Response to intravenous racemic ketamine after switch from intranasal (S)-ketamine on symptoms of treatment-resistant depression and post-traumatic stress disorder in Veterans: A retrospective case series.
Response to intravenous racemic ketamine after switch from intranasal (S)-ketamine on symptoms of treatment-resistant depression and post-traumatic stress disorder in Veterans: A retrospective case series.
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DOI：
10.1002/phar.2664
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发表时间：
2022-03
期刊：
影响因子：
4.1
通讯作者：
Ramanathan D
中科院分区：
文献类型：
--
作者：
Bentley S;Artin H;Mehaffey E;Liu F;Sojourner K;Bismark A;Printz D;Lee EE;Martis B;De Peralta S;Baker DG;Mishra J;Ramanathan D
外消旋（R，S）氯胺酮是一种谷氨酸能药物，具有强效且快速的抗抑郁作用。（S）-氯胺酮的鼻内制剂最近被美国食品和药物管理局（FDA）批准用于患有难治性抑郁症（TRD）的个体。没有数据直接比较这两种氯胺酮制剂之间抑郁或其他合并症的结局。然而，最近的荟萃分析表明，IV外消旋氯胺酮可能比IN-（S）-氯胺酮更有效。我们回顾性分析了在VA圣地亚哥神经调节诊所接受氯胺酮治疗的15名患有难治性抑郁症（TRD）和创伤后应激障碍（PTSD）共病的退伍军人的临床结局。本分析中纳入的所有退伍军人在转换为IV外消旋氯胺酮治疗前接受了至少6次鼻内（IN）-（S）-氯胺酮治疗。接受氯胺酮治疗的退伍军人（包括IN-（S）-氯胺酮和IV-（R，S）-氯胺酮），显示患者健康问卷-9（PHQ-9）（一种测量抑郁症状的自我报告量表）（rmANOVA F（14，42）= 12.6，p < 0.0001）和在PTSD-DSM-5检查表（PCL-5）中，测量PSTD症状的自我报告量表（rm ANOVA F（13，39）= 5.9，p = 0.006）。事后检验显示，与治疗前基线评分相比，（S）-氯胺酮治疗后PHQ-9评分平均降低2.4 +/− 1.2（p=0.18），IV氯胺酮治疗后平均降低5.6 +/−1（p= 0.0003）。与治疗前基线评分相比，IN（S）-氯胺酮治疗后PCL-5评分平均降低4.3 +/− 3.3（p = 0.6），IV氯胺酮治疗后平均降低11.8 +/− 3.5（p = 0.02）。这项工作表明，对于对FDA批准的IN（S）-氯胺酮没有充分反应的患者，可以认为标签外IV（R，S）-氯胺酮是合理的下一步。需要进行进一步的双盲、随机对照试验，以评估IV外消旋氯胺酮是否比IN-（S）-氯胺酮更有效。
Racemic (R,S) ketamine is a glutamatergic drug with potent and rapid acting antidepressant effects. An intranasal formulation of (S)-ketamine was recently approved by the US Food and Drug Administration (FDA) to be used in individuals with treatment-resistant-depression (TRD). There is no data directly comparing outcomes on depression or other co-morbidities between these two formulations of ketamine. However, recent meta-analyses have suggested that IV racemic ketamine may be more potent than IN-(S)-ketamine. We retrospectively analyzed clinical outcomes in 15 Veterans with comorbid treatment resistant depression (TRD) and post-traumatic-stress-disorder (PTSD) who underwent ketamine treatment at the VA San Diego Neuromodulation Clinic. All Veterans included in this analysis were given at least 6 intranasal (IN)-(S)-ketamine treatments prior to switching to treatment with IV racemic ketamine. Veterans receiving ketamine treatment (including both IN-(S)-ketamine and IV-(R,S)-ketamine), showed significant reductions in both the Patient Health Questionnaire-9 (PHQ-9), a self-report scale measuring depression symptoms (rm ANOVA F(14,42) = 12.6, p < 0.0001) and in the PTSD- Checklist for DSM-5 (PCL-5), a self-report scale measuring PSTD symptoms (rm ANOVA F(13,39) = 5.9, p = 0.006). Post-hoc testing revealed that PHQ-9 scores were reduced by an average of 2.4 +/− 1.2 compared to baseline after (S)-ketamine treatments (p=0.18) and by an average of 5.6 +/−1 after IV ketamine treatments (p=.0003) compared to pre-treatment baseline scores. PCL-5 scores were reduced by an average of 4.3 +/− 3.3 after IN (S)-ketamine treatments (p = 0.6) and 11.8 +/− 3.5 after IV ketamine treatments (p = 0.02) compared to pre-treatment base-line scores. This work suggests that off-label IV (R,S)-ketamine could be considered a reasonable next step in patients who do not respond adequately to the FDA-approved IN (S)-ketamine. Further double-blinded, randomized-controlled-trials are warranted to assess whether IV racemic ketamine is more effective than IN-(S)-ketamine.
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影响因子：
64.8
作者：
Autry, Anita E.;Adachi, Megunai;Nosyreva, Elena;Na, Elisa S.;Los, Maarten F.;Cheng, Peng-fei;Kavalali, Ege T.;Monteggia, Lisa M.
通讯作者：
Monteggia, Lisa M.
影响因子：
11
作者：
Fava M;Freeman MP;Flynn M;Judge H;Hoeppner BB;Cusin C;Ionescu DF;Mathew SJ;Chang LC;Iosifescu DV;Murrough J;Debattista C;Schatzberg AF;Trivedi MH;Jha MK;Sanacora G;Wilkinson ST;Papakostas GI
通讯作者：
Papakostas GI
影响因子：
17.7
作者：
Zarate, CA;Singh, JB;Charney, DS
通讯作者：
Charney, DS
DOI：
10.1176/appi.ajp.2013.13030392
发表时间：
2013-10
期刊：
The American journal of psychiatry
影响因子：
--
作者：
Murrough JW;Iosifescu DV;Chang LC;Al Jurdi RK;Green CE;Perez AM;Iqbal S;Pillemer S;Foulkes A;Shah A;Charney DS;Mathew SJ
通讯作者：
Mathew SJ
影响因子：
4.2
作者：
Matveychuk, Dmitriy;Thomas, Rejish K.;Dursun, Serdar M.
通讯作者：
Dursun, Serdar M.