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Li B, Zhao N, Tang N, Friston KJ, Zhai W, Wu D, Liu J, Chen Y, Min Y, Qiao Y, Liu W, Shu W, Liu M, Zhou P, Guo L, Qi S, Cui LB, Wang H. Targeting suicidal ideation in major depressive disorder with MRI-navigated Stanford accelerated intelligent neuromodulation therapy. Transl Psychiatry 2024; 14:21. [PMID: 38199983 PMCID: PMC10781692 DOI: 10.1038/s41398-023-02707-9] [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: 10/27/2022] [Revised: 11/16/2023] [Accepted: 12/07/2023] [Indexed: 01/12/2024] Open
Abstract
High suicide risk represents a serious problem in patients with major depressive disorder (MDD), yet treatment options that could safely and rapidly ameliorate suicidal ideation remain elusive. Here, we tested the feasibility and preliminary efficacy of the Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT) in reducing suicidal ideation in patients with MDD. Thirty-two MDD patients with moderate to severe suicidal ideation participated in the current study. Suicidal ideation and depression symptoms were assessed before and after 5 days of open-label SAINT. The neural pathways supporting rapid-acting antidepressant and suicide prevention effects were identified with dynamic causal modelling based on resting-state functional magnetic resonance imaging. We found that 5 days of SAINT effectively alleviated suicidal ideation in patients with MDD with a high response rate of 65.63%. Moreover, the response rates achieved 78.13% and 90.63% with 2 weeks and 4 weeks after SAINT, respectively. In addition, we found that the suicide prevention effects of SAINT were associated with the effective connectivity involving the insula and hippocampus, while the antidepressant effects were related to connections of the subgenual anterior cingulate cortex (sgACC). These results show that SAINT is a rapid-acting and effective way to reduce suicidal ideation. Our findings further suggest that distinct neural mechanisms may contribute to the rapid-acting effects on the relief of suicidal ideation and depression, respectively.
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Affiliation(s)
- Baojuan Li
- School of Biomedical Engineering, Fourth Military Medical University, 710032, Xi'an, Shaanxi, China
| | - Na Zhao
- Center for Cognition and Brain Disorders, the Affiliated Hospital of Hangzhou Normal University, 310015, Hangzhou, Zhejiang, China
- Institute of Psychological Sciences, Hangzhou Normal University, 311121, Hangzhou, Zhejiang, China
- Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, 310015, Hangzhou, Zhejiang, China
| | - Nailong Tang
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, 710032, Xi'an, China
- Department of Psychiatry, 907 Hospital of Joint Logistics Team, 353000, Nanping, Fujian, China
| | - Karl J Friston
- The Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, WC1N 3AR, UK
| | - Wensheng Zhai
- School of Biomedical Engineering, Fourth Military Medical University, 710032, Xi'an, Shaanxi, China
| | - Di Wu
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, 710032, Xi'an, China
| | - Junchang Liu
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, 710032, Xi'an, China
| | - Yihuan Chen
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, 710032, Xi'an, China
| | - Yan Min
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, 710032, Xi'an, China
| | - Yuting Qiao
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, 710032, Xi'an, China
| | - Wenming Liu
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, 710032, Xi'an, China
| | - Wanqing Shu
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, 710032, Xi'an, China
| | - Min Liu
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, 710032, Xi'an, China
| | - Ping Zhou
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, 710032, Xi'an, China
| | - Li Guo
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, 710032, Xi'an, China
| | - Shun Qi
- Brain Modulation and Scientific Research Center, 710043, Xi'an, China
- Neuromodulation Lab of Brain Science and Humanoid Intelligence Research Center, Xi'an Jiaotong University, 710049, Xi'an, China
| | - Long-Biao Cui
- Shaanxi Provincial Key Laboratory of Clinic Genetics, Fourth Military Medical University, 710032, Xi'an, China.
- Department of Radiology, The Second Medical Center, Chinese PLA General Hospital, 100856, Beijing, China.
| | - Huaning Wang
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, 710032, Xi'an, China.
