Does the intensity of dissociation predict antidepressant effects 24 hours after infusion of racemic ketamine or esketamine in treatment-resistant depression? A secondary analysis from a randomized controlled trial
Abstract Objective Ketamine and esketamine have both shown significant antidepressant effects in treatment-resistant depression (TRD) and conflicting evidence suggests that dissociation induced by these drugs could be a clinical predictor of esketamine/ketamine's efficacy. Methods This study...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Associação de Psiquiatria do Rio Grande do Sul
2025-05-01
|
| Series: | Trends in Psychiatry and Psychotherapy |
| Subjects: | |
| Online Access: | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S2237-60892025000100505&lng=en&tlng=en |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850142458835369984 |
|---|---|
| author | Mariana V. F. Echegaray Rodrigo P. Mello Guilherme M. Magnavita Gustavo C. Leal Fernanda S. Correia-Melo Ana Paula Jesus-Nunes Flávia Vieira Igor D. Bandeira Ana Teresa Caliman-Fontes Manuela Telles Lívia N. F. Guerreiro-Costa Roberta Ferrari Marback Breno Souza-Marques Daniel H. Lins-Silva Cassio Santos-Lima Taiane de Azevedo Cardoso Flávio Kapczinski Acioly L. T. Lacerda Lucas C. Quarantini |
| author_facet | Mariana V. F. Echegaray Rodrigo P. Mello Guilherme M. Magnavita Gustavo C. Leal Fernanda S. Correia-Melo Ana Paula Jesus-Nunes Flávia Vieira Igor D. Bandeira Ana Teresa Caliman-Fontes Manuela Telles Lívia N. F. Guerreiro-Costa Roberta Ferrari Marback Breno Souza-Marques Daniel H. Lins-Silva Cassio Santos-Lima Taiane de Azevedo Cardoso Flávio Kapczinski Acioly L. T. Lacerda Lucas C. Quarantini |
| author_sort | Mariana V. F. Echegaray |
| collection | DOAJ |
| description | Abstract Objective Ketamine and esketamine have both shown significant antidepressant effects in treatment-resistant depression (TRD) and conflicting evidence suggests that dissociation induced by these drugs could be a clinical predictor of esketamine/ketamine's efficacy. Methods This study is a secondary analysis of data from a two-center, randomized, controlled trial. Participants were randomly assigned 1:1 to receive an IV infusion of either esketamine (0.25 mg/kg) or racemic ketamine (0.50 mg/kg) over 40 minutes. Dissociative symptoms were assessed using the Clinician-Administered Dissociative State Scale (CADSS) 40 minutes following the beginning of the infusion. Variations in depression scores were measured with the Montgomery-Åsberg Depression Rating Scale (MADRS), which was administered before the intervention as a baseline measure and 24 hours, 72 hours, and 7 days following infusion. Results Sixty-one patients were included in the analysis. Examining CADSS scores of 15 or below, for every 1-point increment in the CADSS score, there was a mean change of −0.5 (standard deviation [SD] = 0.25; p = 0.04) of predicted MADRS score from baseline to 24 hours. The results for 72 hours and 7 days following infusion were not significant. Since the original trial was not designed to assess the relationship between ketamine or esketamine-induced dissociation and antidepressant effects as the main outcome, confounding variables for this relationship were not controlled. Conclusion We suggest a positive relationship between dissociation intensity measured with the CADSS and the antidepressant effects of ketamine and esketamine 24 hours after infusion for CADSS scores of up to 15 points. |
| format | Article |
| id | doaj-art-0884ef21c9454794bd931f09d4da4b78 |
| institution | OA Journals |
| issn | 2238-0019 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Associação de Psiquiatria do Rio Grande do Sul |
| record_format | Article |
| series | Trends in Psychiatry and Psychotherapy |
| spelling | doaj-art-0884ef21c9454794bd931f09d4da4b782025-08-20T02:29:04ZengAssociação de Psiquiatria do Rio Grande do SulTrends in Psychiatry and Psychotherapy2238-00192025-05-014710.47626/2237-6089-2022-0593Does the intensity of dissociation predict antidepressant effects 24 hours after infusion of racemic ketamine or esketamine in treatment-resistant depression? A secondary analysis from a randomized controlled trialMariana V. F. Echegarayhttps://orcid.org/0000-0002-4891-2354Rodrigo P. Mellohttps://orcid.org/0000-0002-1809-088XGuilherme M. Magnavitahttps://orcid.org/0000-0002-2577-9896Gustavo C. Lealhttps://orcid.org/0000-0001-5447-025XFernanda