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Espinoza RT. Transitions in the Journal of ECT: An Introduction and Vision. J ECT 2024; 40:4-5. [PMID: 38232048 DOI: 10.1097/yct.0000000000000995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Affiliation(s)
- Randall T Espinoza
- Department of Psychiatry and Biobehavioral Sciences, Geffen School of Medicine at UCLA, University of California, Los Angeles, CA
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Espinoza RT, Antongiorgi Z. Glucagon-Like Peptide-1 Receptor Agonists During Electroconvulsive Therapy: Case Report With Evolving Concerns and Management Considerations. J ECT 2024:00124509-990000000-00141. [PMID: 38315827 DOI: 10.1097/yct.0000000000000992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
ABSTRACT Glucagon-like peptide-1 receptor agonists are an emerging class of medications transforming the management of diabetes mellitus and obesity, two highly prevalent and chronic medical conditions associated with significant morbidity and posing serious public health concerns. Although generally well tolerated and relatively safe to use, case reports of patients taking these medications while undergoing elective procedures with general anesthesia describe a potential heightened risk of regurgitation and pulmonary aspiration of gastric contents, deriving from the delayed gastric emptying effect of these agents. Based on increased recognition of this risk, the American Society of Anesthesiologists convened a task force to review available data, resulting in the promulgation of a new procedural management guideline for patients on these drugs and undergoing elective procedures with general anesthesia. However, this guideline pertains mostly to procedures and situations that are distinct from electroconvulsive therapy (ECT). This case report describes the experience of a patient on semaglutide, a glucagon-like peptide-1 receptor agonist for obesity, undergoing ECT, provides a general overview of this novel drug class, identifies issues specific to ECT management, and suggests potential adaptations to patient care over different phases of ECT practice.
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Affiliation(s)
| | - Zarah Antongiorgi
- Department of Anesthesiology and Perioperative Medicine, Geffen School of Medicine at UCLA, Los Angeles, CA
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Brooks JO, Kruse JL, Kubicki A, Hellemann G, Espinoza RT, Irwin MR, Narr KL. Structural brain plasticity and inflammation are independently related to changes in depressive symptoms six months after an index ECT course. Psychol Med 2024; 54:108-116. [PMID: 36600668 DOI: 10.1017/s0033291722003555] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is effective for treatment-resistant depression and leads to short-term structural brain changes and decreases in the inflammatory response. However, little is known about how brain structure and inflammation relate to the heterogeneity of treatment response in the months following an index ECT course. METHODS A naturalistic six-month study following an index ECT course included 20 subjects with treatment-resistant depression. Upon conclusion of the index ECT course and again after six months, structural magnetic resonance imaging scans and peripheral inflammation measures [interleukin-6 (IL-6), IL-8, tumor necrosis factor (TNF-α), and C-reactive protein] were obtained. Voxel-based morphometry processed with the CAT-12 Toolbox was used to estimate changes in gray matter volume. RESULTS Between the end of the index ECT course and the end of follow-up, we found four clusters of significant decreases in gray matter volume (p < 0.01, FWE) and no regions of increased volume. Decreased HAM-D scores were significantly related only to reduced IL-8 level. Decreased volume in one cluster, which included the right insula and Brodmann's Area 22, was related to increased HAM-D scores over six months. IL-8 levels did not mediate or moderate the relationship between volumetric change and depression. CONCLUSIONS Six months after an index ECT course, multiple regions of decreased gray matter volume were observed in a naturalistic setting. The independent relations between brain volume and inflammation to depressive symptoms suggest novel explanations of the heterogeneity of longer-term ECT treatment response.
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Affiliation(s)
- John O Brooks
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Jennifer L Kruse
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Antoni Kubicki
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Department of Neurology, Ahmanson-Lovelace Brain Mapping Center, Geffen School of Medicine at the University of California, Los Angeles, CA, USA
| | | | - Randall T Espinoza
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Michael R Irwin
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Katherine L Narr
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Department of Neurology, Ahmanson-Lovelace Brain Mapping Center, Geffen School of Medicine at the University of California, Los Angeles, CA, USA
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Rhee TG, Shim SR, Popp JH, Trikalinos TA, Rosenheck RA, Kellner CH, Seiner SJ, Espinoza RT, Forester BP, McIntyre RS. Efficacy and safety of ketamine-assisted electroconvulsive therapy in major depressive episode: a systematic review and network meta-analysis. Mol Psychiatry 2023:10.1038/s41380-023-02366-8. [PMID: 38123725 DOI: 10.1038/s41380-023-02366-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/27/2023] [Accepted: 12/01/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE To meta-analyze clinical efficacy and safety of ketamine compared with other anesthetic agents in the course of electroconvulsive therapy (ECT) in major depressive episode (MDE). METHODS PubMed/MEDLINE, Cochrane Library, Embase, GoogleScholar, and US and European trial registries were searched from inception through May 23, 2023, with no language limits. We included RCTs with (1) a diagnosis of MDE; (2) ECT intervention with ketamine and/or other anesthetic agents; and (3) measures included: depressive symptoms, cognitive performance, remission or response rates, and serious adverse events. Network meta-analysis (NMA) was performed to compare ketamine and 7 other anesthetic agents. Hedges' g standardized mean differences (SMDs) were used for continuous measures, and relative risks (RRs) were used for other binary outcomes using random-effects models. RESULTS Twenty-two studies were included in the systematic review. A total of 2322 patients from 17 RCTs were included in the NMA. The overall pooled SMD of ketamine, as compared with propofol as a reference group, was -2.21 (95% confidence interval [CI], -3.79 to -0.64) in depressive symptoms, indicating that ketamine had better antidepressant efficacy than propofol. In a sensitivity analysis, however, ketamine-treated patients had a worse outcome in cognitive performance than propofol-treated patients (SMD, -0.18; 95% CI, -0.28 to -0.09). No other statistically significant differences were found. CONCLUSIONS Ketamine-assisted ECT is tolerable and may be efficacious in improving depressive symptoms, but a relative adverse impact on cognition may be an important clinical consideration. Anesthetic agents should be considered based on patient profiles and/or preferences to improve effectiveness and safety of ECT use.