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Charlton CE, Karvelis P, McIntyre RS, Diaconescu AO. Suicide prevention and ketamine: insights from computational modeling. Front Psychiatry 2023; 14:1214018. [PMID: 37457775 PMCID: PMC10342546 DOI: 10.3389/fpsyt.2023.1214018] [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: 04/28/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
Suicide is a pressing public health issue, with over 700,000 individuals dying each year. Ketamine has emerged as a promising treatment for suicidal thoughts and behaviors (STBs), yet the complex mechanisms underlying ketamine's anti-suicidal effect are not fully understood. Computational psychiatry provides a promising framework for exploring the dynamic interactions underlying suicidality and ketamine's therapeutic action, offering insight into potential biomarkers, treatment targets, and the underlying mechanisms of both. This paper provides an overview of current computational theories of suicidality and ketamine's mechanism of action, and discusses various computational modeling approaches that attempt to explain ketamine's anti-suicidal effect. More specifically, the therapeutic potential of ketamine is explored in the context of the mismatch negativity and the predictive coding framework, by considering neurocircuits involved in learning and decision-making, and investigating altered connectivity strengths and receptor densities targeted by ketamine. Theory-driven computational models offer a promising approach to integrate existing knowledge of suicidality and ketamine, and for the extraction of model-derived mechanistic parameters that can be used to identify patient subgroups and personalized treatment approaches. Future computational studies on ketamine's mechanism of action should optimize task design and modeling approaches to ensure parameter reliability, and external factors such as set and setting, as well as psychedelic-assisted therapy should be evaluated for their additional therapeutic value.
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Affiliation(s)
- Colleen E. Charlton
- Krembil Center for Neuroinformatics, Center for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Povilas Karvelis
- Krembil Center for Neuroinformatics, Center for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Roger S. McIntyre
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Andreea O. Diaconescu
- Krembil Center for Neuroinformatics, Center for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
- Department of Psychology, University of Toronto, Toronto, ON, Canada
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3
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Dai Z, Zhang S, Wang H, Chen Z, Zhang W, Hu X, Yao Z, Lu Q. Hampered gamma oscillations induced by sad emotion underlying suicide attempt in major depressive disorder. Psychiatry Clin Neurosci 2023; 77:20-29. [PMID: 36207792 DOI: 10.1111/pcn.13487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/18/2022] [Accepted: 09/30/2022] [Indexed: 01/06/2023]
Abstract
AIM Major depressive disorder (MDD) is associated with high suicidality, especially for those with suicide attempt (SA). Although impaired oscillatory activity has been previously reported in patients with SA, little is known about precise temporal-spatial variability of its neural dynamics. To solve this, the current study probed the spectral power and network interactions underlying SA in MDD. METHODS The present study recruited 104 subjects including 56 subjects with MDD (30 with SA and 26 without SA) and 48 healthy controls, who performed sad expressions recognition task during magnetoencephalography (MEG) recording. By investigating source-reconstructed MEG-data, brain states representing different task stages were estimated from a Hidden Markov model. Spectrum power and network connectivity were compared via Gaussian Mixture Models, and fractional occupancy (FO) of states were compared via an independent F-test. RESULTS Brain states were corresponding to various frequencies (theta/beta/low gamma/ high gamma). In low gamma band (35-45 Hz), the early visual state exhibited increased activation and hyper inter-network connectivity between visual regions and the limbic system, while the middle fronto-parietal state exhibited attenuated activation and decreased intra-network connectivity within fronto-parietal regions in SA group. Crucially, FO values of these two states were significantly correlated with the suicide risks. CONCLUSIONS Suicide behavior of patients with MDD was significantly associated with aberrant oscillations in low gamma band. Elevated oscillations in occipital cortices and attenuated oscillations in fronto-parietal cortices were significantly associated with SA. Manifesting sadness indulging and reckless decision-making, the hampered temporal characteristics could help explain the neural-electric basis of SA.
