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Does body mass index predict response to intravenous ketamine treatment in adults with major depressive and bipolar disorder? Results from the Canadian Rapid Treatment Center of Excellence

Published online by Cambridge University Press:  03 December 2020

Orly Lipsitz Open the ORCID record for Orly Lipsitz [Opens in a new window] ,
Roger S. McIntyre Open the ORCID record for Roger S. McIntyre [Opens in a new window] ,
Nelson B. Rodrigues ,
Yena Lee ,
Hartej Gill ,
Mehala Subramaniapillai ,
Kevin Kratiuk ,
Flora Nasri ,
Rodrigo B. Mansur  and
Joshua D. Rosenblat
Orly Lipsitz
Affiliation:
Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada Canadian Rapid Treatment Center of Excellence, Mississauga, Ontario, Canada
Roger S. McIntyre*
Affiliation:
Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada Canadian Rapid Treatment Center of Excellence, Mississauga, Ontario, Canada Brain and Cognition Discovery Foundation, Toronto, Ontario, Canada Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
Nelson B. Rodrigues
Affiliation:
Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada Canadian Rapid Treatment Center of Excellence, Mississauga, Ontario, Canada
Yena Lee
Affiliation:
Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada Canadian Rapid Treatment Center of Excellence, Mississauga, Ontario, Canada
Hartej Gill
Affiliation:
Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada Canadian Rapid Treatment Center of Excellence, Mississauga, Ontario, Canada
Mehala Subramaniapillai
Affiliation:
Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada Canadian Rapid Treatment Center of Excellence, Mississauga, Ontario, Canada
Kevin Kratiuk
Affiliation:
Canadian Rapid Treatment Center of Excellence, Mississauga, Ontario, Canada Department of Clinical Immunology, Poznan University of Medical Sciences
Flora Nasri
Affiliation:
Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada
Rodrigo B. Mansur
Affiliation:
Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
Joshua D. Rosenblat
Affiliation:
Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada Canadian Rapid Treatment Center of Excellence, Mississauga, Ontario, Canada Brain and Cognition Discovery Foundation, Toronto, Ontario, Canada Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
*
*Author for correspondence: Roger S. McIntyre Email: roger.mcintyre@uhn.ca
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Abstract

Background

Higher body mass index (BMI) has been found to predict greater antidepressant response to intravenous (IV) ketamine treatment. We evaluated the association between BMI and response to repeat-dose IV ketamine in patients with treatment-resistant depression (TRD).

Methods

Adults (N = 230) with TRD received four infusions of IV ketamine at a community-based clinic. Changes in symptoms of depression (ie, Quick Inventory for Depressive Symptomatology-Self-Report 16; QIDS-SR16), suicidal ideation (SI; ie, QIDS-SR16 SI item), anxiety (ie, Generalized Anxiety Disorder-7 Scale), anhedonic severity (ie, Snaith–Hamilton Pleasure Scale), and functioning (ie, Sheehan Disability Scale) following infusions were evaluated. Participants were stratified by BMI as normal (18.0-24.9 kg/m2; n = 72), overweight (25-29.9 kg/m2; n = 76), obese I (30-34.9 kg/m2; n = 47), or obese II (≥35.0 kg/m2; n = 35).

Results

Similar antidepressant effects with repeat-dose ketamine were reported between BMI groups (P = .261). In addition, categorical partial response (P = .149), response (P = .526), and remission (P = .232) rates were similar between the four BMI groups.

Conclusions

The findings are limited by the observational, open-label design of this retrospective analysis. Pretreatment BMI did not predict response to IV ketamine, which was effective regardless of BMI.

Keywords

Adiposityesketamineglutamateobesityoverweight
Type
Original Research
Information
CNS Spectrums , Volume 27 , Issue 3 , June 2022 , pp. 322 - 330
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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References