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Affiliation(s)
- Taeho Greg Rhee
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA.
- VA New England Mental Illness, Research, Education and Clinical Center (MIRECC), VA Connecticut Healthcare System, West Haven, CT, USA.
- Department of Public Health Sciences, School of Medicine, University of Connecticut, Farmington, CT, USA.
| | - Sung Ryul Shim
- Department of Biomedical Informatics, College of Medicine, Konyang University, Daejeon, Chungcheongnam-do, Republic of Korea
| | - Jonah H Popp
- Center for Evidence Synthesis in Health, Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Thomas A Trikalinos
- Center for Evidence Synthesis in Health, Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Robert A Rosenheck
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
- VA New England Mental Illness, Research, Education and Clinical Center (MIRECC), VA Connecticut Healthcare System, West Haven, CT, USA
| | - Charles H Kellner
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Stephen J Seiner
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Division of Neurotherapeutics, McLean Hospital, Belmont, MA, USA
| | - Randall T Espinoza
- Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, CA, USA
| | - Brent P Forester
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Division of Neurotherapeutics, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Tufts University School of Medicine, Boston, MA, USA
| | - Roger S McIntyre
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Espinoza RT, Kaufman A. COVID-19 Delirium and Motoric Subtypes: Opportunities to Improve Outcomes. J Clin Psychiatry 2023; 84:23com14814. [PMID: 37616484 DOI: 10.4088/jcp.23com14814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Affiliation(s)
- Randall T Espinoza
- Resnick Neuropsychiatric Hospital at UCLA and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, University of California, Los Angeles
- Corresponding Author: Randall T. Espinoza, MD, MPH, 300 UCLA Medical Plaza, Ste 2235, Los Angeles, CA 90095
| | - Aaron Kaufman
- Resnick Neuropsychiatric Hospital at UCLA and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, University of California, Los Angeles
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Zavaliangos-Petropulu A, McClintock SM, Khalil J, Joshi SH, Taraku B, Al-Sharif NB, Espinoza RT, Narr KL. Neurocognitive effects of subanesthetic serial ketamine infusions in treatment resistant depression. J Affect Disord 2023; 333:161-171. [PMID: 37060953 DOI: 10.1016/j.jad.2023.04.015] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/05/2023] [Accepted: 04/10/2023] [Indexed: 04/17/2023]
Abstract
INTRODUCTION Ketamine treatment prompts a rapid antidepressant response in treatment-resistant depression (TRD). We performed an exploratory investigation of how ketamine treatment in TRD affects different cognitive domains and relates to antidepressant response. METHODS Patients with TRD (N = 66; 30 M/35F; age = 39.5 ± 11.1 years) received four ketamine infusions (0.5 mg/kg). Neurocognitive function and depressive symptoms were assessed at baseline, 24 h after the first and fourth ketamine infusion, and 5 weeks following end of treatment. Mixed effect models tested for changes in seven neurocognitive domains and antidepressant response, with post-hoc pairwise comparisons between timepoints, including follow-up. Relationships between change in neurocognitive function and antidepressant response over the course of treatment were tested with Pearson's correlation and mediation analyses. Associations between baseline neurocognitive performance and antidepressant response were tested with Pearson's correlation. RESULTS Significant improvements in inhibition, working memory, processing speed, and overall fluid cognition were observed after the first and fourth ketamine infusion. Improvements in processing speed and overall fluid cognition persisted through follow-up. Significant improvements in depressive symptoms reverted towards baseline at follow-up. Baseline working memory and change in inhibition were moderately correlated with antidepressant response, however, improvements in neurocognitive performance were statistically independent from antidepressant response. CONCLUSION Antidepressant ketamine leads to improved neurocognitive function, which persist for at least 5 weeks. Neurocognitive improvements observed appear independent of antidepressant response, suggesting ketamine may target overlapping but distinct functional brain systems. Limitations Research investigating repeated serial ketamine treatments is important to determine cognitive safety. This study is a naturalistic design and does not include placebo.
