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Single i.v. ketamine augmentation of newly initiated escitalopram for major depression: Results from a randomized, placebo-controlled 4-week study
Hu Y.-D.1,2,3; Xiang Y.-T.4; Fang J.-X.3; Zu S.3; Sha S.1; Shi H.1,3; Ungvari G.S.5,6; Correll C.U.7; Chiu H.F.K.8; Xue Y.1; Tian T.-F.1; Wu A.-S.3; Ma X.1,2; Wang G.1,2
2016
Source PublicationPsychological Medicine
ISSN332917
Volume46Issue:3Pages:623
Abstract

Background While oral antidepressants reach efficacy after weeks, single-dose intravenous (i.v.) ketamine has rapid, yet time-limited antidepressant effects. We aimed to determine the efficacy and safety of single-dose i.v. ketamine augmentation of escitalopram in major depressive disorder (MDD). Method Thirty outpatients with severe MDD (17-item Hamilton Rating Scale for Depression total score ≥24) were randomized to 4 weeks double-blind treatment with escitalopram 10 mg/day+single-dose i.v. ketamine (0.5 mg/kg over 40 min) or escitalopram 10 mg/day + placebo (0.9% i.v. saline). Depressive symptoms were measured using the Montgomery-Asberg Depression Rating Scale (MADRS) and the Quick Inventory of Depressive Symptomatology - Self-Report (QIDS-SR). Suicidal ideation was evaluated with the QIDS-SR item 12. Adverse psychopathological effects were measured with the Brief Psychiatric Rating Scale (BPRS)-positive symptoms, Young Mania Rating Scale (YMRS) and Clinician Administered Dissociative States Scale (CADSS). Patients were assessed at baseline, 1, 2, 4, 24 and 72 h and 7, 14, 21 and 28 days. Time to response (≥50% MADRS score reduction) was the primary outcome. Results By 4 weeks, more escitalopram + ketamine-treated than escitalopram + placebo-treated patients responded (92.3% v. 57.1%, p = 0.04) and remitted (76.9% v. 14.3%, p = 0.001), with significantly shorter time to response [hazard ratio (HR) 0.04, 95% confidence interval (CI) 0.01-0.22, p < 0.001] and remission (HR 0.11, 95% CI 0.02-0.63, p = 0.01). Compared to escitalopram + placebo, escitalopram + ketamine was associated with significantly lower MADRS scores from 2 h to 2 weeks [(peak = 3 days-2 weeks; effect size (ES) = 1.08-1.18)], QIDS-SR scores from 2 h to 2 weeks (maximum ES = 1.27), and QIDS-SR suicidality from 2 to 72 h (maximum ES = 2.24). Only YMRS scores increased significantly with ketamine augmentation (1 and 2 h), without significant BPRS or CADSS elevation. Conclusions Single-dose i.v. ketamine augmentation of escitalopram was safe and effective in severe MDD, holding promise for speeding up early oral antidepressant efficacy. © Cambridge University Press 2015.

KeywordEscitalopram Ketamine Key Words Efficacy Major Depression Response Tolerability
DOIhttp://doi.org/10.1017/S0033291715002159
URLView the original
Indexed BySCI
Language英语
WOS Research AreaPsychology ; Psychiatry
WOS SubjectPsychology, Clinical ; Psychiatry ; Psychology
WOS IDWOS:000367172500016
The Source to ArticleScopus
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Cited Times [WOS]:42   [WOS Record]     [Related Records in WOS]
Document TypeJournal article
CollectionFaculty of Health Sciences
Corresponding AuthorXiang Y.-T.; Wang G.
Affiliation1.China & Beijing Key Laboratory of Mental Disorders, The National Clinical Research Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
2.Department of Psychiatry, Capital Medical University, China & Center of Depression, Beijing Institute for Brain Disorders, Beijing, China
3.Unit of Psychological Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
4.Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
5.The University of Notre Dame Australia/Marian Centre, Perth, Australia
6.School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth, Australia
7.Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, NY, USA
8.Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China
Corresponding Author AffilicationFaculty of Health Sciences
Recommended Citation
GB/T 7714
Hu Y.-D.,Xiang Y.-T.,Fang J.-X.,et al. Single i.v. ketamine augmentation of newly initiated escitalopram for major depression: Results from a randomized, placebo-controlled 4-week study[J]. Psychological Medicine,2016,46(3):623.
APA Hu Y.-D..,Xiang Y.-T..,Fang J.-X..,Zu S..,Sha S..,...&Wang G..(2016).Single i.v. ketamine augmentation of newly initiated escitalopram for major depression: Results from a randomized, placebo-controlled 4-week study.Psychological Medicine,46(3),623.
MLA Hu Y.-D.,et al."Single i.v. ketamine augmentation of newly initiated escitalopram for major depression: Results from a randomized, placebo-controlled 4-week study".Psychological Medicine 46.3(2016):623.
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