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Affiliation(s)
- Zhongpeng Dai
- School of Biological Sciences & Medical Engineering, Child Development and Learning Science, Key Laboratory of Child Development and Learning Science, Ministry of Education, Research Center for Learning Science, Southeast University, Nanjing, China.,Centre for Human Brain Health, School of Psychology, University of Birmingham, Birmingham, UK
| | - Siqi Zhang
- School of Biological Sciences & Medical Engineering, Child Development and Learning Science, Key Laboratory of Child Development and Learning Science, Ministry of Education, Research Center for Learning Science, Southeast University, Nanjing, China
| | - Huan Wang
- School of Biological Sciences & Medical Engineering, Child Development and Learning Science, Key Laboratory of Child Development and Learning Science, Ministry of Education, Research Center for Learning Science, Southeast University, Nanjing, China
| | - Zhilu Chen
- Nanjing Brain Hospital, Medical School of Nanjing University, Nanjing, China
| | - Wei Zhang
- School of Biological Sciences & Medical Engineering, Child Development and Learning Science, Key Laboratory of Child Development and Learning Science, Ministry of Education, Research Center for Learning Science, Southeast University, Nanjing, China
| | - Xiaowen Hu
- School of Biological Sciences & Medical Engineering, Child Development and Learning Science, Key Laboratory of Child Development and Learning Science, Ministry of Education, Research Center for Learning Science, Southeast University, Nanjing, China
| | - Zhijian Yao
- Nanjing Brain Hospital, Medical School of Nanjing University, Nanjing, China.,Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Qing Lu
- School of Biological Sciences & Medical Engineering, Child Development and Learning Science, Key Laboratory of Child Development and Learning Science, Ministry of Education, Research Center for Learning Science, Southeast University, Nanjing, China
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Zhang S, Litvak V, Tian S, Dai Z, Tang H, Wang X, Yao Z, Lu Q. Spontaneous transient states of fronto-temporal and default-mode networks altered by suicide attempt in major depressive disorder. Eur Arch Psychiatry Clin Neurosci 2022; 272:1547-1557. [PMID: 35088122 PMCID: PMC8794625 DOI: 10.1007/s00406-021-01371-8] [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: 07/02/2021] [Accepted: 12/10/2021] [Indexed: 11/30/2022]
Abstract
Major depressive disorder (MDD) is associated with increased suicidality, and it's still challenging to identify suicide in clinical practice. Although suicide attempt (SA) is the most relevant precursor with multiple functional abnormalities reported from neuroimaging studies, little is known about how the spontaneous transient activated patterns organize and coordinate brain networks underlying SA. Thus, we obtained resting-state magnetoencephalography data for two MDD subgroups of 44 non-suicide patients and 34 suicide-attempted patients, together with 49 matched health-controls. For the source-space signals, Hidden Markov Model (HMM) helped to capture the sub-second dynamic activity via a hidden sequence of finite number of states. Temporal parameters and spectral activation were acquired for each state and then compared between groups. Here, HMM states characterized the spatiotemporal signatures of eight networks. The activity of suicide attempters switches more frequently into the fronto-temporal network, as the time spent occupancy of fronto-temporal state is increased and interval time is decreased compared with the non-suicide patients. Moreover, these changes are significantly correlated with Nurses' Global Assessment of Suicide Risk scores. Suicide attempters also exhibit increased state-wise activations in the theta band (4-8 Hz) in the posterior default mode network centered on posterior cingulate cortex, which can't be detected in the static spectral analysis. These alternations may disturb the time allocations of cognitive control regulations and cause inflexible decision making to SA. As the better sensitivity of dynamic study in reflecting SA diathesis than the static is validated, dynamic stability could serve as a potential neuronal marker for SA.