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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, CA, USA.
| | - Shawn M McClintock
- Division of Psychology, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Jacqueline Khalil
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, Geffen School of Medicine at the University of California, Los Angeles, CA, USA
| | - Shantanu H Joshi
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, Geffen School of Medicine at the University of California, Los Angeles, CA, USA
| | - Brandon Taraku
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, Geffen School of Medicine at the University of California, Los Angeles, CA, USA
| | - Noor B Al-Sharif
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, Geffen School of Medicine at the University of California, Los Angeles, CA, USA
| | - 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, CA, USA
| | - Katherine L Narr
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, Geffen School of Medicine at the University of California, Los Angeles, CA, USA
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8
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Blanken MAJT, Oudega ML, Hoogendoorn AW, Sonnenberg CS, Rhebergen D, Klumpers UMH, Van Diermen L, Birkenhager T, Schrijvers D, Redlich R, Dannlowski U, Heindel W, Coenjaerts M, Nordanskog P, Oltedal L, Kessler U, Frid LM, Takamiya A, Kishimoto T, Jorgensen MB, Jorgensen A, Bolwig T, Emsell L, Sienaert P, Bouckaert F, Abbott CC, Péran P, Arbus C, Yrondi A, Kiebs M, Philipsen A, van Waarde JA, Prinsen E, van Verseveld M, Van Wingen G, Ten Doesschate F, Camprodon JA, Kritzer M, Barbour T, Argyelan M, Cardoner N, Urretavizcaya M, Soriano-Mas C, Narr KL, Espinoza RT, Prudic J, Rowny S, van Eijndhoven P, Tendolkar I, Dols A. Sex-specifics of ECT outcome. J Affect Disord 2023; 326:243-248. [PMID: 36632848 DOI: 10.1016/j.jad.2022.12.144] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 12/23/2022] [Accepted: 12/25/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Electroconvulsive therapy (ECT) is the most effective treatment for patients with severe major depressive disorder (MDD). Given the known sex differences in MDD, improved knowledge may provide more sex-specific recommendations in clinical guidelines and improve outcome. In the present study we examine sex differences in ECT outcome and its predictors. METHODS Clinical data from 20 independent sites participating in the Global ECT-MRI Research Collaboration (GEMRIC) were obtained for analysis, totaling 500 patients with MDD (58.6 % women) with a mean age of 54.8 years. Severity of depression before and after ECT was assessed with validated depression scales. Remission was defined as a HAM-D score of 7 points or below after ECT. Variables associated with remission were selected based on literature (i.e. depression severity at baseline, age, duration of index episode, and presence of psychotic symptoms). RESULTS Remission rates of ECT were independent of sex, 48.0 % in women and 45.7 % in men (X2(1) = 0.2, p = 0.70). In the logistic regression analyses, a shorter index duration was identified as a sex-specific predictor for ECT outcome in women (X2(1) = 7.05, p = 0.01). The corresponding predictive margins did show overlapping confidence intervals for men and women. CONCLUSION The evidence provided by our study suggests that ECT as a biological treatment for MDD is equally effective in women and men. A shorter duration of index episode was an additional sex- specific predictor for remission in women. Future research should establish whether the confidence intervals for the corresponding predictive margins are overlapping, as we find, or not.
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Affiliation(s)
- M A J T Blanken
- Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands; Amsterdam UMC, location Vumc, Amsterdam, the Netherlands.
| | - M L Oudega
- GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands; Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands; Psychiatry, Amsterdam Public Health (Research Institute), Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands; Amsterdam UMC, location Vumc, Amsterdam, the Netherlands
| | - A W Hoogendoorn
- GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands; Psychiatry, Amsterdam Public Health (Research Institute), Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands; Amsterdam UMC, location Vumc, Amsterdam, the Netherlands
| | - C S Sonnenberg
- Psychiatry, Amsterdam Public Health (Research Institute), Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands; GGZ Parnassia NH, Specialized Mental Health Care, Castricum, the Netherlands
| | - D Rhebergen
- Psychiatry, Amsterdam Public Health (Research Institute), Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands; Amsterdam UMC, location Vumc, Amsterdam, the Netherlands; GGZ Centraal, Specialized Mental Health Care, Amersfoort, the Netherlands
| | - U M H Klumpers
- GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands; Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands; Psychiatry, Amsterdam Public Health (Research Institute), Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands; Amsterdam UMC, location Vumc, Amsterdam, the Netherlands
| | - L Van Diermen
- Psychiatric Center Bethanië, Andreas Vesaliuslaan 39, 2980 Zoersel, Belgium; Department of Biomedical Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp. Universiteitsplein 1, 2610 Antwerp, Belgium; University Psychiatric Center (UPC) Duffel, Stationsstraat 22c, 2570 Duffel, Belgium
| | - T Birkenhager
- Department of Biomedical Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp. Universiteitsplein 1, 2610 Antwerp, Belgium; Erasmus MC, Rotterdam, the Netherlands
| | - D Schrijvers
- Department of Biomedical Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp. Universiteitsplein 1, 2610 Antwerp, Belgium; University Psychiatric Center (UPC) Duffel, Stationsstraat 22c, 2570 Duffel, Belgium
| | - R Redlich
- Department of Psychology, University of Halle, Germany; Institute for Translational Psychiatry, University of Münster Germany, Germany
| | - U Dannlowski
- Institute for Translational Psychiatry, University of Münster Germany, Germany
| | - W Heindel
- Department of Radiology, University of Münster Germany, Germany
| | - M Coenjaerts
- Division of Medical Psychology, Department of Psychiatry and Psychotherapy, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - P Nordanskog
- Center for Social and Affective Neuroscience (CSAN), Department of Biomedical and Clinical Sciences, Linköping University, Department of Psychiatry, Linköping University Hospital, Sweden
| | - L Oltedal
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - U Kessler
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - L M Frid
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - A Takamiya