S. Correia-Melohttps://orcid.org/0000-0002-0954-6590Ana Paula Jesus-Nuneshttps://orcid.org/0000-0002-0389-1940Flávia Vieirahttps://orcid.org/0000-0001-5987-2450Igor D. Bandeirahttps://orcid.org/0000-0002-6714-2658Ana Teresa Caliman-Fonteshttps://orcid.org/0000-0003-4675-5268Manuela TellesLívia N. F. Guerreiro-Costahttps://orcid.org/0000-0002-2367-0870Roberta Ferrari Marbackhttps://orcid.org/0000-0003-3870-8963Breno Souza-Marqueshttps://orcid.org/0000-0002-3431-7888Daniel H. Lins-SilvaCassio Santos-Limahttps://orcid.org/0000-0002-7685-9829Taiane de Azevedo Cardosohttps://orcid.org/0000-0003-1925-8709Flávio Kapczinskihttps://orcid.org/0000-0001-8738-856XAcioly L. T. Lacerdahttps://orcid.org/0000-0002-9370-0449Lucas C. Quarantinihttps://orcid.org/0000-0002-8807-8464Abstract Objective Ketamine and esketamine have both shown significant antidepressant effects in treatment-resistant depression (TRD) and conflicting evidence suggests that dissociation induced by these drugs could be a clinical predictor of esketamine/ketamine's efficacy. Methods This study is a secondary analysis of data from a two-center, randomized, controlled trial. Participants were randomly assigned 1:1 to receive an IV infusion of either esketamine (0.25 mg/kg) or racemic ketamine (0.50 mg/kg) over 40 minutes. Dissociative symptoms were assessed using the Clinician-Administered Dissociative State Scale (CADSS) 40 minutes following the beginning of the infusion. Variations in depression scores were measured with the Montgomery-Åsberg Depression Rating Scale (MADRS), which was administered before the intervention as a baseline measure and 24 hours, 72 hours, and 7 days following infusion. Results Sixty-one patients were included in the analysis. Examining CADSS scores of 15 or below, for every 1-point increment in the CADSS score, there was a mean change of −0.5 (standard deviation [SD] = 0.25; p = 0.04) of predicted MADRS score from baseline to 24 hours. The results for 72 hours and 7 days following infusion were not significant. Since the original trial was not designed to assess the relationship between ketamine or esketamine-induced dissociation and antidepressant effects as the main outcome, confounding variables for this relationship were not controlled. Conclusion We suggest a positive relationship between dissociation intensity measured with the CADSS and the antidepressant effects of ketamine and esketamine 24 hours after infusion for CADSS scores of up to 15 points.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S2237-60892025000100505&lng=en&tlng=enKetamineesketaminetreatment-resistant depressionmajor depressive disorderdissociation |
| spellingShingle | Mariana V. F. Echegaray Rodrigo P. Mello Guilherme M. Magnavita Gustavo C. Leal Fernanda S. Correia-Melo Ana Paula Jesus-Nunes Flávia Vieira Igor D. Bandeira Ana Teresa Caliman-Fontes Manuela Telles Lívia N. F. Guerreiro-Costa Roberta Ferrari Marback Breno Souza-Marques Daniel H. Lins-Silva Cassio Santos-Lima Taiane de Azevedo Cardoso Flávio Kapczinski Acioly L. T. Lacerda Lucas C. Quarantini Does the intensity of dissociation predict antidepressant effects 24 hours after infusion of racemic ketamine or esketamine in treatment-resistant depression? A secondary analysis from a randomized controlled trial Trends in Psychiatry and Psychotherapy Ketamine esketamine treatment-resistant depression major depressive disorder dissociation |
| title | Does the intensity of dissociation predict antidepressant effects 24 hours after infusion of racemic ketamine or esketamine in treatment-resistant depression? A secondary analysis from a randomized controlled trial |
| title_full | Does the intensity of dissociation predict antidepressant effects 24 hours after infusion of racemic ketamine or esketamine in treatment-resistant depression? A secondary analysis from a randomized controlled trial |
| title_fullStr | Does the intensity of dissociation predict antidepressant effects 24 hours after infusion of racemic ketamine or esketamine in treatment-resistant depression? A secondary analysis from a randomized controlled trial |
| title_full_unstemmed | Does the intensity of dissociation predict antidepressant effects 24 hours after infusion of racemic ketamine or esketamine in treatment-resistant depression? A secondary analysis from a randomized controlled trial |
| title_short | Does the intensity of dissociation predict antidepressant effects 24 hours after infusion of racemic ketamine or esketamine in treatment-resistant depression? A secondary analysis from a randomized controlled trial |