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Affiliation(s)
- Siqi Zhang
- Key Laboratory of Child Development and Learning Science of Ministry of Education, School of Biological Sciences & Medical Engineering, Southeast University, No. 2 Sipailou, Nanjing, 210096 Jiangsu China
| | - Vladimir Litvak
- Wellcome Centre for Human Neuroimaging, UCL Institute of Neurology, London, UK
| | - Shui Tian
- Key Laboratory of Child Development and Learning Science of Ministry of Education, School of Biological Sciences & Medical Engineering, Southeast University, No. 2 Sipailou, Nanjing, 210096 Jiangsu China
| | - Zhongpeng Dai
- Key Laboratory of Child Development and Learning Science of Ministry of Education, School of Biological Sciences & Medical Engineering, Southeast University, No. 2 Sipailou, Nanjing, 210096 Jiangsu China
| | - Hao Tang
- Department of Psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Xinyi Wang
- Key Laboratory of Child Development and Learning Science of Ministry of Education, School of Biological Sciences & Medical Engineering, Southeast University, No. 2 Sipailou, Nanjing, 210096 Jiangsu China
| | - Zhijian Yao
- Department of Psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China ,Nanjing Brain Hospital, Medical School of Nanjing University, Nanjing, China
| | - Qing Lu
- Key Laboratory of Child Development and Learning Science of Ministry of Education, School of Biological Sciences & Medical Engineering, Southeast University, No. 2 Sipailou, Nanjing, 210096, Jiangsu, China.
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5
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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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6
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Gilbert JR, Galiano CS, Nugent AC, Zarate CA. Ketamine and Attentional Bias Toward Emotional Faces: Dynamic Causal Modeling of Magnetoencephalographic Connectivity in Treatment-Resistant Depression. Front Psychiatry 2021; 12:673159. [PMID: 34220581 PMCID: PMC8249755 DOI: 10.3389/fpsyt.2021.673159] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/25/2021] [Indexed: 12/11/2022] Open
Abstract
The glutamatergic modulator ketamine rapidly reduces depressive symptoms in individuals with treatment-resistant major depressive disorder (TRD) and bipolar disorder. While its underlying mechanism of antidepressant action is not fully understood, modulating glutamatergically-mediated connectivity appears to be a critical component moderating antidepressant response. This double-blind, crossover, placebo-controlled study analyzed data from 19 drug-free individuals with TRD and 15 healthy volunteers who received a single intravenous infusion of ketamine hydrochloride (0.5 mg/kg) as well as an intravenous infusion of saline placebo. Magnetoencephalographic recordings were collected prior to the first infusion and 6-9 h after both drug and placebo infusions. During scanning, participants completed an attentional dot probe task that included emotional faces. Antidepressant response was measured across time points using the Montgomery-Asberg Depression Rating Scale (MADRS). Dynamic causal modeling (DCM) was used to measure changes in parameter estimates of connectivity via a biophysical model that included realistic local neuronal architecture and receptor channel signaling, modeling connectivity between the early visual cortex, fusiform cortex, amygdala, and inferior frontal gyrus. Clinically, ketamine administration significantly reduced depressive symptoms in TRD participants. Within the model, ketamine administration led to faster gamma aminobutyric acid (GABA) and N-methyl-D-aspartate (NMDA) transmission in the early visual cortex, faster NMDA transmission in the fusiform cortex, and slower NMDA transmission in the amygdala. Ketamine administration also led to direct and indirect changes in local inhibition in the early visual cortex and inferior frontal gyrus and to indirect increases in cortical excitability within the amygdala. Finally, reductions in depressive symptoms in TRD participants post-ketamine were associated with faster α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) transmission and increases in gain control of spiny stellate cells in the early visual cortex. These findings provide additional support for the GABA and NMDA inhibition and disinhibition hypotheses of depression and support the role of AMPA throughput in ketamine's antidepressant effects. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT00088699?term=NCT00088699&draw=2&rank=1, identifier NCT00088699.