Organizatiorn WH, Others. Obesity and overweight. Fact Sheet no. 311. Geneva: WHO; 2013. 2015.Google Scholar
Marcus, M, Taghi Yasamy, M, van van Ommeren, M, Chisholm, D, Saxena, S. Depression: a global public health concern. PsycEXTRA Dataset. 2012. doi:10.1037/e517532013-004.CrossRefGoogle Scholar
Luppino, FS, de Wit, LM, Bouvy, PF, et al. Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry. 2010;67(3):220–229. doi:10.1001/archgenpsychiatry.2010.2.CrossRefGoogle ScholarPubMed
Ma, J, Xiao, L. Obesity and depression in US women: results from the 2005-2006 National Health and Nutritional Examination Survey. Obesity. 2010;18(2):347–353. doi:10.1038/oby.2009.213.CrossRefGoogle ScholarPubMed
Papakostas, GI, Petersen, T, Iosifescu, DV, et al. Obesity among outpatients with major depressive disorder. Int J Neuropsychopharmacol. 2005;8(1):59–63. doi:10.1017/S1461145704004602.CrossRefGoogle ScholarPubMed
Markowitz, S, Friedman, MA, Arent, SM. Understanding the Relation Between Obesity and Depression: Causal Mechanisms and Implications for Treatment. Clin Psychol Sci & Pract. 2008;15(1):1–20. doi:10.1111/j.1468-2850.2008.00106.x CrossRefGoogle Scholar
Dixon, JB, Dixon, ME, O’Brien, PE. Depression in association with severe obesity: changes with weight loss. Arch Intern Med. 2003;163(17):2058–2065. doi:10.1001/archinte.163.17.2058.CrossRefGoogle ScholarPubMed
Goldstein, BI, Carnethon, MR, Matthews, KA, et al. Major depressive disorder and bipolar disorder predispose youth to accelerated atherosclerosis and early cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2015;132(10):965–986. doi:10.1161/CIR.0000000000000229.CrossRefGoogle ScholarPubMed
Krogh, J, Hjorthøj, C, Speyer, H, Gluud, C, Nordentoft, M. Exercise for patients with major depression: a systematic review with meta-analysis and trial sequential analysis. BMJ Open. 2017;7(9):e014820. doi:10.1136/bmjopen-2016-014820.CrossRefGoogle ScholarPubMed
Finkelstein, EA, Ruhm, CJ, Kosa, KM. Economic causes and consequences of obesity. Annu Rev Public Health. 2005;26:239–257. doi:10.1146/annurev.publhealth.26.021304.144628.CrossRefGoogle ScholarPubMed
Tremmel, M, Gerdtham, U-G, Nilsson, PM, Saha, S. Economic burden of obesity: a systematic literature review. Int J Environ Res Public Health. 2017;14(4). doi:10.3390/ijerph14040435.CrossRefGoogle ScholarPubMed
Lin, C-H, Chen, C-C, Wong, J, McIntyre, RS. Both body weight and BMI predicts improvement in symptom and functioning for patients with major depressive disorder. J Affect Disord. 2014;161:123–126. doi:10.1016/j.jad.2014.02.039.CrossRefGoogle ScholarPubMed
Kloiber, S, Ising, M, Reppermund, S, et al. Overweight and obesity affect treatment response in major depression. Biol Psychiatry. 2007;62(4):321–326. doi:10.1016/j.biopsych.2006.10.001.CrossRefGoogle ScholarPubMed
Jha, MK, Wakhlu, S, Dronamraju, N, Minhajuddin, A, Greer, TL, Trivedi, MH. Validating pretreatment body mass index as moderator of antidepressant treatment outcomes: findings from CO-MED trial. J Affect Disord. 2018;234:34–37. doi:10.1016/j.jad.2018.02.089.CrossRefGoogle Scholar
Papakostas, GI, Shelton, RC, Zajecka, JM, et al. Effect of adjunctivel-methylfolate 15 mg among inadequate responders to SSRIS in depressed patients who were stratified by biomarker levels and genotype. J Clin Psychiatry. 2014;75(08):855–863. doi:10.4088/jcp.13m08947.CrossRefGoogle ScholarPubMed
aan het Rot, M, Collins, KA, Murrough, JW, et al. Safety and efficacy of repeated-dose intravenous ketamine for treatment-resistant depression. Biol Psychiatry. 2010;67(2):139–145. doi:10.1016/j.biopsych.2009.08.038.CrossRefGoogle ScholarPubMed
Murrough, JW, Iosifescu, DV, Chang, LC, et al. Antidepressant efficacy of ketamine in treatment-resistant major depression: a two-site randomized controlled trial. Am J Psychiatry. 2013;170(10):1134–1142. doi:10.1176/appi.ajp.2013.13030392.CrossRefGoogle ScholarPubMed
