Depression involves disrupted communication between the frontal cortex and striatum. In 48 patients with treatment-resistant depression, those with lower baseline connectivity in these circuits showed greater symptom improvement after a single low-dose (0.2 mg/kg) ketamine infusion, but not after a higher dose (0.5 mg/kg) or placebo. Reduced connectivity between the superior frontal cortex and striatum predicted treatment response. Patients had weaker frontostriatal connections than healthy controls.
In two clinical trials involving a total of 96 patients with treatment-resistant depression, a single low dose of ketamine altered specific connections between the thalamus and frontal brain regions, measured by resting-state functional MRI three days after infusion. Some thalamocortical connections increased and others decreased in the ketamine groups compared to placebo or midazolam groups. However, these brain connectivity changes were not statistically significantly linked to improvements in depression or suicidal thoughts after correcting for multiple comparisons. The results suggest that while ketamine may modify thalamocortical connectivity, whether these changes underlie its antidepressant and antisuicidal effects remains uncertain and requires further study.