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Efficacy of Ketamine with and without Lamotrigine in Treatment-Resistant Depression: A Preliminary Report

Intravenous (IV) ketamine and FDA-approved intranasal (IN) esketamine are increasingly used for treatment-resistant depression (TRD). Preliminary studies have suggested a synergistic effect of ketamine and lamotrigine, although the data are inconclusive. Herein, we report the response to serial keta...

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Autores principales: Joseph, Boney, Nunez, Nicolas A., Kung, Simon, Vande Voort, Jennifer L., Pazdernik, Vanessa K., Schak, Kathryn M., Boehm, Stacey M., Carpenter, Brooke, Johnson, Emily K., Malyshev, Grigoriy, Smits, Nathan, Adewunmi, Daniel O., Brown, Sarah K., Singh, Balwinder
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10459873/
https://www.ncbi.nlm.nih.gov/pubmed/37631079
http://dx.doi.org/10.3390/ph16081164
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author Joseph, Boney
Nunez, Nicolas A.
Kung, Simon
Vande Voort, Jennifer L.
Pazdernik, Vanessa K.
Schak, Kathryn M.
Boehm, Stacey M.
Carpenter, Brooke
Johnson, Emily K.
Malyshev, Grigoriy
Smits, Nathan
Adewunmi, Daniel O.
Brown, Sarah K.
Singh, Balwinder
author_facet Joseph, Boney
Nunez, Nicolas A.
Kung, Simon
Vande Voort, Jennifer L.
Pazdernik, Vanessa K.
Schak, Kathryn M.
Boehm, Stacey M.
Carpenter, Brooke
Johnson, Emily K.
Malyshev, Grigoriy
Smits, Nathan
Adewunmi, Daniel O.
Brown, Sarah K.
Singh, Balwinder
author_sort Joseph, Boney
collection PubMed
description Intravenous (IV) ketamine and FDA-approved intranasal (IN) esketamine are increasingly used for treatment-resistant depression (TRD). Preliminary studies have suggested a synergistic effect of ketamine and lamotrigine, although the data are inconclusive. Herein, we report the response to serial ketamine/esketamine treatment among patients with TRD with or without lamotrigine therapy. In this historical cohort study, we included adult patients with TRD who received serial IV racemic ketamine (0.5 mg/kg over 40−100 min) or IN esketamine (56/84 mg) treatments. A change in depressive symptoms was assessed using the 16-item Quick Inventory of Depressive Symptomatology self-report (QIDS-SR) scale. There were no significant differences in response or remission rates among the patients on or not on lamotrigine during the ketamine/esketamine treatments. For a percent change in the QIDS-SR from baseline, no interaction was found between the lamotrigine groups and treatment number (p = 0.70), nor the overall effect of the group (p = 0.38). There was a trend towards lower dissociation (based on the CADSS score) among current lamotrigine users, especially in patients who received IV ketamine. A major limitation is the limited number of patients taking lamotrigine (n = 13). This preliminary study provides insufficient evidence that continuing lamotrigine therapy attenuates the antidepressant effect of repeated ketamine/esketamine; however, there seems to be a signal toward attenuating dissociation with lamotrigine in patients receiving serial ketamine treatments. Further observational studies or randomized controlled trials are needed to replicate these findings.
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spelling pubmed-104598732023-08-27 Efficacy of Ketamine with and without Lamotrigine in Treatment-Resistant Depression: A Preliminary Report Joseph, Boney Nunez, Nicolas A. Kung, Simon Vande Voort, Jennifer L. Pazdernik, Vanessa K. Schak, Kathryn M. Boehm, Stacey M. Carpenter, Brooke Johnson, Emily K. Malyshev, Grigoriy Smits, Nathan Adewunmi, Daniel O. Brown, Sarah K. Singh, Balwinder Pharmaceuticals (Basel) Perspective Intravenous (IV) ketamine and FDA-approved intranasal (IN) esketamine are increasingly used for treatment-resistant depression (TRD). Preliminary studies have suggested a synergistic effect of ketamine and lamotrigine, although the data are inconclusive. Herein, we report the response to serial ketamine/esketamine treatment among patients with TRD with or without lamotrigine therapy. In this historical cohort study, we included adult patients with TRD who received serial IV racemic ketamine (0.5 mg/kg over 40−100 min) or IN esketamine (56/84 mg) treatments. A change in depressive symptoms was assessed using the 16-item Quick Inventory of Depressive Symptomatology self-report (QIDS-SR) scale. There were no significant differences in response or remission rates among the patients on or not on lamotrigine during the ketamine/esketamine treatments. For a percent change in the QIDS-SR from baseline, no interaction was found between the lamotrigine groups and treatment number (p = 0.70), nor the overall effect of the group (p = 0.38). There was a trend towards lower dissociation (based on the CADSS score) among current lamotrigine users, especially in patients who received IV ketamine. A major limitation is the limited number of patients taking lamotrigine (n = 13). This preliminary study provides insufficient evidence that continuing lamotrigine therapy attenuates the antidepressant effect of repeated ketamine/esketamine; however, there seems to be a signal toward attenuating dissociation with lamotrigine in patients receiving serial ketamine treatments. Further observational studies or randomized controlled trials are needed to replicate these findings. MDPI 2023-08-16 /pmc/articles/PMC10459873/ /pubmed/37631079 http://dx.doi.org/10.3390/ph16081164 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Perspective
Joseph, Boney
Nunez, Nicolas A.
Kung, Simon
Vande Voort, Jennifer L.
Pazdernik, Vanessa K.
Schak, Kathryn M.
Boehm, Stacey M.
Carpenter, Brooke
Johnson, Emily K.
Malyshev, Grigoriy
Smits, Nathan
Adewunmi, Daniel O.
Brown, Sarah K.
Singh, Balwinder
Efficacy of Ketamine with and without Lamotrigine in Treatment-Resistant Depression: A Preliminary Report
title Efficacy of Ketamine with and without Lamotrigine in Treatment-Resistant Depression: A Preliminary Report
title_full Efficacy of Ketamine with and without Lamotrigine in Treatment-Resistant Depression: A Preliminary Report
title_fullStr Efficacy of Ketamine with and without Lamotrigine in Treatment-Resistant Depression: A Preliminary Report
title_full_unstemmed Efficacy of Ketamine with and without Lamotrigine in Treatment-Resistant Depression: A Preliminary Report
title_short Efficacy of Ketamine with and without Lamotrigine in Treatment-Resistant Depression: A Preliminary Report
title_sort efficacy of ketamine with and without lamotrigine in treatment-resistant depression: a preliminary report
topic Perspective
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10459873/
https://www.ncbi.nlm.nih.gov/pubmed/37631079
http://dx.doi.org/10.3390/ph16081164
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