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Hills Joint Research Laboratory for Future Preventive Medicine and Wellness, Keio University School of Medicine, Tokyo, Japan; Neuropsychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Belgium
| | - T Kishimoto
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Hills Joint Research Laboratory for Future Preventive Medicine and Wellness, Keio University School of Medicine, Tokyo, Japan
| | - M B Jorgensen
- Psychiatric Centre Copenhagen and Institute of Clinical Medicine, University of Copenhagen, Denmark
| | - A Jorgensen
- Psychiatric Centre Copenhagen and Institute of Clinical Medicine, University of Copenhagen, Denmark
| | - T Bolwig
- Psychiatric Centre Copenhagen and Institute of Clinical Medicine, University of Copenhagen, Denmark
| | - L Emsell
- Neuropsychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Belgium
| | - P Sienaert
- Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center (UPC) - KU Leuven, Kortenberg, Belgium
| | - F Bouckaert
- Neuropsychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Belgium
| | - C C Abbott
- University of New Mexico Department of Psychiatry, 87131, United States of America
| | - P Péran
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France
| | - C Arbus
- Service de Psychiatrie et de Psychologie Médicale, Centre Expert Dépression Résistante FondaMental, CHU Toulouse, Hospital Purpan, ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France
| | - A Yrondi
- Service de Psychiatrie et de Psychologie Médicale, Centre Expert Dépression Résistante FondaMental, CHU Toulouse, Hospital Purpan, ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France
| | - M Kiebs
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany; Section of Medical Psychology, University of Bonn, Bonn, Germany; School of Medicine & Health Sciences University Hospital Oldenburg at the Karl-Jaspers Clinic, Germany
| | - A Philipsen
- Section of Medical Psychology, University of Bonn, Bonn, Germany
| | | | | | | | - G Van Wingen
- Amsterdam UMC, location University of Amsterdam, Department of Psychiatry, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - F Ten Doesschate
- Rijnstate Arnhem, the Netherlands; Amsterdam UMC, location University of Amsterdam, Department of Psychiatry, Meibergdreef 9, Amsterdam, the Netherlands
| | - J A Camprodon
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - M Kritzer
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - T Barbour
- Massachusetts General Hospital, United States of America
| | - M Argyelan
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY, United States of America
| | - N Cardoner
- Sant Pau Mental Health Research Group, Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, School of Medicine Bellaterra, Universitat Autònoma de Barcelona, Barcelona, Spain; CIBERSAM, Carlos III Health Institute, Madrid, Spain
| | - M Urretavizcaya
- CIBERSAM, Carlos III Health Institute, Madrid, Spain; Bellvitge Biomedical Research Institute-IDIBELL, Department of Psychiatry, Bellvitge University Hospital, Barcelona, Spain; Department of Clinical Sciences, Bellvitge Campus, Universitat de Barcelona-UB, Barcelona, Spain
| | - C Soriano-Mas
- CIBERSAM, Carlos III Health Institute, Madrid, Spain; Bellvitge Biomedical Research Institute-IDIBELL, Department of Psychiatry, Bellvitge University Hospital, Barcelona, Spain; Department of Social Psychology and Quantitative Psychology, Universitat de Barcelona-UB, Barcelona, Spain
| | - K L Narr
- Department of Neurology, Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, United States of America
| | - R T Espinoza
- Department of Neurology, Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, United States of America
| | - J Prudic
- Columbia University Irving Medical Center, United States of America
| | - S Rowny
- Columbia University Irving Medical Center, United States of America
| | | | - I Tendolkar
- Radboud University, Nijmegen, the Netherlands
| | - A Dols
- Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands; Amsterdam UMC, location Vumc, Amsterdam, the Netherlands; Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
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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. Biol Psychiatry Cogn Neurosci Neuroimaging 2022; 8:361-386. [PMID: 36775711 DOI: 10.1016/j.bpsc.2022.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [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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10
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Langhein M, Seitz-Holland J, Lyall AE, Pasternak O, Chunga N, Cetin-Karayumak S, Kubicki A, Mulert C, Espinoza RT, Narr KL, Kubicki M. Association between peripheral inflammation and free-water imaging in Major Depressive Disorder before and after ketamine treatment - A pilot study. J Affect Disord 2022; 314:78-85. [PMID: 35779673 DOI: 10.1016/j.jad.2022.06.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 05/27/2022] [Accepted: 06/20/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Alterations in the peripheral inflammatory profile and white matter (WM) deterioration are frequent in Major Depressive Disorder (MDD). The present study applies free-water imaging to investigate the relationship between altered peripheral inflammation and WM microstructure and their predictive value in determining response to ketamine treatment in MDD. METHODS Ten individuals with MDD underwent diffusion-weighted magnetic resonance imaging and a blood-draw before and 24 h after ketamine infusion. We utilized MANCOVAs and ANCOVAs to compare tissue-specific fractional anisotropy (FAT) and free-water (FW) of the forceps and cingulum, and the ratio of pro-inflammatory interleukin(IL)-8/anti-inflammatory IL-10 between individuals with MDD and 15 healthy controls at baseline. Next, we compared all baseline measures between ketamine responders (6) and non-responders (4) and analyzed changes in imaging and blood data after ketamine infusion. RESULTS The MDD group exhibited an increased IL-8/IL-10 ratio compared to controls at baseline (p = .040), which positively correlated with average FW across regions of interest (p = .013). Ketamine responders demonstrated higher baseline FAT in the left cingulum than non-responders (p = .023). Ketamine infusion did not influence WM microstructure but decreased the IL-8/IL-10 ratio (p = .043). LIMITATIONS The small sample size and short follow-up period limit the conclusion regarding the longer-term effects of ketamine in MDD. CONCLUSIONS This pilot study provides evidence for the role of inflammation in MDD by illustrating an association between peripheral inflammation and WM microstructure. Additionally, we demonstrate that free-water diffusion-weighted imaging might be a valuable tool to determine which individuals with MDD benefit from the anti-inflammatory mediated effects of ketamine treatment.
