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Colla M, Offenhammer B, Scheerer H, Kronenberg G, Vetter S, Mutschler J, Mikoteit T, Bankwitz A, Adank A, Schaekel L, Eicher C, Brühl AB, Seifritz E. Oral prolonged-release ketamine in treatment-resistant depression - A double-blind randomized placebo-controlled multicentre trial of KET01, a novel ketamine formulation - Clinical and safety results. J Psychiatr Res 2024; 173:124-130. [PMID: 38522166 DOI: 10.1016/j.jpsychires.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 02/26/2024] [Accepted: 03/03/2024] [Indexed: 03/26/2024]
Abstract
INTRODUCTION We investigated the antidepressant effects of a novel oral prolonged-release formulation of racemic ketamine (KET01) in patients suffering from treatment-resistant depression (TRD) as add-on therapy. MATERIAL AND METHODS Patients were randomized to an additional 160 mg/day or 240 mg/day KET01 or placebo for 14 days. The primary endpoint was change in Montgomery-Åsberg Depression Rating Scale (MADRS) scores from baseline to day 15. For treatment group comparisons, we used ANOVA with pairwise least squares mean difference tests in a mixed model repeated measures analysis. RESULTS Twenty-seven patients completed the double-blind protocol before trial premature termination due to poor recruitment during the COVID-19 pandemic. Mean (SD) MADRS scores on day 15 were 23 (10.32) in placebo, 25 (8.28) with 160 mg/day and 17 (10.32) with 240 mg/day KET01. MADRS change was numerically larger but statistically non-significant in the 240 mg/day KET01 group vs placebo on day 7 (-5.67; p = 00.106) and day 15 was (difference: 4.99; p = 00.15). In exploratory analysis, baseline leukocyte count correlated with response to KET01 (p = 00.01). Distribution of adverse event rates were comparable between the treatment arms. Safety analysis did not identify increased risk of suicidality, dissociation, hear rate, systolic and diastolic blood pressure associated with trial treatment. DISCUSSION Our results suggest that adjunctive oral administration of prolonged-release ketamine at a dose of 240 mg/day shows a positive, although statistically non-significant, trend towards antidepressant efficacy, however, the benefit could not be confirmed due to premature trial termination. Given its ease of use and low side effects, further trials are warranted to investigate this route of ketamine administration as a promising potential treatment of TRD.
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Affiliation(s)
- M Colla
- Department of Adult Psychiatry and Psychotherapy, Psychiatric University Clinic Zurich and University of Zurich, Switzerland.
| | - B Offenhammer
- Department of Adult Psychiatry and Psychotherapy, Psychiatric University Clinic Zurich and University of Zurich, Switzerland
| | - H Scheerer
- Department of Adult Psychiatry and Psychotherapy, Psychiatric University Clinic Zurich and University of Zurich, Switzerland
| | - G Kronenberg
- Department of Adult Psychiatry and Psychotherapy, Psychiatric University Clinic Zurich and University of Zurich, Switzerland
| | - S Vetter
- Department of Adult Psychiatry and Psychotherapy, Psychiatric University Clinic Zurich and University of Zurich, Switzerland
| | - J Mutschler
- Psychiatric Hospital Meiringen, Meiringen, Switzerland; Psychiatric Services Lucerne, Lucerne, Switzerland
| | - T Mikoteit
- Psychiatric Services Solothurn and University of Basel, Solothurn, Switzerland
| | - A Bankwitz
- Department of Adult Psychiatry and Psychotherapy, Psychiatric University Clinic Zurich and University of Zurich, Switzerland
| | - A Adank
- Department of Adult Psychiatry and Psychotherapy, Psychiatric University Clinic Zurich and University of Zurich, Switzerland
| | - L Schaekel
- Department of Adult Psychiatry and Psychotherapy, Psychiatric University Clinic Zurich and University of Zurich, Switzerland
| | - C Eicher
- Department of Adult Psychiatry and Psychotherapy, Psychiatric University Clinic Zurich and University of Zurich, Switzerland
| | - A B Brühl
- Department of Adult Psychiatry and Psychotherapy, Psychiatric University Clinic Zurich and University of Zurich, Switzerland; University Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - E Seifritz
- Department of Adult Psychiatry and Psychotherapy, Psychiatric University Clinic Zurich and University of Zurich, Switzerland
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Rüesch A, Ip CT, Bankwitz A, Villar de Araujo T, Hörmann C, Adank A, Schoretsanitis G, Kleim B, Olbrich S. EEG wakefulness regulation in transdiagnostic patients after a recent suicide attempt. Clin Neurophysiol 2023; 156:272-280. [PMID: 37749014 DOI: 10.1016/j.clinph.2023.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 08/11/2023] [Accepted: 08/22/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVE Decades of research have not yet produced statistically reliable predictors of preparatory behavior eventually leading to suicide attempts or deaths by suicide. As the nature of suicidal behavior is complex, it is best investigated in a transdiagnostic approach, while assessing objective markers, as proposed by the Research Domain Criteria (Cuthbert, 2013). METHODS A 15-min resting-state EEG was recorded in 45 healthy controls, and 49 transdiagnostic in-patients with a recent (<6 months) suicide attempt. Brain arousal regulation in eyes-closed condition was assessed with the Vigilance Algorithm Leipzig (VIGALL) (Sander et al., 2015). RESULTS A significant incline of median vigilance and vigilance slope was observed in patients within the first 3-min of the EEG recording. Additionally, a significant positive correlation of self-reported suicidal ideation with the vigilance slope over 15-min recording time, as well as a significant negative correlation with EEG vigilance stage A1 during the first 3-min was found. CONCLUSIONS Transdiagnostic patients with a recent suicide attempt show a distinct vigilance regulation pattern. Further studies including a control group consisting of patients without life-time suicide attempts are needed to increase the clinical utility of the findings. SIGNIFICANCE These findings might serve as potential objective markers of suicidal behavior.