Coyle, CM, Laws, KR. The use of ketamine as an antidepressant: a systematic review and meta-analysis. Hum Psychopharmacol Clin Exp. 2015;30(3):152–163. https://onlinelibrary.wiley.com/doi/abs/10.1002/hup.2475?casa_token=BD3UQmDhb9cAAAAA:pQ9dHRErFBR4VGeZfAnV9KvwmBqHmOTT4C7r3VnMjjMT7zxNUFV0LSES6z9Dos-xqOJiemErX-LD_PE.CrossRefGoogle ScholarPubMed
Feifel, D, Malcolm, B, Boggie, D, Lee, K. Low-dose ketamine for treatment resistant depression in an academic clinical practice setting. J Affect Disord. 2017;221:283–288. doi:10.1016/j.jad.2017.06.043.CrossRefGoogle Scholar
Phillips, JL, Norris, S, Talbot, J, et al. Single, repeated, and maintenance ketamine infusions for treatment-resistant depression: a randomized controlled trial. Am J Psychiatry. 2019;176(5):401–409. doi:10.1176/appi.ajp.2018.18070834.CrossRefGoogle ScholarPubMed
Machado-Vieira, R, Gold, PW, Luckenbaugh, DA, et al. The role of adipokines in the rapid antidepressant effects of ketamine. Mol Psychiatry. 2017;22(1):127–133. doi:10.1038/mp.2016.36.CrossRefGoogle ScholarPubMed
Niciu, MJ, Luckenbaugh, DA, Ionescu, DF, et al. Clinical predictors of ketamine response in treatment-resistant major depression. J Clin Psychiatry. 2014;75(5):e417–e423. doi:10.4088/JCP.13m08698.CrossRefGoogle ScholarPubMed
Rong, C, Park, C, Rosenblat, JD, et al. Predictors of response to ketamine in treatment resistant major depressive disorder and bipolar disorder. Int J Environ Res Public Health. 2018;15(4). doi:10.3390/ijerph15040771.CrossRefGoogle ScholarPubMed
Cizza, G, Nguyen, VT, Eskandari, F, et al. Low 24-hour adiponectin and high nocturnal leptin concentrations in a case–control study of community-dwelling premenopausal women with major depressive disorder. J Clin Psychiatry. 2010;71(08):1079–1087. doi:10.4088/jcp.09m05314blu.CrossRefGoogle Scholar
Ahima, RS, Lazar, MA. Adipokines and the peripheral and neural control of energy balance. Mol Endocrinol. 2008;22(5):1023–1031. doi:10.1210/me.2007-0529.CrossRefGoogle ScholarPubMed
Haroon, E, Chen, X, Li, Z, et al. Increased inflammation and brain glutamate define a subtype of depression with decreased regional homogeneity, impaired network integrity, and anhedonia. Transl Psychiatry. 2018;8(1):189. doi:10.1038/s41398-018-0241-4.CrossRefGoogle ScholarPubMed
Ballard, ED, Yarrington, JS, Farmer, CA, et al. Characterizing the course of suicidal ideation response to ketamine. J Affect Disord. 2018;241:86–93. doi:10.1016/j.jad.2018.07.077.CrossRefGoogle Scholar
Singh, B, Bobo, WV, Rasmussen, KG, et al. The association between body mass index and remission rates in patients with treatment-resistant depression who received intravenous ketamine. J Clin Psychiatry. 2019;80(6). doi:10.4088/JCP.19l12852.CrossRefGoogle ScholarPubMed
Freeman, MP, Hock, RS, Papakostas, GI, et al. Body mass index as a moderator of treatment response to ketamine for major depressive disorder. J Clin Psychopharmacol. 2020;40(3):287–292. doi:10.1097/JCP.0000000000001209.CrossRefGoogle ScholarPubMed
Dale, RM, Bryant, KA, Thompson, NR. Metabolic syndrome rather than body mass index is associated with treatment response to ketamine infusions. J Clin Psychopharmacol. 2020;40(1):75–79. doi:10.1097/JCP.0000000000001149.CrossRefGoogle ScholarPubMed
Rodrigues, NB, McIntyre, RS, Lipsitz, O, et al. Safety and tolerability of IV ketamine in adults with major depressive or bipolar disorder: results from the Canadian Rapid Treatment Center of Excellence. Expert Opin Drug Saf. 2020;19:1–10. doi:10.1080/14740338.2020.1776699.CrossRefGoogle ScholarPubMed
McIntyre, RS, Rodrigues, NB, Lee, Y, et al. The effectiveness of repeated intravenous ketamine on depressive symptoms, suicidal ideation and functional disability in adults with major depressive disorder and bipolar disorder: results from the Canadian Rapid Treatment Center of Excellence. J. Affect. Disord. 2020;274:903–910. doi:10.1016/j.jad.2020.05.088.CrossRefGoogle ScholarPubMed
Rush, AJ, Trivedi, MH, Ibrahim, HM, et al. The 16-item quick inventory of depressive symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression. Biol Psychiatry. 2003;54(5):573–583. doi:10.1016/S0006-3223(02)01866-8.CrossRefGoogle ScholarPubMed
