroscience Institute, University of Iowa Health Care, Iowa City, IA, USA
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35
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Kruse JL, Vasavada MM, Olmstead R, Hellemann G, Wade B, Breen EC, Brooks JO, Congdon E, Espinoza R, Narr KL, Irwin MR. Depression treatment response to ketamine: sex-specific role of interleukin-8, but not other inflammatory markers. Transl Psychiatry 2021; 11:167. [PMID: 33723220 PMCID: PMC7960960 DOI: 10.1038/s41398-021-01268-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 01/08/2021] [Accepted: 01/20/2021] [Indexed: 12/11/2022] Open
Abstract
Inflammation plays a role in depression pathophysiology and treatment response, with effects varying by sex and therapeutic modality. Lower levels of interleukin(IL)-8 predict depression response to antidepressant medication and to electroconvulsive therapy (ECT), although ECT effects are specific to females. Whether IL-8 predicts depression response to ketamine and in a sex-specific manner is not known. Here, depressed patients (n = 46; female, n = 17) received open label infusion of ketamine (0.5 mg/kg over 40 min; NCT02165449). Plasma levels of IL-8 were evaluated at baseline and post-treatment. Baseline levels of IL-8 had a trending association with response to ketamine, depending upon sex (responder status × sex interaction: p = 0.096), in which lower baseline levels of IL-8 in females (p = 0.095) but not males (p = 0.96) trended with treatment response. Change in levels of IL-8 from baseline to post-treatment differed significantly by responder status (defined as ≥50% reduction in Hamilton Depression Rating Scale [HAM-D] Score), depending upon sex (responder status × sex × time interaction: F(1,42)=6.68, p = 0.01). In addition, change in IL-8 interacted with sex to predict change in HAM-D score (β = -0.63, p = 0.003); increasing IL-8 was associated with decreasing HAM-D score in females (p = 0.08) whereas the inverse was found in males (p = 0.02). Other inflammatory markers (IL-6, IL-10, tumor necrosis factor-α, C-reactive protein) were explored with no significant relationships identified. Given these preliminary findings, further evaluation of sex differences in the relationship between IL-8 and treatment response is warranted to elucidate mechanisms of response and aid in the development of personalized approaches to depression treatment.
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Affiliation(s)
- Jennifer L. Kruse
- grid.19006.3e0000 0000 9632 6718Cousins Center for Psychoneuroimmunology, University of California at Los Angeles, Los Angeles, CA USA ,grid.19006.3e0000 0000 9632 6718Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Los Angeles, CA USA
| | - Megha M. Vasavada
- grid.19006.3e0000 0000 9632 6718Department of Neurology, University of California at Los Angeles, Los Angeles, CA USA
| | - Richard Olmstead
- grid.19006.3e0000 0000 9632 6718Cousins Center for Psychoneuroimmunology, University of California at Los Angeles, Los Angeles, CA USA ,grid.19006.3e0000 0000 9632 6718Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Los Angeles, CA USA
| | - Gerhard Hellemann
- grid.19006.3e0000 0000 9632 6718Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Los Angeles, CA USA
| | - Benjamin Wade
- grid.19006.3e0000 0000 9632 6718Department of Neurology, University of California at Los Angeles, Los Angeles, CA USA
| | - Elizabeth C. Breen
- grid.19006.3e0000 0000 9632 6718Cousins Center for Psychoneuroimmunology, University of California at Los Angeles, Los Angeles, CA USA ,grid.19006.3e0000 0000 9632 6718Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Los Angeles, CA USA
| | - John O. Brooks
- grid.19006.3e0000 0000 9632 6718Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Los Angeles, CA USA
| | - Eliza Congdon
- grid.19006.3e0000 0000 9632 6718Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Los Angeles, CA USA
| | - Randall Espinoza
- grid.19006.3e0000 0000 9632 6718Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Los Angeles, CA USA
| | - Katherine L. Narr
- grid.19006.3e0000 0000 9632 6718Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Los Angeles, CA USA ,grid.19006.3e0000 0000 9632 6718Department of Neurology, University of California at Los Angeles, Los Angeles, CA USA
| | - Michael R. Irwin
- grid.19006.3e0000 0000 9632 6718Cousins Center for Psychoneuroimmunology, University of California at Los Angeles, Los Angeles, CA USA ,grid.19006.3e0000 0000 9632 6718Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Los Angeles, CA USA
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Nakamura T, Tomita M, Horikawa N, Ishibashi M, Uematsu K, Hiraki T, Abe T, Uchimura N. Functional connectivity between the amygdala and subgenual cingulate gyrus predicts the antidepressant effects of ketamine in patients with treatment-resistant depression. Neuropsychopharmacol Rep 2021; 41:168-178. [PMID: 33615749 PMCID: PMC8340826 DOI: 10.1002/npr2.12165] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/21/2021] [Accepted: 01/23/2021] [Indexed: 12/28/2022] Open
Abstract