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Affiliation(s)
- Mina Langhein
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Psychiatry Neuroimaging Branch, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johanna Seitz-Holland
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Amanda E Lyall
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ofer Pasternak
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Natalia Chunga
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Suheyla Cetin-Karayumak
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Antoni Kubicki
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, Geffen School of Medicine at the University of California, Los Angeles, CA, USA
| | - Christoph Mulert
- Centre for Psychiatry, Justus-Liebig-University, Giessen, Germany
| | - 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, CA, USA
| | - Katherine L Narr
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, Geffen School of Medicine at the University of California, Los Angeles, CA, USA; 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, CA, USA
| | - Marek Kubicki
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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11
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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12
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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 - CORRIGENDUM. Psychol Med 2022; 52:2399. [PMID: 35726509 PMCID: PMC9981470 DOI: 10.1017/s0033291722001659] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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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13
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Affiliation(s)
- Randall T Espinoza
- From the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (R.T.E.); and the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston (C.H.K.)
| | - Charles H Kellner
- From the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (R.T.E.); and the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston (C.H.K.)
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14
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Wade BSC, Hellemann G, Espinoza RT, Woods RP, Joshi SH, Redlich R, Dannlowski U, Jorgensen A, Abbott CC, Oltedal L, Narr KL. Accounting for symptom heterogeneity can improve neuroimaging models of antidepressant response after electroconvulsive therapy. Hum Brain Mapp 2021; 42:5322-5333. [PMID: 34390089 PMCID: PMC8519875 DOI: 10.1002/hbm.25620] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/21/2021] [Accepted: 07/29/2021] [Indexed: 12/19/2022] Open
Abstract
Depression symptom heterogeneity limits the identifiability of treatment‐response biomarkers. Whether improvement along dimensions of depressive symptoms relates to separable neural networks remains poorly understood. We build on work describing three latent symptom dimensions within the 17‐item Hamilton Depression Rating Scale (HDRS) and use data‐driven methods to relate multivariate patterns of patient clinical, demographic, and brain structural changes over electroconvulsive therapy (ECT) to dimensional changes in depressive symptoms. We included 110 ECT patients from Global ECT‐MRI Research Collaboration (GEMRIC) sites who underwent structural MRI and HDRS assessments before and after treatment. Cross validated random forest regression models predicted change along symptom dimensions. HDRS symptoms clustered into dimensions of somatic disturbances (SoD), core mood and anhedonia (CMA), and insomnia. The coefficient of determination between predicted and actual changes were 22%, 39%, and 39% (all p < .01) for SoD, CMA, and insomnia, respectively. CMA and insomnia change were predicted more accurately than HDRS‐6 and HDRS‐17 changes (p < .05). Pretreatment symptoms, body‐mass index, and age were important predictors. Important imaging predictors included the right transverse temporal gyrus and left frontal pole for the SoD dimension; right transverse temporal gyrus and right rostral middle frontal gyrus for the CMA dimension; and right superior parietal lobule and left accumbens for the insomnia dimension. Our findings support that recovery along depressive symptom dimensions is predicted more accurately than HDRS total scores and are related to unique and overlapping patterns of clinical and demographic data and volumetric changes in brain regions related to depression and near ECT electrodes.
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Affiliation(s)
- Benjamin S C Wade
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, UCLA, Los Angeles, California, USA
| | - Gerhard Hellemann
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Randall T Espinoza
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Roger P Woods
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, UCLA, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Shantanu H Joshi
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, UCLA, Los Angeles, California, USA
| | - Ronny Redlich
- Institute of Translational Psychiatry, Department of Mental Health, University of Münster, Münster, Germany.,Department of Clinical Psychology, University of Halle, Halle, Germany
| | - Udo Dannlowski
- Institute of Translational Psychiatry, Department of Mental Health, University of Münster, Münster, Germany
| | | | - Christopher C Abbott
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Leif Oltedal
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Katherine L Narr
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, UCLA, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
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15
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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. Biol Psychiatry Cogn Neurosci 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] [What about the content of this article? (0)] [Affiliation(s)] [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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16
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Affiliation(s)
- Randall T. Espinoza
- Department of Psychiatry and Biobehavioral Sciences, Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA
| | - Charles H. Kellner
- Department of Psychiatry (Adjunct), Medical University of South Carolina, Charleston, SC
| | - William V. McCall
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, GA
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17
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Affiliation(s)
- Randall T Espinoza
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA.