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Affiliation(s)
- Annia Rüesch
- University of Zurich, Psychiatric University Hospital Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich, Switzerland.
| | - Cheng-Teng Ip
- Center for Cognitive and Brain Sciences, University of Macau, Taipa, Macau SAR, China
| | - Anna Bankwitz
- University of Zurich, Psychiatric University Hospital Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich, Switzerland
| | - Tania Villar de Araujo
- University of Zurich, Psychiatric University Hospital Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich, Switzerland
| | - Christoph Hörmann
- University of Zurich, Psychiatric University Hospital Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich, Switzerland
| | - Atalìa Adank
- University of Zurich, Psychiatric University Hospital Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich, Switzerland
| | - Georgios Schoretsanitis
- Psychiatric University Hospital Zurich, Zurich, Switzerland; The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, NY, USA; Department of Psychiatry, Zucker School of Medicine at Northwell/Hofstra, Hempstead, NY, USA
| | - Birgit Kleim
- University of Zurich, Psychiatric University Hospital Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich, Switzerland; University of Zurich, Institute of Psychology, Experimental Psychopathology and Psychotherapy, Zurich, Switzerland
| | - Sebastian Olbrich
- University of Zurich, Psychiatric University Hospital Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich, Switzerland
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Bankwitz A, Rüesch A, Adank A, Hörmann C, Villar de Araujo T, Schoretsanitis G, Kleim B, Olbrich S. EEG source functional connectivity in patients after a recent suicide attempt. Clin Neurophysiol 2023; 154:60-69. [PMID: 37562347 DOI: 10.1016/j.clinph.2023.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 06/03/2023] [Accepted: 06/30/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE Electroencephalogram (EEG) based frequency measures within the alpha frequency range (AFR), including functional connectivity, show potential in assessing the underlying pathophysiology of depression and suicide-related outcomes. We investigated the association between AFR connectivity, suicidal thoughts and behaviors, and depression in a transdiagnostic sample of patients after a recent suicide attempt (SA). METHODS Lagged source-based measures of linear and nonlinear whole-brain connectivity within the standard AFR ([sAFR], 8-12 Hz) and the individually referenced AFR (iAFR) were applied to 70 15-minute resting-state EEGs from patients after a SA and 70 age- and gender-matched healthy controls (HC). Hypotheses were tested using network-based statistics and multiple regression models. RESULTS Results showed no significant differences between patients after a SA and HC in any of the assessed connectivity modalities. However, a subgroup analysis revealed significantly increased nonlinear connectivity within the sAFR for patients after a SA with a depressive disorder or episode ([DD], n = 53) compared to matched HC. Furthermore, a multiple regression model, including significant main effects for group and global nonlinear connectivity within the sAFR outperformed all other models in explaining variance in depressive symptom severity. CONCLUSIONS Our study further supports the importance of the AFR in pathomechanisms of suicidality and depression. The iAFR does not seem to improve validity of phase-based connectivity. SIGNIFICANCE Our results implicate distinct neurophysiological patterns in suicidal subgroups. Exploring the potential of these patterns for treatment stratification might advance targeted interventions for suicidal thoughts and behaviors.
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Affiliation(s)
- Anna Bankwitz
- University of Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Lenggstrasse 31, 8032 Zurich, Switzerland; Psychiatric University Hospital Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland.
| | - Annia Rüesch
- University of Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Lenggstrasse 31, 8032 Zurich, Switzerland; Psychiatric University Hospital Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland.
| | - Atalìa Adank
- University of Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Lenggstrasse 31, 8032 Zurich, Switzerland; Psychiatric University Hospital Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland.
| | - Christoph Hörmann
- University of Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Lenggstrasse 31, 8032 Zurich, Switzerland; Psychiatric University Hospital Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland.
| | - Tania Villar de Araujo
- University of Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Lenggstrasse 31, 8032 Zurich, Switzerland; Psychiatric University Hospital Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland.
| | - Georgios Schoretsanitis
- Psychiatric University Hospital Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland; The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, 75-59 263rd St, Queens, NY 11004, USA; Department of Psychiatry, Zucker School of Medicine at Northwell/Hofstra, Hempstead, 500 Hofstra Blvd, Hempstead, NY 11549, USA.
| | - Birgit Kleim
- University of Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Lenggstrasse 31, 8032 Zurich, Switzerland; Psychiatric University Hospital Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland; University of Zurich, Department of Psychology, Experimental Psychopathology and Psychotherapy, Binzmühlestrasse 14, 8050 Zurich, Switzerland.
| | - Sebastian Olbrich
- University of Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Lenggstrasse 31, 8032 Zurich, Switzerland; Psychiatric University Hospital Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland.
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