The effectiveness of ketamine on anxiety, irritability, and agitation: Implications for treating mixed features in adults with major depressive or bipolar disorder.
Adult
Anxiety
/ diagnosis
Bipolar Disorder
/ diagnosis
Depressive Disorder, Major
/ diagnosis
Depressive Disorder, Treatment-Resistant
/ drug therapy
Female
Humans
Irritable Mood
/ drug effects
Ketamine
/ administration & dosage
Male
Middle Aged
Psychomotor Agitation
/ drug therapy
Retrospective Studies
Self Report
Suicidal Ideation
NMDA
bipolar depression
intravenous ketamine
suicidal ideation
treatment-resistant depression
Journal
Bipolar disorders
ISSN: 1399-5618
Titre abrégé: Bipolar Disord
Pays: Denmark
ID NLM: 100883596
Informations de publication
Date de publication:
12 2020
12 2020
Historique:
pubmed:
15
5
2020
medline:
2
2
2021
entrez:
15
5
2020
Statut:
ppublish
Résumé
To determine the effectiveness of intravenous (IV) ketamine on anxiety, irritability, agitation, and suicidality, in adults with treatment-resistant major depressive disorder (MDD) or bipolar disorder (BD). Adults (N = 201) with treatment-resistant MDD or BD received repeat-dose IV ketamine treatment at a community-based clinic. Mixed features were measured using symptoms of anxiety, irritability, and agitation (AIA), as measured by the Generalized Anxiety Disorder-7 (GAD-7) scale. The Quick Inventory for Depressive Symptomatology Self-Report-16 (QIDS-SR In this retrospective analysis, 113 participants met AIA criteria. Participants with AIA experienced a significantly greater reduction in overall depressive symptoms (F(1, 558) = 9.49, P = .002), SI (F(1, 558) = 3.103, P = .079), anxiety (F(1, 198) = 5.52, P = .007), irritability (F(1, 198) = 28.35, P < .001), and agitation as measured by "trouble relaxing" (F(1, 198) = 6.70, P = .010) from baseline compared to the non-AIA group, regardless of number of treatments received. Our preliminary results suggest that IV ketamine is effective in rapidly treating AIA and SI in adults with treatment-resistant mood disorders. This observation suggests that IV ketamine could be considered a treatment alternative for adults with MDD or BD presenting with mixed features.
Substances chimiques
Ketamine
690G0D6V8H
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
831-840Subventions
Organisme : CIHR
Pays : Canada
Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Références
Malhi GS, Byrow Y, Outhred T, Fritz K. Exclusion of overlapping symptoms in DSM-5 mixed features specifier: heuristic diagnostic and treatment implications. CNS Spectr. 2017;22(2):126-133.
McIntyre RS, Soczynska JK, Cha DS, et al. The prevalence and illness characteristics of DSM-5-defined “mixed feature specifier” in adults with major depressive disorder and bipolar disorder: results from the International Mood Disorders Collaborative Project. J Affect Disord. 2015;172:259-264.
Perugi G, Angst J, Azorin J-M, et al. Mixed features in patients with a major depressive episode: the BRIDGE-II-MIX study. J Clin Psychiatry. 2015;76(3):e351-e358.
McIntyre RS. Mixed features and mixed states in psychiatry: from calculus to geometry. CNS Spectr. 2017;22(2):116-117.
Stahl SM, Morrissette DA, Faedda G, et al. Guidelines for the recognition and management of mixed depression. CNS Spectr. 2017;22(2):203-219.
Malhi GS, Fritz K, Elangovan P, Irwin L. Mixed states: modelling and management. CNS Drugs. 2019;33(4):301-313.
Popovic D, Vieta E, Azorin J-M, et al. Suicide attempts in major depressive episode: evidence from the BRIDGE-II-Mix study. Bipolar Disord. 2015;17(7):795-803.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). American Psychiatric Pub; 2013.
Young AH, Eberhard J. Evaluating depressive symptoms in mania: a naturalistic study of patients with bipolar disorder. Neuropsychiatr Dis Treat. 2015;11:1137-1143.
Vieta E, Grunze H, Azorin J-M, Fagiolini A. Phenomenology of manic episodes according to the presence or absence of depressive features as defined in DSM-5: Results from the IMPACT self-reported online survey. J Affect Disord. 2014;156:206-213.
