Department of Adult Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland; University Psychiatric Clinics, University of Basel, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland. Electronic address: annette.Bruehl@upk.ch.
3 papers in the library · 5 citations · publishing 2025-2026
A higher percentage of EEG vigilance stage A1, a measure of brain activity, is associated with response to intravenous ketamine in major depression. In a phase-2 randomized controlled trial of oral prolonged-release ketamine for treatment-resistant depression, no significant interaction between response and treatment was found for this EEG marker. However, a small-scale meta-analysis showed a significant pooled mean difference between ketamine responders and non-responders. Applying a previously proposed A1 cutoff of 43% yielded chance-level prediction accuracy in the combined ketamine group but 75% accuracy in the 240 mg subgroup. Responders to 240 mg ketamine also showed more stable vigilance over time. These findings support EEG vigilance as a predictive biomarker for treatment outcomes in depression, though further validation is needed.
Adding a daily 30-day mindfulness mobile app (Headspace) to standard treatment helped reduce depression severity more than standard treatment alone in people with major depressive disorder. In a randomized trial with 83 patients, those using the app showed a significantly greater decrease in clinician-rated depression scores (HDRS) and lower systolic blood pressure after one month. Both groups improved from partial remission at hospital discharge, but the app group improved more. The total dropout rate was 29%. Short-term app-based mindfulness appears beneficial as a supplement to usual care.
Intranasal racemic ketamine is non-inferior to esketamine for reducing depression symptoms in adults with treatment-resistant depression, with comparable symptom improvement over four weeks. However, remission rates were higher with esketamine (38.7%) than with racemic ketamine (15.6%), and racemic ketamine failed to meet non-inferiority for remission. Safety profiles were similar, though racemic ketamine caused slightly more transient blood pressure elevations. Racemic ketamine may be a cost-effective alternative where esketamine access is limited, but higher remission with esketamine warrants further study.