Aim Approximately one‐third of patients with major depressive disorder develop treatment‐resistant depression. One‐third of patients with treatment‐resistant depression demonstrate resistance to ketamine, which is a novel antidepressant effective for this disorder. The objective of this study was to examine the utility of resting‐state functional magnetic resonance imaging for the prediction of treatment response to ketamine in treatment‐resistant depression. Methods An exploratory seed‐based resting‐state functional magnetic resonance imaging analysis was performed to examine baseline resting‐state functional connectivity differences between ketamine responders and nonresponders before treatment with multiple intravenous ketamine infusions. Results Fifteen patients with treatment‐resistant depression received multiple intravenous subanesthetic (0.5 mg/kg/40 minutes) ketamine infusions, and nine were identified as responders. The exploratory resting‐state functional magnetic resonance imaging analysis identified a cluster of significant baseline resting‐state functional connectivity differences associating ketamine response between the amygdala and subgenual anterior cingulate gyrus in the right hemisphere. Using anatomical region of interest analysis of the resting‐state functional connectivity, ketamine response was predicted with 88.9% sensitivity and 100% specificity. The resting‐state functional connectivity of significant group differences between responders and nonresponders retained throughout the treatment were considered a trait‐like feature of heterogeneity in treatment‐resistant depression. Conclusion This study suggests the possible clinical utility of resting‐state functional magnetic resonance imaging for predicting the antidepressant effects of ketamine in treatment‐resistant depression patients and implicated resting‐state functional connectivity alterations to determine the trait‐like pathophysiology underlying treatment response heterogeneity in treatment‐resistant depression. This study illustrates that the alteration in the RSFC within the right AN in TRD patients reflects the antidepressant response to ketamine at baseline. The alteration remained throughout the 2‐week treatment with multiple ketamine infusions and seemed to reflect the trait‐like features underlying treatment heterogeneity in TRD. By employing an anatomical ROI of the sc/sgACC, the present study also suggests the possible clinical utility of the rsfMRI to predict the treatment response to ketamine in TRD patients.
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Affiliation(s)
- Tomoyuki Nakamura
- Department of Neuropsychiatry, Kurume University School of Medicine, Kurume City, Japan
| | - Masaru Tomita
- Department of Neuropsychiatry, Kurume University School of Medicine, Kurume City, Japan.,Elm-tree Mental Clinic, Ogori City, Japan
| | - Naoki Horikawa
- Department of Neuropsychiatry, Kurume University School of Medicine, Kurume City, Japan.,Nozoe Hills Hospital, Kurume City, Japan
| | - Masatoshi Ishibashi
- Department of Neuropsychiatry, Kurume University School of Medicine, Kurume City, Japan
| | - Ken Uematsu
- Uematsu Mental Clinic, Chikugo City, Japan.,Department of Pharmacology, Kurume University School of Medicine, Kurume City, Japan
| | - Teruyuki Hiraki
- Department of Anaesthesiology, Kurume University School of Medicine, Kurume City, Japan
| | - Toshi Abe
- Department of Radiology, Kurume University School of Medicine, Kurume City, Japan
| | - Naohisa Uchimura
- Department of Neuropsychiatry, Kurume University School of Medicine, Kurume City, Japan
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37
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Is ketamine an appropriate alternative to ECT for patients with treatment resistant depression? A systematic review. J Affect Disord 2021; 281:82-89. [PMID: 33307338 DOI: 10.1016/j.jad.2020.11.123] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 11/23/2020] [Accepted: 11/26/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Ketamine has repeatedly shown to have rapid and robust antidepressant effects in patients with treatment resistant depression (TRD). An important question is whether ketamine is as effective and safe as the current gold standard electroconvulsive therapy (ECT). METHODS The literature was searched for trials comparing ketamine treatment with ECT for depression in the Pubmed/MEDLINE database and Cochrane Trials Library. RESULTS A total of 137 manuscripts were identified, 6 articles were included in this review. Overall quality of the included studies was diverse with relevant risk of bias for some of the studies. Results suggest that ketamine treatment might give faster but perhaps less durable antidepressant effects. Side effects differed from ECT, in particular less cognitive impairment was apparent in ketamine treatment. LIMITATIONS The included studies have limited sample sizes, use different treatment protocols and in most trials, longer term follow up is lacking. Furthermore, allocation bias appears likely in the non-randomized trials. CONCLUSIONS Current available literature does not yet provide convincing evidence to consider ketamine as an equally effective treatment alternative to ECT in patients with TRD. There are indications for a more favourable short term cognitive side effect profile after ketamine treatment. Methodologically well-designed studies with larger sample sizes and longer follow up duration are warranted.
