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

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.

[Unemployment and Addiction: The SUNRISE Project]

OBJECTIVES

In the SUNRISE-project, the unemployment benefit office refers long-term unemployed clients (25-49 years old) to medical and psychological specialists of an addiction clinic, if substance-related problems are suspected as an obstacle for job placement. The present study aims at characterizing these clients with respect to educational qualifications, vocational training, diagnosed addictive disorders, and other mental disorders. Of special interest is the temporal sequence of unemployment and addictive disorders.

METHOD

Officials referred clients to medical examination if substance abuse was suspected. The examination was based on Europ-ASI, diagnosis of mental disorders based on SCID-I and SCID-II.

RESULTS

In 87 out of the first 100 examined persons, an addictive disorder was diagnosed, most frequently alcohol-related disorders, and often multiple addictive disorders. These 87 clients were on average 40 years old (SD 8.5), and mostly male (73 out of 87 clients). About one-third had very low school qualification, and 55.2% had not completed vocational training. An additional psychiatric diagnosis was made in 51.7%. Addictive disorders had commenced during adolescence or early adulthood in most cases. The longest duration of continuous employment was 3 years (median). In only a few cases (7.4%), the current period of unemployment had started before regular substance use.

CONCLUSION

Many long-term unemployed clients examined here showed deficits in schooling and vocational training, early onset of regular substance use, and additional mental disorders. In most cases, the addictive disorder did not emerge as a consequence of unemployment, but had existed before. Programs combining the efforts of unemployment benefit offices and the healthcare system are needed for these clients to help them gain access to the regular job market.

Assessment of mature serum brain-derived neurotrophic factor (BDNF) is not superior to total serum BDNF in prediction of antidepressant treatment outcome

Background

Serum BDNF levels are decreased in major depressive disorder (MDD) and tend to normalize under antidepressant treatment, serving as a treatment outcome predictor. BDNF is initially synthetized as precursor protein proBDNF and is cleaved to mature BDNF (mBDNF) while only the latter exerts neurotrophic activity.

Aim

The aim was to explore if a specific enzyme-linked immunosorbent assay (ELISA) kit for mBDNF in serum would be superior to the unspecific assessment of total serum BDNF in predicting treatment response in MDD.

Methods

Twenty-five patients with MDD underwent standardized treatment with duloxetine. Severity of depression was measured by Hamilton Depression Rating Scale (HDRS) at baseline (BL), after one (W1), two (W2) and six weeks (W6) of treatment. Treatment response was defined as a HDRS ≥ 50% reduction of BL score at W6. mBDNF and total BDNF serum levels were determined at BL, W1 and W2.

Results

A high and stable correlation was found between mBDNF and total BDNF serum levels over all measurements. The predictive value of mBDNF BL levels and mBDNFΔW1 to response was similar to that of total BDNF BL and total BDNFΔW1. The assessment of serum mBDNF was not superior to total BDNF in prediction of treatment outcome.

Conclusions

Not only baseline total BDNF but also mBDNF is predictive to treatment outcome. The later might represent the main player in this respect, which supports the idea of a functional link between neuroplasticity and MDD.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Treatment Options in Depression During the Postpartum

Objective:

A group therapy specifically adjusted to the needs of depressed mothers was developed in Basel and was compared to individual therapy-as-usual.

Method:

The group program which consisted of 12 group and 1 couple session was administered in 5 consecutive groups to 31 participants. the main therapeutic method used was cognitive behavioral therapy (CBT). Antidepressants were prescribed if necessary. in a second step a control group of 21 participants receiving individual therapy-as-usual has now been evaluated and compared to the specific treatment group in a pre-post-design using Beck-Depression-Inventory (BDI), Symptom-Check-List (SCL-90-R) and other scales. Symptom reduction and other outcome variables were determined. in a further step demographic characteristics of responders and non-responders were analysed.

Results:

Both, treatment group and control group showed significant improvement of depression, there was no significant difference between the two treatment strategies. However differences were seen in acceptance, satisfaction with treatment as well as in terms of treatment costs. There was a trend for more frequent antidepressant use in the control group. Also multipara showed a significantly better outcome in the treatment group than single mothers.

Conclusions:

This manualized group therapy proved to be effective for mothers with depression. It could be an alternative treatment to avoid antidepressants during pregnancy and postpartum and might be less stigmatizing.

Markers of coagulation activation for evaluation of the antithrombotic efficacy of heparin: a prospective study in acute deep venous thrombosis

The potential value of measurements of prothrombin fragment 1 + 2 (F1 + 2), thrombin-antithrombin complexes (TAT) and D-dimer for the assessment of antithrombotic efficacy of heparin in acute deep venous thrombosis (DVT) was prospectively investigated. These variables were determined at presentation and subsequently once daily during a course of seven days heparin therapy. Heparin doses were adjusted according to the activated partial thromboplastin time (APTT). Compression ultrasonography was performed at presentation and on day 7 to determine the extent of thrombosis according to a predefined score. Out of a total of 50 patients accrued to the study 44 patients had reduced or unchanged extent of thrombosis, whereas in six patients an extension was documented. Although thrombin generation was significantly inhibited after initiation of heparin therapy as reflected by a decrease in F1 + 2 and TAT levels, these markers were not useful for the detection of patients with DVT extension. In contrast, anti-factor-Xa activities but not APTT measurements were significantly lower in the group of patients with propagation of DVT (median: 0.22 U/ml versus 0.38 U/ml, interquartile range: 0.1-0.33 U/ml versus 0.19-0.55 U/ml; P = 0.001). D-dimer decreased within the first days of heparin therapy but failed to indicate DVT progression. These data suggest that plasma anti-factor-Xa activity correlates better with the antithrombotic efficacy of heparin than APTT measurements and markers of coagulation or fibrinolysis activation.