Lamotrigine is not associated with differential clinical outcomes in a real-world sample of patients with unipolar depression receiving ketamine or esketamine.
Mia C Santucci, Rachel B Katz, Brian Pittman, Sina Nikayin, Samuel T Wilkinson
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引用次数: 0
Abstract
Rationale: Ketamine has emerged as a rapid-acting antidepressant. Lamotrigine is used as an off-label treatment for major depressive disorder. Some theorize, based on mechanism, that lamotrigine might interfere with ketamine's antidepressant effects.
Objectives: To report on clinical outcomes for patients with depression treated concomitantly with/without lamotrigine and ketamine/esketamine.
Methods: Clinical outcomes based on the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Quick Inventory of Depressive Symptomatology-Self Report (QIDS) were organized from patients with major depressive disorder treated with ketamine/esketamine at Yale Psychiatric Hospital from 2014 through November 2023. Patients were treated with intravenous ketamine (0.5 mg/kg over 40 min) or intranasal esketamine (56 or 84 mg) twice per week for two to four weeks.
Results: Overall, 347 patients with depression were treated with ketamine/esketamine, 57 of which were concurrently taking lamotrigine during the treatment period. Most (207/347, 59.7%) patients were women, with an average age of 45.6 (standard deviation [SD] = 16.6). The average dose of lamotrigine was 210.1 (SD = 153.9). In the initial, unadjusted model, there was no group (lamotrigine v. no lamotrigine) by time interaction using the MADRS (F2,345=1.19, p = 0.30) or QIDS (F2,338=0.51, p = 0.60) as outcomes. Adjusting for concomitant medications (antidepressants, benzodiazepines), prior exposure to electroconvulsive therapy, sex, age, race, history of psychiatric hospitalization, additional psychiatric comorbidities, and whether patients started treatment as an outpatient or inpatient did not affect results.
Conclusions: We found no clinical evidence for an interaction between lamotrigine and treatment with ketamine/esketamine in a real-world sample of treatment-seeking patients with major depressive disorder.
期刊介绍：
Official Journal of the European Behavioural Pharmacology Society (EBPS)
Psychopharmacology is an international journal that covers the broad topic of elucidating mechanisms by which drugs affect behavior. The scope of the journal encompasses the following fields:
Human Psychopharmacology: Experimental
This section includes manuscripts describing the effects of drugs on mood, behavior, cognition and physiology in humans. The journal encourages submissions that involve brain imaging, genetics, neuroendocrinology, and developmental topics. Usually manuscripts in this section describe studies conducted under controlled conditions, but occasionally descriptive or observational studies are also considered.
Human Psychopharmacology: Clinical and Translational
This section comprises studies addressing the broad intersection of drugs and psychiatric illness. This includes not only clinical trials and studies of drug usage and metabolism, drug surveillance, and pharmacoepidemiology, but also work utilizing the entire range of clinically relevant methodologies, including neuroimaging, pharmacogenetics, cognitive science, biomarkers, and others. Work directed toward the translation of preclinical to clinical knowledge is especially encouraged. The key feature of submissions to this section is that they involve a focus on clinical aspects.
Preclinical psychopharmacology: Behavioral and Neural
This section considers reports on the effects of compounds with defined chemical structures on any aspect of behavior, in particular when correlated with neurochemical effects, in species other than humans. Manuscripts containing neuroscientific techniques in combination with behavior are welcome. We encourage reports of studies that provide insight into the mechanisms of drug action, at the behavioral and molecular levels.
Preclinical Psychopharmacology: Translational
This section considers manuscripts that enhance the confidence in a central mechanism that could be of therapeutic value for psychiatric or neurological patients, using disease-relevant preclinical models and tests, or that report on preclinical manipulations and challenges that have the potential to be translated to the clinic. Studies aiming at the refinement of preclinical models based upon clinical findings (back-translation) will also be considered. The journal particularly encourages submissions that integrate measures of target tissue exposure, activity on the molecular target and/or modulation of the targeted biochemical pathways.
Preclinical Psychopharmacology: Molecular, Genetic and Epigenetic
This section focuses on the molecular and cellular actions of neuropharmacological agents / drugs, and the identification / validation of drug targets affecting the CNS in health and disease. We particularly encourage studies that provide insight into the mechanisms of drug action at the molecular level. Manuscripts containing evidence for genetic or epigenetic effects on neurochemistry or behavior are welcome.
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