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Kadriu B, Greenwald M, Henter ID, Gilbert JR, Kraus C, Park LT, Zarate CA. Ketamine and Serotonergic Psychedelics: Common Mechanisms Underlying the Effects of Rapid-Acting Antidepressants. Int J Neuropsychopharmacol 2021; 24:8-21. [PMID: 33252694 PMCID: PMC7816692 DOI: 10.1093/ijnp/pyaa087] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/13/2020] [Accepted: 11/16/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The glutamatergic modulator ketamine has created a blueprint for studying novel pharmaceuticals in the field. Recent studies suggest that "classic" serotonergic psychedelics (SPs) may also have antidepressant efficacy. Both ketamine and SPs appear to produce rapid, sustained antidepressant effects after a transient psychoactive period. METHODS This review summarizes areas of overlap between SP and ketamine research and considers the possibility of a common, downstream mechanism of action. The therapeutic relevance of the psychoactive state, overlapping cellular and molecular effects, and overlapping electrophysiological and neuroimaging observations are all reviewed. RESULTS Taken together, the evidence suggests a potentially shared mechanism wherein both ketamine and SPs may engender rapid neuroplastic effects in a glutamatergic activity-dependent manner. It is postulated that, though distinct, both ketamine and SPs appear to produce acute alterations in cortical network activity that may initially produce psychoactive effects and later produce milder, sustained changes in network efficiency associated with therapeutic response. However, despite some commonalities between the psychoactive component of these pharmacologically distinct therapies-such as engagement of the downstream glutamatergic pathway-the connection between psychoactive impact and antidepressant efficacy remains unclear and requires more rigorous research. CONCLUSIONS Rapid-acting antidepressants currently under investigation may share some downstream pharmacological effects, suggesting that their antidepressant effects may come about via related mechanisms. Given the prototypic nature of ketamine research and recent progress in this area, this platform could be used to investigate entirely new classes of antidepressants with rapid and robust actions.
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Affiliation(s)
- Bashkim Kadriu
- Section on the Neurobiology and Treatment of Mood Disorders, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Maximillian Greenwald
- Section on the Neurobiology and Treatment of Mood Disorders, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Ioline D Henter
- Section on the Neurobiology and Treatment of Mood Disorders, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Jessica R Gilbert
- Section on the Neurobiology and Treatment of Mood Disorders, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Christoph Kraus
- Section on the Neurobiology and Treatment of Mood Disorders, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Lawrence T Park
- Section on the Neurobiology and Treatment of Mood Disorders, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Carlos A Zarate
- Section on the Neurobiology and Treatment of Mood Disorders, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
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39
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Peräkylä J, Järventausta K, Haapaniemi P, Camprodon JA, Hartikainen KM. Threat-Modulation of Executive Functions-A Novel Biomarker of Depression? Front Psychiatry 2021; 12:670974. [PMID: 34276442 PMCID: PMC8283506 DOI: 10.3389/fpsyt.2021.670974] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/29/2021] [Indexed: 12/15/2022] Open
Abstract
Background: Alterations in executive functions, emotion regulation, and their interaction are common concomitants of depression. Executive dysfunction frequently lingers after treatment, has adverse effects on daily life, and predisposes to recurrence of depression. Yet, sensitive measures of executive function for reliable assessment of cognitive outcomes are still lacking in clinical practice. To better understand the impact of depression and its most effective treatment, electroconvulsive therapy (ECT), on cognition, we assessed executive functions pre- and post-ECT and whether objective measures reflecting alterations in emotion-executive function interaction correlate with depression severity or with cognitive outcome. Methods: Executive functions were assessed in 21 patients with major depressive disorder (MDD) before and after ECT using subjective measures from the Behavior Rating Inventory of Executive Function-Adult version (BRIEF-A) and objective cognitive performance measures derived from computer-based test of executive function, Executive Reaction Time (RT) Test. In addition, we created novel indices reflecting emotional modulation of cognitive performance by subtracting different performance measures in the context of neutral distractors from those in the context of threat-related distractors. We correlated these indices with Beck Depression Inventory (BDI) and BRIEF-A scores. Results: Depression was significantly alleviated, and executive functions improved post-ECT, as seen in reduced BDI scores, BRIEF-A scores, and number of errors in Executive RT Test. Pre-ECT BDI scores correlated with threat modulation of RT (tmRT) and threat modulation of working memory (tmWM). Post-ECT tmRT correlated with several Behavioral Regulation scales and tmWM with several Metacognition scales of BRIEF-A. Conclusion: While caution is warranted, results from both subjective and objective measures suggest that ECT significantly improves executive functions and emotion regulation along with alleviation of depression. Novel indices derived from threat modulation of executive function and working memory show promise as objective biomarkers of depression severity pre-ECT and cognitive outcome post-ECT with potential for guiding depression treatments.
