Archival ReportRelationship of Ketamine's Plasma Metabolites with Response, Diagnosis, and Side Effects in Major Depression
Section snippets
Participants
Sixty-seven patients with TRD (MDD = 45; BD = 22) currently experiencing a major depressive episode without psychotic features were enrolled in this study; diagnosis was confirmed by the Structured Clinical Interview for Axis I DSM-IV Disorders–Patient Version (27). The efficacy and side effects of ketamine in a subset of these patients were previously published (9, 10, 28, 29). All subjects were studied as inpatients at the National Institute of Mental Health Clinical Research Center, Mood
Subject Characteristics
The subject population in this study included 67 subjects (33 female subjects, 34 male subjects; age range: 21 to 65 years [mean 46.1 ± 12.5 years]; Table 1).
Differences were observed between diagnostic groups in both the proportion of female subjects and the response rate at 230 minutes.
Patients with BD
Concentrations of ketamine and its major metabolites were analyzed in the plasma samples obtained from BD patients using the liquid chromatography-tandem mass spectrometry assay; a representative chromatogram
Discussion
To our knowledge, this study is the first to examine the relationship between plasma concentrations of downstream ketamine metabolites and antidepressant efficacy, diagnosis, and psychotic and dissociative symptoms in patients with TRD.
One of the most interesting findings was that levels of several ketamine metabolites—specifically, DHNK, HNK4a, and HNK4c—were consistently higher in patients with BD than in patients with MDD. Only plasma ketamine levels at the 40-minute time point and HK5a
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