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18
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Holtzheimer PE, Husain MM, Lisanby SH, Taylor SF, Whitworth LA, McClintock S, Slavin KV, Berman J, McKhann GM, Patil PG, Rittberg BR, Abosch A, Pandurangi AK, Holloway KL, Lam RW, Honey CR, Neimat JS, Henderson JM, DeBattista C, Rothschild AJ, Pilitsis JG, Espinoza RT, Petrides G, Mogilner AY, Matthews K, Peichel D, Gross RE, Hamani C, Lozano AM, Mayberg HS. Subcallosal cingulate deep brain stimulation for treatment-resistant depression: a multisite, randomised, sham-controlled trial. Lancet Psychiatry 2017; 4:839-849. [PMID: 28988904 DOI: 10.1016/s2215-0366(17)30371-1] [Citation(s) in RCA: 290] [Impact Index Per Article: 41.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 08/05/2017] [Accepted: 08/21/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Deep brain stimulation (DBS) of the subcallosal cingulate white matter has shown promise as an intervention for patients with chronic, unremitting depression. To test the safety and efficacy of DBS for treatment-resistant depression, a prospective, randomised, sham-controlled trial was conducted. METHODS Participants with treatment-resistant depression were implanted with a DBS system targeting bilateral subcallosal cingulate white matter and randomised to 6 months of active or sham DBS, followed by 6 months of open-label subcallosal cingulate DBS. Randomisation was computer generated with a block size of three at each site before the site started the study. The primary outcome was frequency of response (defined as a 40% or greater reduction in depression severity from baseline) averaged over months 4-6 of the double-blind phase. A futility analysis was performed when approximately half of the proposed sample received DBS implantation and completed the double-blind phase. At the conclusion of the 12-month study, a subset of patients were followed up for up to 24 months. The study is registered at ClinicalTrials.gov, number NCT00617162. FINDINGS Before the futility analysis, 90 participants were randomly assigned to active (n=60) or sham (n=30) stimulation between April 10, 2008, and Nov 21, 2012. Both groups showed improvement, but there was no statistically significant difference in response during the double-blind, sham-controlled phase (12 [20%] patients in the stimulation group vs five [17%] patients in the control group). 28 patients experienced 40 serious adverse events; eight of these (in seven patients) were deemed to be related to the study device or surgery. INTERPRETATION This study confirmed the safety and feasibility of subcallosal cingulate DBS as a treatment for treatment-resistant depression but did not show statistically significant antidepressant efficacy in a 6-month double-blind, sham-controlled trial. Future studies are needed to investigate factors such as clinical features or electrode placement that might improve efficacy. FUNDING Abbott (previously St Jude Medical).
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Affiliation(s)
- Paul E Holtzheimer
- Department of Psychiatry and Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
| | - Mustafa M Husain
- Department of Psychiatry, Neurology and Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA; Department of Psychiatry and Behavioral Science, Duke University School of Medicine, Durham, NC, USA
| | | | - Stephan F Taylor
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Louis A Whitworth
- Neurological Surgery, Radiation Oncology, Department of Neurological Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA
| | - Shawn McClintock
- Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA; Department of Psychiatry and Behavioral Science, Duke University School of Medicine, Durham, NC, USA
| | - Konstantin V Slavin
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Joshua Berman
- Department of Psychiatry, Division of Experimental Therapeutics, Columbia University College of Physicians & Surgeons, New York, NY, USA
| | - Guy M McKhann
- Department of Neurosurgery, Columbia University Medical Center, New York Presbyterian Hospital, New York, NY, USA
| | - Parag G Patil
- Department of Neurosurgery, Neurology, Anesthesiology and Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Barry R Rittberg
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - Aviva Abosch
- Department of Neurosurgery and Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Ananda K Pandurangi
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
| | - Kathryn L Holloway
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Christopher R Honey
- Department of Surgery (Neurosurgery), University of British Columbia, Vancouver, BC, Canada
| | - Joseph S Neimat
- Department of Neurological Surgery, University of Louisville, Louisville, KY, USA
| | - Jaimie M Henderson
- Stanford Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Charles DeBattista
- Department of Psychiatry, Stanford University School of Medicine, Stanford, CA, USA
| | - Anthony J Rothschild
- Department of Psychiatry, University of Massachusetts Medical School and UMass Memorial HealthCare, Worcester, MA, USA
| | - Julie G Pilitsis
- Department of Neuroscience and Experimental Therapeutics and the Department of Neurosurgery, Albany Medical College, Albany, NY, USA
| | - Randall T Espinoza
- Department of Psychiatry and Biobehavioral Sciences, Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Georgios Petrides
- The Zucker Hillside Hospital, Northwell Health System, Glen Oaks, NY, USA; Hofstra Northwell School of Medicine, Hempstead, NY, USA
| | - Alon Y Mogilner
- Department of Neurosurgery, Center for Neuromodulation, NYU Langone Medical Center, New York, NY, USA
| | - Keith Matthews
- Division of Neuroscience, School of Medicine, University of Dundee, Dundee, UK; Advanced Interventions Service, NHS Tayside, Ninewells Hospital and Medical School, Dundee, UK
| | - DeLea Peichel
- Clinical Studies Department, Abbott (previously St Jude Medical), Plano, TX, USA
| | - Robert E Gross
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Clement Hamani
- Behavioural Neurobiology Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health and Division of Neurosurgery, Toronto Western Hospital, Toronto, ON, Canada
| | - Andres M Lozano
- Department of Neurosurgery and Neuroscience, Toronto Western Hospital, Toronto, ON, Canada
| | - Helen S Mayberg
- Department of Psychiatry and Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
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19
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Joshi SH, Espinoza RT, Pirnia T, Shi J, Wang Y, Ayers B, Leaver A, Woods RP, Narr KL. Structural Plasticity of the Hippocampus and Amygdala Induced by Electroconvulsive Therapy in Major Depression. Biol Psychiatry 2016; 79:282-92. [PMID: 25842202 PMCID: PMC4561035 DOI: 10.1016/j.biopsych.2015.02.029] [Citation(s) in RCA: 205] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 02/03/2015] [Accepted: 02/19/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Electroconvulsive therapy (ECT) elicits a rapid and robust clinical response in patients with refractory depression. Neuroimaging measurements of structural plasticity relating to and predictive of ECT response may point to the mechanisms underlying rapid antidepressant effects and establish biomarkers to inform other treatments. Here, we determine the effects of diagnosis and of ECT on global and local variations of hippocampal and amygdala structures in major depression and predictors of ECT-related clinical response. METHODS Longitudinal changes in hippocampal and amygdala structures were examined in patients with major depression (N = 43, scanned three times: prior to ECT, after the second ECT session, and within 1 week of completing the ECT treatment series), referred for ECT as part of their standard clinical care. Cross-sectional comparisons with demographically similar controls (N = 32, scanned twice) established effects of diagnosis. RESULTS Patients showed smaller hippocampal volumes than controls at baseline (p < .04). Both the hippocampal and the amygdala volumes increased with ECT (p < .001) and in relation to symptom improvement (p < .01). Hippocampal volume at baseline predicted subsequent clinical response (p < .05). Shape analysis revealed pronounced morphometric changes in the anterior hippocampus and basolateral and centromedial amygdala. All structural measurements remained stable across time in controls. CONCLUSIONS ECT-induced neuroplasticity in the hippocampus and amygdala relates to improved clinical response and is pronounced in regions with prominent connections to ventromedial prefrontal cortex and other limbic structures. Smaller hippocampal volumes at baseline predict a more robust clinical response. Neurotrophic processes including neurogenesis shown in preclinical studies may underlie these structural changes.
