Cognitive Behavior Therapy May Sustain Antidepressant Effects of Intravenous Ketamine in Treatment-Resistant Depression

• Published in: Psychotherapy and psychosomatics 2017-01, Vol.86 (3), p.162-167
• Main Authors: Wilkinson, Samuel T., Wright, DaShaun, Fasula, Madonna K., Fenton, Lisa, Griepp, Matthew, Ostroff, Robert B., Sanacora, Gerard
• Format: Article
• Language: English
• Subjects: Administration, Intravenous; Adult; Antidepressants; Antidepressive Agents - pharmacology; Care and treatment; Clinical Note; Cognition; Cognitive therapy; Cognitive Therapy - methods; Combined Modality Therapy; Depression, Mental; Depressive Disorder, Major - therapy; Depressive Disorder, Treatment-Resistant - therapy; Female; Humans; Kaplan-Meier Estimate; Ketamine; Ketamine - pharmacology; Male; Methods; Middle Aged; Patient outcomes; Psychiatric Status Rating Scales; Recurrence; Remission Induction; Treatment Outcome; Young Adult
• ISSN: 0033-3190; 1423-0348
• DOI: 10.1159/000457960

Introduction: Ketamine has shown rapid though short-lived antidepressant effects. The possibility of concerning neurobiological changes following repeated exposure to the drug motivates the development of strategies that obviate or minimize the need for longer-term treatment with ketamine. In this open-label trial, we investigated whether cognitive behavioral therapy (CBT) can sustain or extend ketamine's antidepressant effects. Methods: Patients who were pursuing ketamine infusion therapy for treatment-resistant depression were invited to participate in the study. If enrolled, the subjects initiated a 12-session, 10-week course of CBT concurrently with a short 4-treatment, 2-week course of intravenous ketamine (0.5 mg/kg infused over 40 min) provided under a standardized clinical protocol. Results: Sixteen participants initiated the protocol, with 8 (50%) attaining a response to the ketamine and 7 (43.8%) achieving remission during the first 2 weeks of protocol. Among ketamine responders, the relapse rate at the end of the CBT course (8 weeks following the last ketamine exposure) was 25% (2/8). On longer-term follow-up, 5 of 8 subjects eventually relapsed, the median time to relapse being 12 weeks following ketamine exposure. Among ketamine remitters, 3 of 7 retained remission until at least 4 weeks following the last ketamine exposure, with 2 retaining remission through 8 weeks following ketamine exposure. Ketamine nonresponders did not appear to benefit from CBT. Conclusions: CBT may sustain the antidepressant effects of ketamine in treatment-resistant depression. Well-powered randomized controlled trials are warranted to further investigate this treatment combination as a way to sustain ketamine's antidepressant effects.