Jiangxi Provincial Key Laboratory for Precision Pathology and Intelligent Diagnosis, Department of Radiology, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Jiangxi, China.
2 papers in the library · 14 citations · publishing 2025
People with major depressive disorder show widespread damage to the brain's white matter, particularly in fibers connecting different regions. A two-week treatment with intravenous esketamine (0.25 mg/kg) effectively reduced depression, anxiety, and suicidal thoughts and improved cognitive function in 20 patients compared to 20 healthy controls. However, brain scans revealed that the damaged white matter did not recover during this short treatment period. The degree of damage in certain projection fibers was linked to the severity of anxiety and suicidal ideation. The study lacked a placebo control and many patients also took sertraline, making it difficult to isolate esketamine's specific effects on the brain.
In 29 patients with major depressive disorder, six intravenous infusions of esketamine led to significant reductions in depression, anxiety, and suicidal ideation scores, along with improved cognitive scores. After two weeks, functional connectivity between the right caudal hippocampus and the left cerebellum, precuneus, and middle temporal gyrus increased. The connectivity between the right caudal hippocampus and left middle temporal gyrus negatively correlated with cognitive scores. The altered hippocampal connectivity may reflect esketamine's regulatory mechanism on depressive symptoms, involving the default network and cortico-cerebellar loop.