| title_sort | does the intensity of dissociation predict antidepressant effects 24 hours after infusion of racemic ketamine or esketamine in treatment resistant depression a secondary analysis from a randomized controlled trial |
| topic | Ketamine esketamine treatment-resistant depression major depressive disorder dissociation |
| url | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S2237-60892025000100505&lng=en&tlng=en |
| work_keys_str_mv | AT marianavfechegaray doestheintensityofdissociationpredictantidepressanteffects24hoursafterinfusionofracemicketamineoresketamineintreatmentresistantdepressionasecondaryanalysisfromarandomizedcontrolledtrial AT rodrigopmello doestheintensityofdissociationpredictantidepressanteffects24hoursafterinfusionofracemicketamineoresketamineintreatmentresistantdepressionasecondaryanalysisfromarandomizedcontrolledtrial AT guilhermemmagnavita doestheintensityofdissociationpredictantidepressanteffects24hoursafterinfusionofracemicketamineoresketamineintreatmentresistantdepressionasecondaryanalysisfromarandomizedcontrolledtrial AT gustavocleal doestheintensityofdissociationpredictantidepressanteffects24hoursafterinfusionofracemicketamineoresketamineintreatmentresistantdepressionasecondaryanalysisfromarandomizedcontrolledtrial AT fernandascorreiamelo doestheintensityofdissociationpredictantidepressanteffects24hoursafterinfusionofracemicketamineoresketamineintreatmentresistantdepressionasecondaryanalysisfromarandomizedcontrolledtrial AT anapaulajesusnunes doestheintensityofdissociationpredictantidepressanteffects24hoursafterinfusionofracemicketamineoresketamineintreatmentresistantdepressionasecondaryanalysisfromarandomizedcontrolledtrial AT flaviavieira doestheintensityofdissociationpredictantidepressanteffects24hoursafterinfusionofracemicketamineoresketamineintreatmentresistantdepressionasecondaryanalysisfromarandomizedcontrolledtrial AT igordbandeira doestheintensityofdissociationpredictantidepressanteffects24hoursafterinfusionofracemicketamineoresketamineintreatmentresistantdepressionasecondaryanalysisfromarandomizedcontrolledtrial AT anateresacalimanfontes doestheintensityofdissociationpredictantidepressanteffects24hoursafterinfusionofracemicketamineoresketamineintreatmentresistantdepressionasecondaryanalysisfromarandomizedcontrolledtrial AT manuelatelles doestheintensityofdissociationpredictantidepressanteffects24hoursafterinfusionofracemicketamineoresketamineintreatmentresistantdepressionasecondaryanalysisfromarandomizedcontrolledtrial AT livianfguerreirocosta doestheintensityofdissociationpredictantidepressanteffects24hoursafterinfusionofracemicketamineoresketamineintreatmentresistantdepressionasecondaryanalysisfromarandomizedcontrolledtrial AT robertaferrarimarback doestheintensityofdissociationpredictantidepressanteffects24hoursafterinfusionofracemicketamineoresketamineintreatmentresistantdepressionasecondaryanalysisfromarandomizedcontrolledtrial AT brenosouzamarques doestheintensityofdissociationpredictantidepressanteffects24hoursafterinfusionofracemicketamineoresketamineintreatmentresistantdepressionasecondaryanalysisfromarandomizedcontrolledtrial AT danielhlinssilva doestheintensityofdissociationpredictantidepressanteffects24hoursafterinfusionofracemicketamineoresketamineintreatmentresistantdepressionasecondaryanalysisfromarandomizedcontrolledtrial AT cassiosantoslima doestheintensityofdissociationpredictantidepressanteffects24hoursafterinfusionofracemicketamineoresketamineintreatmentresistantdepressionasecondaryanalysisfromarandomizedcontrolledtrial AT taianedeazevedocardoso doestheintensityofdissociationpredictantidepressanteffects24hoursafterinfusionofracemicketamineoresketamineintreatmentresistantdepressionasecondaryanalysisfromarandomizedcontrolledtrial AT flaviokapczinski doestheintensityofdissociationpredictantidepressanteffects24hoursafterinfusionofracemicketamineoresketamineintreatmentresistantdepressionasecondaryanalysisfromarandomizedcontrolledtrial AT aciolyltlacerda doestheintensityofdissociationpredictantidepressanteffects24hoursafterinfusionofracemicketamineoresketamineintreatmentresistantdepressionasecondaryanalysisfromarandomizedcontrolledtrial AT lucascquarantini doestheintensityofdissociationpredictantidepressanteffects24hoursafterinfusionofracemicketamineoresketamineintreatmentresistantdepressionasecondaryanalysisfromarandomizedcontrolledtrial |