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Affiliation(s)
- Jari Peräkylä
- Behavioral Neurology Research Unit, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Kaija Järventausta
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Psychiatry, Tampere University Hospital, Tampere, Finland
| | - Piia Haapaniemi
- Behavioral Neurology Research Unit, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Joan A Camprodon
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States
| | - Kaisa M Hartikainen
- Behavioral Neurology Research Unit, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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40
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Haarsma J, Harmer CJ, Tamm S. A continuum hypothesis of psychotomimetic rapid antidepressants. Brain Neurosci Adv 2021; 5:23982128211007772. [PMID: 34017922 PMCID: PMC8114748 DOI: 10.1177/23982128211007772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 03/08/2021] [Indexed: 01/10/2023] Open
Abstract
Ketamine, classical psychedelics and sleep deprivation are associated with rapid effects on depression. Interestingly, these interventions also have common psychotomimetic actions, mirroring aspects of psychosis such as an altered sense of self, perceptual distortions and distorted thinking. This raises the question whether these interventions might be acute antidepressants through the same mechanisms that underlie some of their psychotomimetic effects. That is, perhaps some symptoms of depression can be understood as occupying the opposite end of a spectrum where elements of psychosis can be found on the other side. This review aims at reviewing the evidence underlying a proposed continuum hypothesis of psychotomimetic rapid antidepressants, suggesting that a range of psychotomimetic interventions are also acute antidepressants as well as trying to explain these common features in a hierarchical predictive coding framework, where we hypothesise that these interventions share a common mechanism by increasing the flexibility of prior expectations. Neurobiological mechanisms at play and the role of different neuromodulatory systems affected by these interventions and their role in controlling the precision of prior expectations and new sensory evidence will be reviewed. The proposed hypothesis will also be discussed in relation to other existing theories of antidepressants. We also suggest a number of novel experiments to test the hypothesis and highlight research areas that could provide further insights, in the hope to better understand the acute antidepressant properties of these interventions.
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Affiliation(s)
- Joost Haarsma
- Wellcome Centre for Human Neuroimaging, University College London, London, UK
| | - Catherine J Harmer
- Department of Psychiatry and Oxford Health NHS Foundation Trust, Warneford Hospital, University of Oxford, Oxford, UK
| | - Sandra Tamm
- Department of Psychiatry and Oxford Health NHS Foundation Trust, Warneford Hospital, University of Oxford, Oxford, UK
- Stress Research Institute, Department of Psychology, Stockholm University, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
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41
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Seok D, Smyk N, Jaskir M, Cook P, Elliott M, Girelli T, Scott JC, Balderston N, Beer J, Stock J, Makhoul W, Gur RC, Davatzikos C, Shinohara R, Sheline Y. Dimensional connectomics of anxious misery, a human connectome study related to human disease: Overview of protocol and data quality. NEUROIMAGE-CLINICAL 2020; 28:102489. [PMID: 33395980 PMCID: PMC7708855 DOI: 10.1016/j.nicl.2020.102489] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/09/2020] [Accepted: 10/27/2020] [Indexed: 11/19/2022]
Abstract
We present a new imaging study of 200 adults experiencing depression and anxiety. Quantitative measures of image quality indicate comparable quality to the HCP-YA. In addition, a comprehensive set of assessments measured patients’ symptom profiles. Data will be publicly available through the NIMH Data Archive starting fall 2020.
