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517. Effects of Ketamine on Atypical and Typical Symptoms of Depression
Biological Psychiatry
Friday Abstracts
Background: Meta-analyses of randomized controlled trials (RCTs) report omega-3 fatty acids can reduce symptoms of attention deficit hyperactivity disorder (ADHD) in children. Here we present baseline data from a currently un-blinded RCT designed to evaluate efficacy in adults; the Neuroimaging, Omega-3 and Reward in Adults with ADHD trial (NCT02156089). Methods: Thirty participants with ADHD aged 18-55 (M 5 32.87, SD 5 10.97, Female 5 30%) were assessed using the Conner's Adult ADHD Rating Scales (CAARS) Self Report Long Version, the Profile of Mood States-Bipolar (POMS-Bi), and the Beck Depression Inventory (BDI). Concurrently, red blood cells were obtained to quantify fatty acid levels. Results: Higher 22:6 n-3 (DHA) was associated with higher CAARS scores (r5 0.49, p, 0.006) and higher 22:5 n-6 was associated with lower CAARS scores (r5 20.42, p, 0.03). Higher 22:5 n-3 was associated with fewer depression symptoms (r5 20.41, p, 0.03) and higher levels of 20:2 n-6 (Eicosadienoic acid) was associated with greater depression symptoms (r5 0.51, p, 0.004). Higher 20:2 n-6 was positively associated with unsure (r5 20.49, p, 0.006), confused (r5 20.57, p, 0.001), depressed (r5 20.37, p, 0.05), and anxious symptoms (r5 20.52, p, 0.003). Conclusions: The relationships between higher omega-3 and lower scores on the BDI at baseline are concordant with current literature on omega-3 and depression. Contrary to predictions, a positive association of DHA, and a negative association of 22:5n-6, with CAARS scores were found. Findings regarding 20:2n-6 are curious because this metabolic intermediate is not directly related to dietary intakes. Supported By: Intramural Program of the National Institute on Alcohol Abuse and Alcoholism Keywords: ADHD, Omega 3, Depressive symptoms, mood symptoms, Nutrition
517. Effects of Ketamine on Atypical and Typical Symptoms of Depression 1
1
1
Kevin Yu , Lawrence Park , David Luckenbaugh , Steven Pennybaker2, Matthew Hopkins3, Marc Lener1, and Carlos Zarate4 National Institutes of Health, NIMH, 2The Johns Hopkins University School of Medicine, 3Georgetown University, Department of Psychiatry, 4Experimental Therapeutics & Pathophysiology Branch, National Institutes of Health, NIMH 1
Background: Although ketamine has been shown to produce a rapid antidepressant effect, little has been reported regarding ketamine’s effects on subtypes of depression. Atypical depression, compared to typical (melancholic) depression, comprises a unique symptom cluster and may respond differentially to antidepressant treatments. We investigated whether atypical depressive symptoms, as measured by the Scale for Atypical Symptoms (SAS), improve after ketamine and if atypical symptoms improve more than typical symptoms, as measured by the Montgomery-Asberg Depression Rating Scale (MADRS). Methods: 68 subjects with treatment-resistant major depressive disorder (unmedicated) or bipolar disorder (on a
S210
therapeutic-dose lithium or valproate) were pooled across three double-blind, placebo-controlled, crossover studies investigating the efficacy of intravenous ketamine for depressive symptoms. Clinical symptoms were collected pre-infusion, and up to 14 days post-infusion, with effect sizes measured on days one and three post-infusion. Analysis of overall MADRS scores, SAS scores, and individual symptoms was performed in an exploratory manner. Results: Overall MADRS (Cohen’s d50.55) and SAS (d50.33) scores demonstrated significant improvement one day postinfusion, with the most statistically significant (p,0.05) improvements in MADRS individual items: pessimistic thoughts (d50.52), reported sadness (d50.47), and inability to feel (d50.45). On day three, MADRS reported sadness (d50.37), inability to feel (d50.36), concentration difficulties (d50.33), and apparent sadness (d50.33) demonstrated the most statistically significant individual symptom improvement. Overall MADRS (d50.43) and SAS (d50.33) scores continued to be significantly improved over placebo. Conclusions: Although ketamine ameliorates both typical and atypical depressive symptoms, the effect size of ketamine over placebo was greater for typical symptoms one and three days post-infusion. Supported By: ETPB, NIMH Keywords: Ketamine, Treatment Resistant Depression, Major Depressive Disorder (MDD), Atypical Depression, Melancholic Depression