Malhi GS, Fritz K, Allwang C, et al. Are manic symptoms that “dip” into depression the essence of mixed features? J Affect Disord. 2016;192:104-108.
Brancati GE, Vieta E, Azorin J-M, et al. The role of overlapping excitatory symptoms in major depression: are they relevant for the diagnosis of mixed state? J Psychiatr Res. 2019;115:151-157.
Malhi GS, Bell E. Mixed states: an early warning sign of profound problems in our taxonomy? Acta Psychiatr Scand. 2019;139(6):489-492.
Tondo L, Vázquez GH, Pinna M, Vaccotto PA, Baldessarini RJ. Characteristics of depressive and bipolar disorder patients with mixed features. Acta Psychiatr Scand. 2018;138(3):243-252.
McIntyre RS, Suppes T, Tandon R, Ostacher M. Florida best practice psychotherapeutic medication guidelines for adults with major depressive disorder. J Clin Psychiatry. 2017;78(06):703-713.
Grunze H, Vieta E, Goodwin GM, et al. The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Bipolar Disorders: Acute and long-term treatment of mixed states in bipolar disorder. World J Biol Psychiatry. 2018;19(1):2-58.
Tohen M, Frank E, Bowden CL, et al. The International Society for Bipolar Disorders (ISBD) Task Force report on the nomenclature of course and outcome in bipolar disorders. Bipolar Disord. 2009;11(5):453-473.
Suppes T, Ostacher M. Mixed features in major depressive disorder: diagnoses and treatments. CNS Spectr. 2017;22(2):155-160.
Suppes T, Silva R, Cucchiaro J, et al. Lurasidone for the treatment of major depressive disorder with mixed features: a randomized, double-blind, placebo-controlled study. Am J Psychiatry. 2016;173(4):400-407.
McIntyre RS, Cucchiaro J, Pikalov A, Kroger H, Loebel A. Lurasidone in the treatment of bipolar depression with mixed (subsyndromal hypomanic) features: post hoc analysis of a randomized placebo-controlled trial. J Clin Psychiatry. 2015;76(4):398-405.
Rosenblat JD, Carvalho AF, Li M, et al. Oral ketamine for depression. J Clin Psychiatry. . 2019;80(3): https://doi.org/10.4088/JCP.18r12475.
Zheng W, Cai D-B, Xiang Y-Q, et al. Adjunctive intranasal esketamine for major depressive disorder: A systematic review of randomized double-blind controlled-placebo studies. J Affect Disord. 2020;265:63-70.
Witt K, Potts J, Hubers A, et al. Ketamine for suicidal ideation in adults with psychiatric disorders: a systematic review and meta-analysis of treatment trials. Aust N Z J Psychiatry. 2020;54(1):29-45.
Suppes T, Eberhard J, Lemming O, Young AH, McIntyre RS. Anxiety, irritability, and agitation as indicators of bipolar mania with depressive symptoms: a post hoc analysis of two clinical trials. Int J Bipolar Disord. 2017;5(1):36.
Rosenblat JD, Simon GE, Sachs GS, et al. Treatment effectiveness and tolerability outcomes that are most important to individuals with bipolar and unipolar depression. J Affect Disord. 2019;243:116-120.
Sanacora G, Frye MA, McDonald W, et al. A consensus statement on the use of ketamine in the treatment of mood disorders. JAMA Psychiatry. 2017;74(4):399-405.
Rosenblat JD, McIntyre RS. Treatment recommendations for DSM-5-defined mixed features. CNS Spectr. 2017;22(2):147-154.
Sackeim HA, Aaronson ST, Bunker MT, et al. The assessment of resistance to antidepressant treatment: Rationale for the Antidepressant Treatment History Form: Short Form (ATHF-SF). J Psychiatr Res. 2019;113:125-136.
McIntyre RS, Filteau M-J, Martin L, et al. Treatment-resistant depression: definitions, review of the evidence, and algorithmic approach. J Affect Disord. 2014;156:1-7.
Benazzi F, Akiskal HS. Psychometric delineation of the most discriminant symptoms of depressive mixed states. Psychiatry Res. 2006;141(1):81-88.
