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Prediction of the Antidepressant Effect of Ketamine Based on Clinical Parameters and Intoxication Phenomenology
Andrashko, Veronika ; Horáček, Jiří (advisor) ; Papežová, Hana (referee) ; Juřica, Jan (referee)
Background: ketamine is a rapid and potent antidepressant treatment, however no sufficient predictors for tailored treatment have been identified to date. The aim of the thesis was to identify possible clinical and phenomenological characteristics, associated with better antidepressant response in patients receiving ketamine. Materials and methods: data from 86 depressed patients from cohorts A (2010-2015) and B (2018-2022) were utilized. All patients underwent ketamine infusion and demographic as well as clinical assessment (severity of depressive symptoms, subjective and objective anxiety and anhedonia before and after ketamine application). In addition, an electrocardiogram was taken to assess heart rate variability in cohort A and blood pressure, heart rate, and altered state of consciousness scales were recorded in cohort B during ketamine intoxication. Results: in cohort A, the use of higher doses of benzodiazepines was associated with worse response at day 3 (p = 0.04) and day 7 (p = 0.02) after ketamine administration. Responders showed higher heart rate (p = 0.001) and differed from nonresponders in heart rate variability (p = 0.011). In cohort B, responders reached higher values od systolic (p = 0.003) and diastolic (p = 0.005) blood pressure during intoxication, but not higher heart...
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Antidepressant effect of ketamine
Revayová, Anna ; Valeš, Karel (advisor) ; Šóš, Peter (referee)
Ketamine is used as an anaesthetic mainly in veterinary medicine and paediatrics. Thirteen years ago, interest in ketamine as an antidepressant emerged. Ketamine as an antidepressant works rapidly and is also effective in the case of patients suffering from treatment resistant depression.The main disadvantage of ketamine as an antidepressant is its psychotomimetic effect. Ketamine is an antagonist of the NMDA receptor, which has an important influence in brain activity. Through antagonism of this receptor, a large amount of processes can be affected, for example levels of glutamate, excitotoxicity, or density of other receptors. In addition, ketamine probably also affects the D2 receptors, but its role in this is uncertain. Ketamine influences synaptic plasticity and its effect can be modulated by repeated application, co-application with other drugs and other methods. Also gender seems to play role in the effect of ketamine. The aim of this work is to summarise possible mechanisms of effect of ketamine, its effect on synaptic plasticity and also possibilities of modulation of its effect. This thesis mentions the most important studies concerning ketamine as an antidepressant and possible future directions of research. Keywords: major depressive disorder, ketamine, antidepressant, NMDA antagonism,...
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