Predicting Antidepressant Effects of Ketamine: the Role of the Pregenual Anterior Cingulate Cortex as a Multimodal Neuroimaging Biomarker
Anne Weigand, Matti Gärtner, Milan Scheidegger, Patrik O. Wyss, A Henning, Erich Seifritz, Anna Stippl, Ana Lucía Herrera-Meléndez, Malek Bajbouj, Sabine Aust, Simone Grimm
The International Journal of Neuropsychopharmacology August 10, 2022 DOI: 10.1093/ijnp/pyac049 via OpenAlex
Summary
Activity in the pregenual anterior cingulate cortex (pgACC) during emotional stimulation can predict how well a single intravenous infusion of ketamine will relieve depression symptoms in people with major depressive disorder. In 24 patients, pgACC activity was linked to an increase in glutamate in the same brain region 24 hours after the infusion, and this glutamate increase was associated with greater symptom improvement. The findings suggest pgACC activity may serve as a neuroimaging biomarker for early treatment response to ketamine.
Study at a glance
| Characteristics | Observational cohort Peer reviewed |
|---|---|
| Sample size | 24 |
| Population | Patients with major depressive disorder |
| Intervention | Ketamine |
| Dose | single i.v. infusion of ketamine |
| Duration | 24 hours pre- and post-intervention; a subsample of 17 patients had a follow-up scan at 24 hours |
| Topics | Depression Ketamine |
| Keywords | Anterior cingulate cortex Antidepressant Neuroimaging |
| Citations | 22 |
| Key finding | Pregenual anterior cingulate cortex activity during emotional stimulation predicts antidepressant response to ketamine, and this activity is associated with a post-infusion glutamate increase that relates to better clinical outcome. |
Abstract
BACKGROUND: Growing evidence underscores the utility of ketamine as an effective and rapid-acting treatment option for major depressive disorder (MDD). However, clinical outcomes vary between patients. Predicting successful response may enable personalized treatment decisions and increase clinical efficacy. METHODS: We here explored the potential of pregenual anterior cingulate cortex (pgACC) activity to predict antidepressant effects of ketamine in relation to ketamine-induced changes in glutamatergic metabolism. Prior to a single i.v. infusion of ketamine, 24 patients with MDD underwent functional magnetic resonance imaging during an emotional picture-viewing task and magnetic resonance spectroscopy. Changes in depressive symptoms were evaluated using the Beck Depression Inventory measured 24 hours pre- and post-intervention. A subsample of 17 patients underwent a follow-up magnetic resonance spectroscopy scan. RESULTS: Antidepressant efficacy of ketamine was predicted by pgACC activity during emotional stimulation. In addition, pgACC activity was associated with glutamate increase 24 hours after the ketamine infusion, which was in turn related to better clinical outcome. CONCLUSIONS: Our results add to the growing literature implicating a key role of the pgACC in mediating antidepressant effects and highlighting its potential as a multimodal neuroimaging biomarker of early treatment response to ketamine.