Sani G, Vöhringer PA, Barroilhet SA, Koukopoulos AE, Ghaemi SN. The koukopoulos mixed depression rating scale (KMDRS): An International Mood Network (IMN) validation study of a new mixed mood rating scale. J Affect Disord. 2018;232:9-16.
Williams NR, Heifets BD, Blasey C, et al. Attenuation of antidepressant effects of ketamine by opioid receptor antagonism. Am J Psychiatry. 2018;175(12):1205-1215.
Frye MA, Blier P, Tye SJ. Concomitant benzodiazepine use attenuates ketamine response: implications for large scale study design and clinical development. J Clin Psychopharmacol. 2015;35(3):334-336.
Rush AJ, Trivedi MH, Ibrahim HM, et al. The 16-Item quick inventory of depressive symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression. Biol Psychiatry. 2003;54(5):573-583.
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)-a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377-381.
Harris PA, Taylor R, Minor BL, et al. The REDCap consortium: building an international community of software platform partners. J Biomed Inform. 2019;95:103208.
Swann AC, Lafer B, Perugi G, et al. Bipolar mixed states: an international society for bipolar disorders task force report of symptom structure, course of illness, and diagnosis. Am J Psychiatry. 2013;170(1):31-42.
Eberhard J, Weiller E. Suicidality and symptoms of anxiety, irritability, and agitation in patients experiencing manic episodes with depressive symptoms: a naturalistic study. Neuropsychiatr Dis Treat. 2016;12:2265-2271.
Lee Y, Syeda K, Maruschak NA, et al. A new perspective on the anti-suicide effects with ketamine treatment: a procognitive effect. J Clin Psychopharmacol. 2016;36(1):50-56.
Jackson E, Endow-Eyer RA. A review of the evidence supporting the use of lithium augmentation therapy for the reduction of suicidal behavior in patients with unipolar depression: Revisiting an overlooked benefit of an older medication. Mental Health Clinician. 2014;4(5):221-225.
Abou-Saleh MT, Müller-Oerlinghausen B, Coppen AJ. Lithium in the episode and suicide prophylaxis and in augmenting strategies in patients with unipolar depression. Int J Bipolar Disord. 2017;5(1):11.
Khan SA, Revicki DA, Hassan M, et al. Assessing the reliability and validity of the sheehan irritability scale in patients with major depressive disorder. J Clin Psychiatry. 2016;77(8):1080-1086.
Holtzman S, O'Connor BP, Barata PC, Stewart DE. The Brief Irritability Test (BITe): a measure of irritability for use among men and women. Assessment. 2015;22(1):101-115.
Grunebaum MF, Galfalvy HC, Choo T-H, et al. Ketamine for rapid reduction of suicidal thoughts in major depression: a midazolam-controlled randomized clinical trial. Am J Psychiatry. 2018;175(4):327-335.
Cusin C, Sakurai H, Bentley K, et al. All suicidal ideation is not created equal: two cases of suicide attempts during maintenance ketamine treatment. Am J Psychiatry. 2020;177(2):173-174.
Lindh ÅU, Dahlin M, Beckman K, et al. A comparison of suicide risk scales in predicting repeat suicide attempt and suicide: a clinical cohort study. J Clin Psychiatry. 2019;80(6): https://doi.org/10.4088/JCP.18m12707.
Maj M, Pirozzi R, Magliano L, Fiorillo A, Bartoli L. Agitated, “unipolar” major depression: prevalence, phenomenology, and outcome. J Clin Psychiatry. 2006;67(5):712-719.
Maj M, Pirozzi R, Magliano L, Bartoli L. Agitated depression in bipolar I disorder: prevalence, phenomenology, and outcome. Am J Psychiatry. 2003;160(12):2134-2140.
Sullivan N, Chen C, Siegel R, et al. Ketamine for emergency sedation of agitated patients: a systematic review and meta-analysis. Am J Emerg Med. 2019; https://doi.org/10.1016/j.ajem.2019.11.007.
Zimmerman M, Clark HL, Multach MD, Walsh E, Rosenstein LK, Gazarian D. Have treatment studies of depression become even less generalizable? a review of the inclusion and exclusion criteria used in placebo-controlled antidepressant efficacy trials published during the past 20 years. Mayo Clin Proc. 2015;90(9):1180-1186.