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Neural correlates of change in major depressive disorder anhedonia following open-label ketamine
Journal article   Open access   Peer reviewed

Neural correlates of change in major depressive disorder anhedonia following open-label ketamine

Níall Lally, Allison C Nugent, David A Luckenbaugh, Mark J Niciu, Jonathan P Roiser and Carlos A Zarate Jr
Journal of psychopharmacology (Oxford), Vol.29(5), pp.596-607
05/2015
DOI: 10.1177/0269881114568041
PMCID: PMC5116382
PMID: 25691504
url
http://doi.org/10.1177/0269881114568041View
Open Access

Abstract

Anhedonia is a cardinal symptom of major depression and is often refractory to standard treatment, yet no approved medication for this specific symptom exists. In this exploratory re-analysis, we assessed whether administration of rapid-acting antidepressant ketamine was associated specifically with reduced anhedonia in medication-free treatment-refractory patients with major depressive disorder in an open-label investigation. Additionally, participants received either oral riluzole or placebo daily beginning 4 hours post-infusion. A subgroup of patients underwent fluorodeoxyglucose positron emission tomography scans at baseline (1-3 days pre-infusion) and 2 hours post-ketamine infusion. Anhedonia rapidly decreased following a single ketamine infusion; this was sustained for up to three days, but was not altered by riluzole. Reduced anhedonia correlated with increased glucose metabolism in the hippocampus and dorsal anterior cingulate cortex (dACC) and decreased metabolism in the inferior frontal gyrus and orbitofrontal cortex (OFC). The tentative relationship between change in anhedonia and glucose metabolism remained significant in dACC and OFC, and at trend level in the hippocampus, a result not anticipated, when controlling for change in total depression score. Results, however, remain tenuous due to the lack of a placebo control for ketamine. In addition to alleviating overall depressive symptoms, ketamine could possess anti-anhedonic potential in major depressive disorder, which speculatively, may be mediated by alterations in metabolic activity in the hippocampus, dACC and OFC.
Depressive Disorder, Treatment-Resistant - psychology Double-Blind Method Humans Middle Aged Gyrus Cinguli - diagnostic imaging Male Treatment Outcome Depressive Disorder, Treatment-Resistant - diagnostic imaging Depressive Disorder, Treatment-Resistant - drug therapy Hippocampus - diagnostic imaging Antidepressive Agents - therapeutic use Depressive Disorder, Major - psychology Anhedonia - drug effects Radionuclide Imaging Adult Female Antidepressive Agents - pharmacology Ketamine - therapeutic use Ketamine - pharmacology Depressive Disorder, Major - drug therapy

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