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Affiliation(s)
- Shantanu H. Joshi
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California at Los Angeles, Los Angeles, CA
| | - Randall T. Espinoza
- Department of Psychiatry and Biobehavioral Sciences, University of Californi at Los Angeles, Los Angeles, CA
| | - Tara Pirnia
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California at Los Angeles, Los Angeles, CA
| | - Jie Shi
- School of Computing, Informatics, and Decision Systems Engineering, Arizona State University, AZ
| | - Yalin Wang
- School of Computing, Informatics, and Decision Systems Engineering, Arizona State University, AZ
| | - Brandon Ayers
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California at Los Angeles, Los Angeles, CA
| | - Amber Leaver
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California at Los Angeles, Los Angeles, CA
| | - Roger P. Woods
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California at Los Angeles, Los Angeles, CA,Department of Psychiatry and Biobehavioral Sciences, University of Californi at Los Angeles, Los Angeles, CA
| | - Katherine L. Narr
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California at Los Angeles, Los Angeles, CA,Department of Psychiatry and Biobehavioral Sciences, University of Californi at Los Angeles, Los Angeles, CA
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20
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Vasavada MM, Leaver AM, Espinoza RT, Joshi SH, Njau SN, Woods RP, Narr KL. Structural connectivity and response to ketamine therapy in major depression: A preliminary study. J Affect Disord 2016; 190:836-841. [PMID: 26630613 PMCID: PMC4685004 DOI: 10.1016/j.jad.2015.11.018] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 10/30/2015] [Accepted: 11/15/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Ketamine elicits an acute antidepressant effect in patients with major depressive disorder (MDD). Here, we used diffusion imaging to explore whether regional differences in white matter microstructure prior to treatment may predict clinical response 24h following ketamine infusion in 10 MDD patients. METHODS FSL's Tract-Based Spatial Statistics (TBSS) established voxel-level differences in fractional anisotropy (FA) between responders (patients showing >50% improvement in symptoms 24h post-infusion) and non-responders in major white matter pathways. Follow-up regions-of-interest (ROI) analyses examined differences in FA and radial (RD), axial (AD) and mean diffusivity (MD) between responders and non-responders and 15 age- and sex-matched controls, with groups compared pairwise. RESULTS Whole brain TBSS (p<0.05, corrected) and confirmatory tract-based regions-of-interest analyses showed larger FA values in the cingulum and forceps minor in responders compared to non-responders; complementary decreases in RD occurred in the cingulum (p<0.05). Only non-responders differed from controls showing decreased FA in the forceps minor, increased RD in the cingulum and forceps minor, and increased MD in the forceps minor (p<0.05). LIMITATIONS Non-responders showed an earlier age of onset and longer current depressive episode than responders. Though these factors did not interact with diffusion metrics, results may be impacted by the limited sample size. CONCLUSIONS Though findings are considered preliminary, significant differences in FA, RD and MD shown in non-responders compared to responders and controls in fronto-limbic and ventral striatal pathways suggest that the structural architecture of specific functional networks mediating emotion may predict ketamine response in MDD.
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Affiliation(s)
- Megha M Vasavada
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA
| | - Amber M Leaver
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA
| | - 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, USA
| | - 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, USA
| | - Stephanie N Njau
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA
| | - Roger P Woods
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA,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, USA
| | - Katherine L Narr
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, Geffen School of Medicine at the University of California, Los Angeles, CA, USA; 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, CA, USA.