Spitzer, RL, Kroenke, K, Williams, JBW, Löwe, B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–1097. doi:10.1001/archinte.166.10.1092.CrossRefGoogle ScholarPubMed
Snaith, RP, Hamilton, M, Morley, S, Humayan, A, Hargreaves, D, Trigwell, P. A scale for the assessment of hedonic tone the Snaith–Hamilton pleasure scale. Br J Psychiatry. 1995;167(1):99–103. doi:10.1192/bjp.167.1.99.CrossRefGoogle ScholarPubMed
Sheehan, DV, Harnett-Sheehan, K, Raj, BA. The measurement of disability. Int Clin Psychopharmacol. 1996;11(Suppl 3):89–95. doi:10.1097/00004850-199606003-00015.CrossRefGoogle ScholarPubMed
Park, M, Newman, LE, Gold, PW, et al. Change in cytokine levels is not associated with rapid antidepressant response to ketamine in treatment-resistant depression. J Psychiatr Res. 2017;84:113–118. doi:10.1016/j.jpsychires.2016.09.025.CrossRefGoogle Scholar
Sanacora, G, Frye, MA, McDonald, W, et al. A consensus statement on the use of ketamine in the treatment of mood disorders. JAMA Psychiatry. 2017;74(4):399–405. doi:10.1001/jamapsychiatry.2017.0080.CrossRefGoogle ScholarPubMed
Wells, JCK. Commentary: the paradox of body mass index in obesity assessment: not a good index of adiposity, but not a bad index of cardio-metabolic risk. Int J Epidemiol. 2014;43(3):672–674. doi:10.1093/ije/dyu060.CrossRefGoogle Scholar
McIntyre, RS, Soczynska, JK, Liauw, SS, et al. The association between childhood adversity and components of metabolic syndrome in adults with mood disorders: results from the International Mood Disorders Collaborative Project. Int J Psychiatry Med. 2012;43(2):165–177. doi:10.2190/pm.43.2.e.CrossRefGoogle ScholarPubMed
McIntyre, RS, Soczynska, JK, Konarski, JZ, et al. Should depressive syndromes be reclassified as “Metabolic Syndrome Type II”? Ann Clin Psychiatry. 2007;19(4):257–264. doi:10.3109/10401230701653377.CrossRefGoogle ScholarPubMed
Pennybaker, SJ, Niciu, MJ, Luckenbaugh, DA, Zarate, CA. Symptomatology and predictors of antidepressant efficacy in extended responders to a single ketamine infusion. J Affect Disord 2017;208:560–566. doi:10.1016/j.jad.2016.10.026.CrossRefGoogle ScholarPubMed
Luckenbaugh, DA, Niciu, MJ, Ionescu, DF, et al. Do the dissociative side effects of ketamine mediate its antidepressant effects? J Affect Disord. 2014;159:56–61. doi:10.1016/j.jad.2014.02.017.CrossRefGoogle ScholarPubMed
Niciu, MJ, Shovestul, BJ, Jaso, BA, et al. Features of dissociation differentially predict antidepressant response to ketamine in treatment-resistant depression. J Affect Disord. 2018;232:310–315. doi:10.1016/j.jad.2018.02.049.CrossRefGoogle ScholarPubMed
Luckenbaugh, DA, Ibrahim, L, Brutsche, N, et al. Family history of alcohol dependence and antidepressant response to an N-methyl-D-aspartate antagonist in bipolar depression. Bipolar Disord. 2012;14(8):880–887. doi:10.1111/bdi.12003.CrossRefGoogle Scholar
Niciu, MJ, Luckenbaugh, DA, Ionescu, DF, et al. Ketamine’s antidepressant efficacy is extended for at least four weeks in subjects with a family history of an alcohol use disorder. Int J Neuropsychopharmacol . 2015;18(1):pyu039. doi:10.1093/ijnp/pyu039.CrossRefGoogle Scholar
Permoda-Osip, A, Dorszewska, J, Bartkowska-Sniatkowska, A, Chlopocka-Wozniak, M, Rybakowski, JK. Vitamin B12 level may be related to the efficacy of single ketamine infusion in bipolar depression. Pharmacopsychiatry. 2013;46(6):227–228. doi:10.1055/s-0033-1349861.Google Scholar
McIntyre, RS. A vision for drug discovery and development: novel targets and multilateral partnerships. Adv Ther. 2014;31(3):245–246. doi:10.1007/s12325-014-0105-0.CrossRefGoogle ScholarPubMed
Trivedi, MH, Chin Fatt, CR, Jha, MK, et al. Comprehensive phenotyping of depression disease trajectory and risk: rationale and design of Texas Resilience Against Depression study (T-RAD). J Psychiatr Res. 2020;122:22–32. doi:10.1016/j.jpsychires.2019.12.004.CrossRefGoogle Scholar