Changes in symptoms of anhedonia in adults with major depressive or bipolar disorder receiving IV ketamine: Results from the Canadian Rapid Treatment Center of Excellence

Nelson B Rodrigues; Roger S McIntyre; Orly Lipsitz; Danielle S Cha; Yena Lee; Hartej Gill; Amna Majeed; Lee Phan; Flora Nasri; Roger Ho; Kangguang Lin; Mehala Subramaniapillai; Kevin Kratiuk; Rodrigo B Mansur; Joshua D Rosenblat

doi:10.1016/j.jad.2020.07.083

Changes in symptoms of anhedonia in adults with major depressive or bipolar disorder receiving IV ketamine: Results from the Canadian Rapid Treatment Center of Excellence

J Affect Disord. 2020 Nov 1:276:570-575. doi: 10.1016/j.jad.2020.07.083. Epub 2020 Jul 20.

Authors

Affiliations

¹ Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada.
² Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada; Brain and Cognition Discovery Foundation, University of Toronto, Toronto, ON, Canada. Electronic address: roger.mcintyre@uhn.ca.
³ Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, Canada.
⁴ Department of Psychological Medicine, National University of Singapore, Singapore.
⁵ Department of Affective Disorder, The Affiliated Brain Hospital of Guangzhou Medical University, (Guangzhou Huiai Hospital), Guangzhou Medical University, Guangzhou, China; Laboratory of Emotion and Cognition, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou Medical University, Guangzhou, China; Laboratory of Neuropsychology, University of Hong Kong, Hong Kong, Hong Kong.
⁶ Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada.
⁷ Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada; Brain and Cognition Discovery Foundation, University of Toronto, Toronto, ON, Canada.

PMID: 32871688
DOI: 10.1016/j.jad.2020.07.083

Abstract

Background: Anhedonia is a trans-diagnostic, multidimensional phenotype that mediates patient outcomes and suicidality. Convergent evidence suggests that ketamine may be effective in targeting measures of anhedonia in adults with treatment resistant depression (TRD).

Methods: This retrospective, post-hoc analysis included 203 (x̄ = 45 ± 14.6 years of age) patients receiving four infusions of intravenous (IV) ketamine at a community-based clinic. The primary outcome measure was change in anhedonia severity, as measured by the Snaith-Hamilton Pleasure Scale (SHAPS). Secondary measures sought to determine if improvement on the SHAPS mediated the effect of repeated IV ketamine infusions on symptoms of depression and suicidal ideations, as measured by the Quick Inventory for Depression Symptomatology-Self Report 16-Item (QIDS-SR₁₆) and anxiety, as measured using the Generalized Anxiety Disorder-7 (GAD-7).

Results: After adjusting for age, sex, primary diagnosis, concomitant medication, body mass index, and baseline depression severity, there was a statistically significant reduction in symptoms of anhedonia with IV ketamine treatment (F (2, 235.6) = 31.6, p < 0.001). Improvements in depressive symptoms, suicidal ideation, and anxiety symptoms with repeated-dose IV ketamine were significantly partially mediated by reduction in anhedonic severity. Moreover, the combination of number of infusions received and change in anhedonic severity accounted for 26% of the variance in depressive score improvements.

Limitations: This is a post-hoc analysis of retrospective data and lacks a control group.

Conclusion: Ketamine was effective in improving measures of anhedonia in this large, well-characterized community-based sample of adults with TRD. Improvements in anhedonia also partially mediated the significant improvement in depressive symptoms, suicidality, and anxiety.

Keywords: Anhedonia; Bipolar disorder; Ketamine; Major depressive disorder; Reward; Treatment-resistant depression.

MeSH terms

Adult
Anhedonia
Bipolar Disorder* / drug therapy
Canada
Depressive Disorder, Major* / drug therapy
Humans
Ketamine*
Retrospective Studies

Substances

Ketamine