Disparate diagnostic categories from the Diagnostic and Statistical Manual of Mental Disorders (DSM), including generalized anxiety disorder, major depressive disorder and post-traumatic stress disorder, share common behavioral and phenomenological dysfunctions. While high levels of comorbidity and common features across these disorders suggest shared mechanisms, past research in psychopathology has largely proceeded based on the syndromal taxonomy established by the DSM rather than on a biologically-informed framework of neural, cognitive and behavioral dysfunctions. In line with the National Institute of Mental Health’s Research Domain Criteria (RDoC) framework, we present a Human Connectome Study Related to Human Disease that is intentionally designed to generate and test novel, biologically-motivated dimensions of psychopathology. The Dimensional Connectomics of Anxious Misery study is collecting neuroimaging, cognitive and behavioral data from a heterogeneous population of adults with varying degrees of depression, anxiety and trauma, as well as a set of healthy comparators (to date, n = 97 and n = 24, respectively). This sample constitutes a dataset uniquely situated to elucidate relationships between brain circuitry and dysfunctions of the Negative Valence construct of the RDoC framework. We present a comprehensive overview of the eligibility criteria, clinical procedures and neuroimaging methods of our project. After describing our protocol, we present group-level activation maps from task fMRI data and independent components maps from resting state data. Finally, using quantitative measures of neuroimaging data quality, we demonstrate excellent data quality relative to a subset of the Human Connectome Project of Young Adults (n = 97), as well as comparable profiles of cortical thickness from T1-weighted imaging and generalized fractional anisotropy from diffusion weighted imaging. This manuscript presents results from the first 121 participants of our full target 250 participant dataset, timed with the release of this data to the National Institute of Mental Health Data Archive in fall 2020, with the remaining half of the dataset to be released in 2021.
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Affiliation(s)
- Darsol Seok
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
| | - Nathan Smyk
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
| | - Marc Jaskir
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
| | - Philip Cook
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, United States
| | - Mark Elliott
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, United States
| | - Tommaso Girelli
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
| | - J Cobb Scott
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
| | - Nicholas Balderston
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
| | - Joanne Beer
- Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, United States
| | - Janet Stock
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
| | - Walid Makhoul
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
| | - Ruben C Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
| | - Christos Davatzikos
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, United States
| | - Russell Shinohara
- Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, United States
| | - Yvette Sheline
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, United States; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States.
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42
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Vasavada MM, Loureiro J, Kubicki A, Sahib A, Wade B, Hellemann G, Espinoza RT, Congdon E, Narr KL, Leaver AM. Effects of Serial Ketamine Infusions on Corticolimbic Functional Connectivity in Major Depression. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2020; 6:735-744. [PMID: 32900657 DOI: 10.1016/j.bpsc.2020.06.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Ketamine is a highly effective antidepressant for patients with treatment-resistant major depressive disorder (MDD). Resting-state functional magnetic resonance imaging studies show disruptions of functional connectivity (FC) between limbic regions and resting-state networks (RSNs) in MDD, including the default mode network, central executive network (CEN), and salience network (SN). Here, we investigated whether serial ketamine treatments change FC between limbic structures and RSNs. METHODS Patients with MDD (n = 44) were scanned at baseline (time 1 [T1]) and 24 hours after the first (T2) and fourth (T3) infusions of ketamine. Healthy control subjects (n = 50) were scanned at baseline, with a subgroup (n = 17) being rescanned at 2 weeks. Limbic regions included the amygdala and hippocampus, and RSNs included the default mode network, CEN, and SN. RESULTS Ketamine increased right amygdala FC to the right CEN (p = .05), decreased amygdala FC to the left CEN (p = .005) at T2 versus T1 (p = .015), which then increased at T3 versus T2 (p = .002), and decreased left amygdala FC to the SN (p = .016). Decreased left amygdala to SN FC at T2 predicted improvements in anxiety at T3 (p = .006). Ketamine increased right hippocampus FC to the left CEN (p = .001), and this change at T2 predicted decreased anhedonia at T3 (p = .005). CONCLUSIONS Ketamine modulates FC between limbic regions and RSNs implicated in MDD. Increases in FC between limbic regions and the CEN suggest that ketamine may be involved in restoring top-down control of emotion processing. FC decreases between the left amygdala and SN suggest that ketamine may ameliorate MDD-related dysconnectivity in these circuits. Early FC changes between limbic regions and RSNs may be predictive of clinical improvements.
