Efficacy of Ketamine with and without Lamotrigine in Treatment-Resistant Depression: A Preliminary Report
B. Joseph, N. Nuñez, S. Kung, Jennifer L. Vande Voort, Vanessa K. Pazdernik, K. Schak, Stacey M. Boehm, Brooke Carpenter, Emily K. Johnson, G. Malyshev, N.a.c. Smits, Daniel O. Adewunmi, Sarah K. Brown, Balwinder Singh
Pharmaceuticals August 1, 2023 DOI: 10.3390/ph16081164 via Semantic Scholar
Summary
For adults with treatment-resistant depression, taking lamotrigine alongside intravenous ketamine or intranasal esketamine does not significantly reduce the antidepressant effect of the treatments. In a historical cohort study, response and remission rates were similar whether patients were on lamotrigine or not. There was a trend toward lower dissociation scores among those taking lamotrigine, especially with IV ketamine. The study was limited by only 13 patients on lamotrigine, so the evidence is insufficient to conclude that lamotrigine attenuates the antidepressant effect, but it may reduce dissociation.
Study at a glance
| Characteristics | Historical cohort study Randomized Peer reviewed |
|---|---|
| Population | Adult patients with treatment-resistant depression receiving serial IV ketamine or IN esketamine |
| Keywords | Medicine |
| Citations | 14 |
| Key finding | No significant differences in antidepressant response or remission rates were found between patients on or off lamotrigine during ketamine/esketamine treatment. |
Abstract
Intravenous (IV) ketamine and FDA-approved intranasal (IN) esketamine are increasingly used for treatment-resistant depression (TRD). Preliminary studies have suggested a synergistic effect of ketamine and lamotrigine, although the data are inconclusive. Herein, we report the response to serial ketamine/esketamine treatment among patients with TRD with or without lamotrigine therapy. In this historical cohort study, we included adult patients with TRD who received serial IV racemic ketamine (0.5 mg/kg over 40−100 min) or IN esketamine (56/84 mg) treatments. A change in depressive symptoms was assessed using the 16-item Quick Inventory of Depressive Symptomatology self-report (QIDS-SR) scale. There were no significant differences in response or remission rates among the patients on or not on lamotrigine during the ketamine/esketamine treatments. For a percent change in the QIDS-SR from baseline, no interaction was found between the lamotrigine groups and treatment number (p = 0.70), nor the overall effect of the group (p = 0.38). There was a trend towards lower dissociation (based on the CADSS score) among current lamotrigine users, especially in patients who received IV ketamine. A major limitation is the limited number of patients taking lamotrigine (n = 13). This preliminary study provides insufficient evidence that continuing lamotrigine therapy attenuates the antidepressant effect of repeated ketamine/esketamine; however, there seems to be a signal toward attenuating dissociation with lamotrigine in patients receiving serial ketamine treatments. Further observational studies or randomized controlled trials are needed to replicate these findings.