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Affiliation(s)
- Jessica R. Gilbert
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
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7
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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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8
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Ballard ED, Gilbert JR, Wusinich C, Zarate CA. New Methods for Assessing Rapid Changes in Suicide Risk. Front Psychiatry 2021; 12:598434. [PMID: 33574775 PMCID: PMC7870718 DOI: 10.3389/fpsyt.2021.598434] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 01/05/2021] [Indexed: 01/16/2023] Open
Abstract
Rapid-acting interventions for the suicide crisis have the potential to transform treatment. In addition, recent innovations in suicide research methods may similarly expand our understanding of the psychological and neurobiological correlates of suicidal thoughts and behaviors. This review discusses the limitations and challenges associated with current methods of suicide risk assessment and presents new techniques currently being developed to measure rapid changes in suicidal thoughts and behavior. These novel assessment strategies include ecological momentary assessment, digital phenotyping, cognitive and implicit bias metrics, and neuroimaging paradigms and analysis methodologies to identify neural circuits associated with suicide risk. This review is intended to both describe the current state of our ability to assess rapid changes in suicide risk as well as to explore future directions for clinical, neurobiological, and computational markers research in suicide-focused clinical trials.
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Affiliation(s)
- Elizabeth D. Ballard
- Section on the Neurobiology and Treatment of Mood Disorders, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
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9
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Neurobiological biomarkers of response to ketamine. ADVANCES IN PHARMACOLOGY (SAN DIEGO, CALIF.) 2020; 89:195-235. [PMID: 32616207 DOI: 10.1016/bs.apha.2020.05.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
As a field, psychiatry is undergoing an exciting paradigm shift toward early identification and intervention that will likely minimize both the burden associated with severe mental illnesses as well as their duration. In this context, the rapid-acting antidepressant ketamine has revolutionized our understanding of antidepressant response and greatly expanded the pharmacologic armamentarium for treatment-resistant depression. Efforts to characterize biomarkers of ketamine response support a growing emphasis on early identification, which would allow clinicians to identify biologically enriched subgroups with treatment-resistant depression who are more likely to benefit from ketamine therapy. This chapter presents a broad overview of a range of translational biomarkers, including those drawn from imaging and electrophysiological studies, sleep and circadian rhythms, and HPA axis/endocrine function as well as metabolic, immune, (epi)genetic, and neurotrophic biomarkers related to ketamine response. Ketamine's unique, rapid-acting properties may serve as a model to explore a whole new class of novel rapid-acting treatments with the potential to revolutionize drug development and discovery. However, it should be noted that although several of the biomarkers reviewed here provide promising insights into ketamine's mechanism of action, most studies have focused on acute rather than longer-term antidepressant effects and, at present, none of the biomarkers are ready for clinical use.
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10
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Ballard ED, Gilbert JR, Fields JS, Nugent AC, Zarate CA. Network Changes in Insula and Amygdala Connectivity Accompany Implicit Suicidal Associations. Front Psychiatry 2020; 11:577628. [PMID: 33192714 PMCID: PMC7543650 DOI: 10.3389/fpsyt.2020.577628] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/02/2020] [Indexed: 02/03/2023] Open
Abstract
Limited knowledge exists regarding the neurobiology of suicidal thoughts, given that there are currently no direct probes of the suicidal state. This pilot study used magnetoencephalography (MEG) to evaluate correlates of the implicit association between the self and death compared to the self and life as objective markers of suicide risk. Healthy volunteers (HVs; n=21) completed a modified version of the Suicide Implicit Association Task (S-IAT) during MEG scanning. Gamma power-which is considered a proxy measure of excitation-inhibition balance-was directly compared in the self-death/self-life contrast. As a proof-of-concept, the ability of dynamic causal modeling to categorize HVs versus four individuals with recent suicide crisis (SC) was evaluated. In HVs, enhanced gamma power in both amygdala and anterior insula were found for the self-death compared with self-life contrast. In addition, connectivity estimates between early visual cortex, anterior insula, and amygdala correctly categorized SC participants with 77% to 82% sensitivity and 80% to 85% specificity. These findings, which implicate network-level changes in salience network and amygdala connectivity in mediating suicidal associations, require further replication in larger samples. Direct probing of suicidal thoughts with the S-IAT may provide foundational markers of neural circuits associated with suicide risk.
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Affiliation(s)
- Elizabeth D Ballard
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
| | - Jessica R Gilbert
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
| | - Jessica S Fields
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
| | - Allison C Nugent
- MEG Core Facility, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
| | - Carlos A Zarate
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
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