518. Patient and Clinician Acceptance of the Suicide Ideation and Behavior Assessment Tool (SIBAT) Larry Alphs1, Dong-Jing Fu2, and Carla Canuso2 1 Ortho-McNeil Janssen Scientific Research & Development, LLC
Affairs,
2
Janssen
Background: Acceptance of new assessment tools by patients and clinicians who use them is important. The Suicide Ideation and Behavior Assessment Tool (SIBAT) has been developed to identify, track, and document suicidal ideation and behaviors in patients at risk for suicide. It has both patient-rated and clinician-rated components for clinical or research use. We demonstrate that this new instrument is acceptable to persons identified to be at risk for suicide and to their clinicians. Methods: Fifteen adolescents with a history of suicide ideation and/or behavior in the prior month were consented to be interviewed using the SIBAT and then provide feedback on their experience with it. Likert scale and qualitative ratings were obtained. Following review of output from videotaped ratings of 3 patients with a varied range of symptoms, 16 clinicians rated their evaluation of each of the constituent modules for making global impression ratings. These clinician ratings were followed by telephone interviews to gain qualitative feedback. Results: Patients ratings for difficulty to understand, repetitiousness, burden, and offensiveness were low (mean changes were 1.5/5.0, 1.4/5.0, 1.1/5.0, and 1.0/5.0, respectively. Clinician ratings for the relative value of each of the SIBAT’s constituent modules for assessing global severity
Biological Psychiatry May 15, 2017; 81:S140–S276 www.sobp.org/journal
Friday Abstracts
Background: Meta-analyses of randomized controlled trials (RCTs) report omega-3 fatty acids can reduce symptoms of attention deficit hyperactivity disorder (ADHD) in children. Here we present baseline data from a currently un-blinded RCT designed to evaluate efficacy in adults; the Neuroimaging, Omega-3 and Reward in Adults with ADHD trial (NCT02156089). Methods: Thirty participants with ADHD aged 18-55 (M 5 32.87, SD 5 10.97, Female 5 30%) were assessed using the Conner's Adult ADHD Rating Scales (CAARS) Self Report Long Version, the Profile of Mood States-Bipolar (POMS-Bi), and the Beck Depression Inventory (BDI). Concurrently, red blood cells were obtained to quantify fatty acid levels. Results: Higher 22:6 n-3 (DHA) was associated with higher CAARS scores (r5 0.49, p, 0.006) and higher 22:5 n-6 was associated with lower CAARS scores (r5 20.42, p, 0.03). Higher 22:5 n-3 was associated with fewer depression symptoms (r5 20.41, p, 0.03) and higher levels of 20:2 n-6 (Eicosadienoic acid) was associated with greater depression symptoms (r5 0.51, p, 0.004). Higher 20:2 n-6 was positively associated with unsure (r5 20.49, p, 0.006), confused (r5 20.57, p, 0.001), depressed (r5 20.37, p, 0.05), and anxious symptoms (r5 20.52, p, 0.003). Conclusions: The relationships between higher omega-3 and lower scores on the BDI at baseline are concordant with current literature on omega-3 and depression. Contrary to predictions, a positive association of DHA, and a negative association of 22:5n-6, with CAARS scores were found. Findings regarding 20:2n-6 are curious because this metabolic intermediate is not directly related to dietary intakes. Supported By: Intramural Program of the National Institute on Alcohol Abuse and Alcoholism Keywords: ADHD, Omega 3, Depressive symptoms, mood symptoms, Nutrition
517. Effects of Ketamine on Atypical and Typical Symptoms of Depression 1
1
1
