Nonresponse to Ketamine in Treatment-Resistant Bipolar Depression.

IF 2 Q3 NEUROSCIENCES

Neuropsychopharmacology Reports Pub Date : 2025-09-01 DOI:10.1002/npr2.70038

Zofia Kachlik, Wiesław Jerzy Cubała, Michał Walaszek, Michał Pastuszak, Krzysztof Pastuszak, Aleksander Kwaśny

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Abstract

Objectives: Ketamine is a prototypical rapid-acting antidepressant for treatment-resistant bipolar depression (TRBD), yet many patients do not achieve a meaningful response. This study explored features of ketamine nonresponse in TRBD.

Methods: In a post hoc analysis of a naturalistic study, 35 TRBD patients received a four-week ketamine regimen (intravenous 0.5 mg/kg or oral 2.0/2.5 mg/kg). Response was measured using the Montgomery-Åsberg Depression Rating Scale, and baseline sociodemographic and clinical features were compared between responders and nonresponders.

Results: Fourteen patients (40%) were nonresponders. They had a higher median number of psychiatric comorbidities (2 vs. 1; p = 0.0366), were more likely to have any psychiatric comorbidity (78.6% vs. 33.3%; p = 0.0153), and had greater prior benzodiazepine use (64.3% vs. 23.8%; p = 0.0332). No significant links emerged between individual comorbidities or baseline suicidality and response.

Conclusion: Ketamine demonstrates a favorable safety and tolerability profile for short time use in TRBD regardless of isolated baseline characteristics, although a more severe comorbidity burden and benzodiazepine use appear to be associated with nonresponse.

Trial registration: NCT04226963 and NCT05565352.

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难治性双相抑郁症对氯胺酮无反应。

目的：氯胺酮是治疗难治性双相抑郁症（TRBD）的一种典型的速效抗抑郁药，然而许多患者并没有达到有意义的反应。本研究探讨了TRBD患者氯胺酮无反应的特点。方法：在一项自然研究的事后分析中，35名TRBD患者接受了为期四周的氯胺酮治疗方案（静脉注射0.5 mg/kg或口服2.0/2.5 mg/kg）。使用Montgomery-Åsberg抑郁评定量表测量反应，并比较反应者和无反应者的基线社会人口学和临床特征。结果：14例（40%）无反应。他们有更高的精神合并症中位数（2比1，p = 0.0366），更有可能有任何精神合并症（78.6%比33.3%,p = 0.0153），并且先前使用过更多的苯二氮卓类药物（64.3%比23.8%,p = 0.0332）。个体合并症或基线自杀率与反应之间没有明显联系。结论：无论孤立的基线特征如何，氯胺酮在TRBD的短期使用中具有良好的安全性和耐受性，尽管更严重的合并症负担和苯二氮卓类药物的使用似乎与无反应相关。试验注册：NCT04226963和NCT05565352。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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