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Amygdala connectivity predicts response to ketamine treatment in anxious depressed patients

Amygdala connectivity predicts response to ketamine treatment in anxious depressed patients

Amygdala connectivity predicts response to ketamine treatment in anxious depressed patients

A brain region known as the amygdala may play a key role in predicting improvement in symptoms after ketamine therapy in patients with treatment-resistant anxious depression, according to new research published in Journal of Affective Disorders.

“Since the antidepressant effects of ketamine in patients with anxious depression are still unclear, it is necessary to investigate potential biomarkers that predict the antidepressant efficacy of ketamine in patients with anxious depression,” said study author Bin Zhang of the Affiliated Brain Hospital of Guangzhou Medical University. .

“Previous studies have indicated that functional differences in amygdala connectivity are associated with improvement in depression after ketamine treatment in depressed patients, but their role in anxious depressed patients is uncertain. Therefore, we investigated the correlation between improvement in depression after ketamine treatment and functional connectivity of the amygdala in patients with anxious depression.”

For their study, the researchers examined neuroimaging data from 31 patients with anxious depression and 18 patients with non-anxious depression.

The researchers only included participants who had a diagnosis of major depression without comorbid psychotic symptoms, had a score greater than 17 on the Hamilton Depression Rating Scale, who had not previously improved after at least two antidepressant treatments, who had completed an fMRI brain scan, and had undergone six ketamine infusion.

Among patients with anxious depression, about 60% (20 patients) showed a clinically significant reduction in depressive symptoms after their sixth infusion of ketamine. The remaining 11 patients with anxiety depression were classified as non-responders.

The researchers found that, prior to the ketamine infusion, responders had greater functional connectivity between the left laterobasal amygdala and left precuneus than non-responders. Additionally, connectivity between the two brain regions was significantly reduced after treatment among responders.

Anxious-depressed patients also tended to have reduced connectivity between the right centriomedial amygdala and right middle temporal gyrus compared to non-anxious-depressed patients, which predicted treatment response.

“Consistent with the key role of the amygdala in emotion regulation, especially in negative emotions, our study showed that functional connectivity of the amygdala was associated with improvement in depression to ketamine infusion in patients with anxious depression,” Zhang told PsyPost.

“The most surprising finding of the current study was that the baseline amygdala-precuneus hyperconnectivity found in responders versus non-responders was significantly reduced at day 13 compared to baseline after six ketamine infusions. This may indicate a potential neural basis by which ketamine exerts its antidepressant effect in patients with anxious depression.”

The results provide new insight into the mechanisms underlying the antidepressant effects of ketamine. But like any study, the new research includes limitations. The researchers noted that their sample size was relatively small. Future studies with larger samples should be conducted to confirm the results.

“Although the findings in our study may suggest that amygdala functional connectivity is a significant predictor of treatment response to ketamine infusions in anxious depressed patients, further validation is needed,” Zhang said. “Furthermore, further studies investigating the potential antidepressant mechanisms of ketamine may help in the treatment of patients with anxious depression.”

The study, “Functional differences in connectivity in the amygdala are associated with the antidepressant efficacy of ketamine in patients with anxious depression“, by Shiqi Yuan, Xin Luo, Xiaoyu Chen, Mingqia Wang, Yiru Hu, Yanling Zhou, Yuping Ning and Bin Zhang.





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