Kevin Yu , Lawrence Park , David Luckenbaugh , Steven Pennybaker2, Matthew Hopkins3, Marc Lener1, and Carlos Zarate4 National Institutes of Health, NIMH, 2The Johns Hopkins University School of Medicine, 3Georgetown University, Department of Psychiatry, 4Experimental Therapeutics & Pathophysiology Branch, National Institutes of Health, NIMH 1
Background: Although ketamine has been shown to produce a rapid antidepressant effect, little has been reported regarding ketamine’s effects on subtypes of depression. Atypical depression, compared to typical (melancholic) depression, comprises a unique symptom cluster and may respond differentially to antidepressant treatments. We investigated whether atypical depressive symptoms, as measured by the Scale for Atypical Symptoms (SAS), improve after ketamine and if atypical symptoms improve more than typical symptoms, as measured by the Montgomery-Asberg Depression Rating Scale (MADRS). Methods: 68 subjects with treatment-resistant major depressive disorder (unmedicated) or bipolar disorder (on a
S210
therapeutic-dose lithium or valproate) were pooled across three double-blind, placebo-controlled, crossover studies investigating the efficacy of intravenous ketamine for depressive symptoms. Clinical symptoms were collected pre-infusion, and up to 14 days post-infusion, with effect sizes measured on days one and three post-infusion. Analysis of overall MADRS scores, SAS scores, and individual symptoms was performed in an exploratory manner. Results: Overall MADRS (Cohen’s d50.55) and SAS (d50.33) scores demonstrated significant improvement one day postinfusion, with the most statistically significant (p,0.05) improvements in MADRS individual items: pessimistic thoughts (d50.52), reported sadness (d50.47), and inability to feel (d50.45). On day three, MADRS reported sadness (d50.37), inability to feel (d50.36), concentration difficulties (d50.33), and apparent sadness (d50.33) demonstrated the most statistically significant individual symptom improvement. Overall MADRS (d50.43) and SAS (d50.33) scores continued to be significantly improved over placebo. Conclusions: Although ketamine ameliorates both typical and atypical depressive symptoms, the effect size of ketamine over placebo was greater for typical symptoms one and three days post-infusion. Supported By: ETPB, NIMH Keywords: Ketamine, Treatment Resistant Depression, Major Depressive Disorder (MDD), Atypical Depression, Melancholic Depression
518. Patient and Clinician Acceptance of the Suicide Ideation and Behavior Assessment Tool (SIBAT) Larry Alphs1, Dong-Jing Fu2, and Carla Canuso2 1 Ortho-McNeil Janssen Scientific Research & Development, LLC
Affairs,
2
Janssen
Background: Acceptance of new assessment tools by patients and clinicians who use them is important. The Suicide Ideation and Behavior Assessment Tool (SIBAT) has been developed to identify, track, and document suicidal ideation and behaviors in patients at risk for suicide. It has both patient-rated and clinician-rated components for clinical or research use. We demonstrate that this new instrument is acceptable to persons identified to be at risk for suicide and to their clinicians. Methods: Fifteen adolescents with a history of suicide ideation and/or behavior in the prior month were consented to be interviewed using the SIBAT and then provide feedback on their experience with it. Likert scale and qualitative ratings were obtained. Following review of output from videotaped ratings of 3 patients with a varied range of symptoms, 16 clinicians rated their evaluation of each of the constituent modules for making global impression ratings. These clinician ratings were followed by telephone interviews to gain qualitative feedback. Results: Patients ratings for difficulty to understand, repetitiousness, burden, and offensiveness were low (mean changes were 1.5/5.0, 1.4/5.0, 1.1/5.0, and 1.0/5.0, respectively. Clinician ratings for the relative value of each of the SIBAT’s constituent modules for assessing global severity
Biological Psychiatry May 15, 2017; 81:S140–S276 www.sobp.org/journal