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21
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Affiliation(s)
- Thomas R Blair
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Randall T Espinoza
- Division of Geriatric Psychiatry, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
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22
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Lyden H, Espinoza RT, Pirnia T, Clark K, Joshi SH, Leaver AM, Woods RP, Narr KL. Electroconvulsive therapy mediates neuroplasticity of white matter microstructure in major depression. Transl Psychiatry 2014; 4:e380. [PMID: 24713861 PMCID: PMC4012285 DOI: 10.1038/tp.2014.21] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 02/25/2014] [Indexed: 12/12/2022] Open
Abstract
Whether plasticity of white matter (WM) microstructure relates to therapeutic response in major depressive disorder (MDD) remains uncertain. We examined diffusion tensor imaging (DTI) correlates of WM structural connectivity in patients receiving electroconvulsive therapy (ECT), a rapidly acting treatment for severe MDD. Tract-Based Spatial Statistics (TBSS) applied to DTI data (61 directions, 2.5 mm(3) voxel size) targeted voxel-level changes in fractional anisotropy (FA), and radial (RD), axial (AD) and mean diffusivity (MD) in major WM pathways in MDD patients (n=20, mean age: 41.15 years, 10.32 s.d.) scanned before ECT, after their second ECT and at transition to maintenance therapy. Comparisons made at baseline with demographically similar controls (n=28, mean age: 39.42 years, 12.20 s.d.) established effects of diagnosis. Controls were imaged twice to estimate scanning-related variance. Patients showed significant increases of FA in dorsal fronto-limbic circuits encompassing the anterior cingulum, forceps minor and left superior longitudinal fasciculus between baseline and transition to maintenance therapy (P<0.05, corrected). Decreases in RD and MD were observed in overlapping regions and the anterior thalamic radiation (P<0.05, corrected). Changes in DTI metrics associated with therapeutic response in tracts showing significant ECT effects differed between patients and controls. All measures remained stable across time in controls. Altered WM microstructure in pathways connecting frontal and limbic areas occur in MDD, are modulated by ECT and relate to therapeutic response. Increased FA together with decreased MD and RD, which trend towards normative values with treatment, suggest increased fiber integrity in dorsal fronto-limbic pathways involved in mood regulation.
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Affiliation(s)
- H Lyden
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA
| | - R 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, USA
| | - T Pirnia
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA
| | - K Clark
- Connectivity and Network Development Laboratory, Institute for Neuroimaging and Informatics, University of Southern California, Los Angeles, CA, USA
| | - S H Joshi
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA
| | - A M Leaver
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA
| | - R P Woods
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA,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, USA
| | - K L Narr
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA,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, USA,Department of Neurology, Geffen School of Medicine at the University of California, Los Angeles, 225 Neuroscience Research Building, 635 Charles Young Drive South, Los Angeles, CA 90095, USA. E-mail:
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24
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Gnanadesigan N, Espinoza RT, Smith R, Israel M, Reuben DB. Interaction of serotonergic antidepressants and opioid analgesics: Is serotonin syndrome going undetected? J Am Med Dir Assoc 2005; 6:265-9. [PMID: 16005413 DOI: 10.1016/j.jamda.2005.04.012] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To describe the potential for interaction between opioids and serotonergic antidepressants leading to the development of serotonin syndrome (SS), mechanism of the interaction, and the spectrum of SS in elderly residents of a long-term care facility. DESIGN Case series. SETTING Long-term care facility (LTCF) in California. PARTICIPANTS Four elderly LTCF residents treated with serotonergic antidepressants including selective serotonin reuptake inhibitor (SSRI) or mirtazapine and opioids. MEASUREMENTS Signs and symptoms suggestive of SS. RESULTS We describe 4 cases of probable SS among elderly residents of a LTCF. The spectrum of serotonin toxicity ranged from visual hallucinations, muscle rigidity, myoclonus, or hypertension in patients taking an opiate with an SSRI to lethargy, hypotension, and hypoxia in a patient taking tramadol and mirtazapine. CONCLUSION While many can benefit from coadministration of serotonergic antidepressants and opioids, it appears that some individuals are at increased risk for SS. Since SS is a clinical diagnosis, heightened clinician awareness of the possibility of SS among patients receiving SSRI or mirtazapine in combination with opioids may lead to earlier detection and avoidance of potentially lethal consequences.
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Gnanadesigan N, Espinoza RT, Smith R, Israel M, Reuben DB. Response to Letter From Dr. P.K. Gillman. J Am Med Dir Assoc 2005. [DOI: 10.1016/j.jamda.2005.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Gnanadesigan N, Espinoza RT, Smith RL. The serotonin syndrome. N Engl J Med 2005; 352:2454-6; author reply 2454-6. [PMID: 15948273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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27
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Khang P, Weintraub N, Espinoza RT. The use, benefits, and costs of cholinesterase inhibitors for Alzheimer's dementia in long-term care: are the data relevant and available? J Am Med Dir Assoc 2004; 5:249-55. [PMID: 15228635 DOI: 10.1097/01.jam.0000131500.41375.1d] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Peter Khang
- UCLA Multi-campus Program in Geriatric Medicine, Geffen School of Medicine, Los Angeles, CA, USA
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Khang P, Weintraub N, Espinoza RT. The use, benefits, and costs of cholinesterase inhibitors for Alzheimer's dementia in long-term care: are the data relevant and available? J Am Med Dir Assoc 2004. [PMID: 15228635 DOI: 10.1016/s1525-8610(04)70131-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Peter Khang
- UCLA Multi-campus Program in Geriatric Medicine, Geffen School of Medicine, Los Angeles, CA, USA
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Affiliation(s)
- Randall T Espinoza
- Inpatient Geriatric Psychiatry and ECT Service, UCLA Neuropsychiatric Institute and Hospital, Department of Psychiatry and Biobehavioral Sciences, Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA.
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