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Affiliation(s)
- Megha M Vasavada
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Joana Loureiro
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Antoni Kubicki
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Ashish Sahib
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Benjamin Wade
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Gerhard Hellemann
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Randall T Espinoza
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Eliza Congdon
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Katherine L Narr
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; Jane and Terry Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Amber M Leaver
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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43
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Loureiro JRA, Leaver A, Vasavada M, Sahib AK, Kubicki A, Joshi S, Woods RP, Wade B, Congdon E, Espinoza R, Narr KL. Modulation of amygdala reactivity following rapidly acting interventions for major depression. Hum Brain Mapp 2020; 41:1699-1710. [PMID: 32115848 PMCID: PMC7268016 DOI: 10.1002/hbm.24895] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 11/26/2019] [Accepted: 11/30/2019] [Indexed: 12/28/2022] Open
Abstract
Electroconvulsive therapy (ECT) and ketamine treatment both induce rapidly acting antidepressant effects in patients with major depressive disorder unresponsive to standard treatments, yet their specific impact on emotion processing is unknown. Here, we examined the neural underpinnings of emotion processing within and across patients (N = 44) receiving either ECT (N = 17, mean age: 36.8, 11.0 SD) or repeated subanesthetic (0.5 mg/kg) intravenous ketamine therapy (N = 27, mean age: 37.3, 10.8 SD) using a naturalistic study design. MRI and clinical data were collected before (TP1) and after treatment (TP2); healthy controls (N = 31, mean age: 34.5, 13.5 SD) completed one MRI session (TP1). An fMRI face-matching task probed negative- and positive-valence systems. Whole-brain analysis, comparing neurofunctional changes within and across treatment groups, targeted brain regions involved in emotional facial processing, and included regions-of-interest analysis of amygdala responsivity. Main findings revealed a decrease in amygdalar reactivity after both ECT and ketamine for positive and negative emotional face processing (p < .05 family wise-error (FWE) corrected). Subthreshold changes were observed between treatments within the dorsolateral prefrontal cortex and insula (p < .005, uncorrected). BOLD change for positive faces in the inferior parietal cortex significantly correlated with overall symptom improvement, and BOLD change in frontal regions correlated with anxiety for negative faces, and anhedonia for positive faces (p < .05 FWE corrected). Both serial ketamine and ECT treatment modulate amygdala response, while more subtle treatment-specific changes occur in the larger functional network. Findings point to both common and differential mechanistic upstream systems-level effects relating to fast-acting antidepressant response, and symptoms of anxiety and anhedonia, for the processing of emotionally valenced stimuli.
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Affiliation(s)
- Joana R. A. Loureiro
- Department of NeurologyAhamason‐Lovelace Brain Mapping CenterLos AngelesCalifornia
| | - Amber Leaver
- Northwestern University Clinical and Translational Sciences Institute (NUCATS)ChicagoIllinois
| | - Megha Vasavada
- Department of NeurologyAhamason‐Lovelace Brain Mapping CenterLos AngelesCalifornia
| | - Ashish K. Sahib
- Department of NeurologyAhamason‐Lovelace Brain Mapping CenterLos AngelesCalifornia
| | - Antoni Kubicki
- Department of NeurologyAhamason‐Lovelace Brain Mapping CenterLos AngelesCalifornia
| | - Shantanu Joshi
- Department of NeurologyAhamason‐Lovelace Brain Mapping CenterLos AngelesCalifornia
| | - Roger P. Woods
- Department of NeurologyAhamason‐Lovelace Brain Mapping CenterLos AngelesCalifornia
| | - Benjamin Wade
- Department of NeurologyAhamason‐Lovelace Brain Mapping CenterLos AngelesCalifornia
| | - Eliza Congdon
- Department of Psychiatry and Biobehavioral SciencesUniversity of California Los AngelesLos AngelesCalifornia
| | - Randall Espinoza
- Department of Psychiatry and Biobehavioral SciencesUniversity of California Los AngelesLos AngelesCalifornia
| | - Katherine L. Narr
- Department of NeurologyAhamason‐Lovelace Brain Mapping CenterLos AngelesCalifornia
- Department of Psychiatry and Biobehavioral SciencesUniversity of California Los AngelesLos AngelesCalifornia
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