Brain-based correlates of antidepressant response to ketamine: a comprehensive systematic review of neuroimaging studies.
Gustavo C Medeiros, Malcolm Matheson, Isabella Demo, Matthew J Reid, Sharaya Matheson, Claire Twose, Gwenn S Smith, Todd D Gould, Carlos A Zarate, Frederick S Barrett, Fernando S Goes
The lancet. Psychiatry October 1, 2023 DOI: 10.1016/S2215-0366(23)00183-9 via PubMed
Summary
AI-generated from the abstractA systematic review of 69 neuroimaging studies (1751 participants) found no well-replicated biomarker for ketamine's antidepressant response, but identified several promising candidates. Response to ketamine was associated with post-treatment increases in gamma power in frontoparietal regions, increased functional connectivity within the prefrontal cortex, and increased functional activation of the striatum. The review highlights substantial methodological heterogeneity across studies and calls for further investigation of these biomarkers.
Study at a glance
| Characteristics | Systematic review Longitudinal Peer reviewed |
|---|---|
| Sample size | 1,751 |
| Population | Participants in neuroimaging studies of ketamine for depression |
| Intervention | Ketamine |
| Citations | 38 |
| Key finding | No well-replicated neuroimaging biomarker of ketamine response was identified, but post-treatment increases in gamma power in frontoparietal regions, prefrontal cortex connectivity, and striatal activation were associated with response. |
Abstract
Ketamine is an effective antidepressant, but there is substantial variability in patient response and the precise mechanism of action is unclear. Neuroimaging can provide predictive and mechanistic insights, but findings are limited by small sample sizes. This systematic review covers neuroimaging studies investigating baseline (pre-treatment) and longitudinal (post-treatment) biomarkers of responses to ketamine. All modalities were included. We performed searches of five electronic databases (from inception to April 26, 2022). 69 studies were included (with 1751 participants). There was substantial methodological heterogeneity and no well replicated biomarker. However, we found convergence across some significant results, particularly in longitudinal biomarkers. Response to ketamine was associated with post-treatment increases in gamma power in frontoparietal regions in electrophysiological studies, post-treatment increases in functional connectivity within the prefrontal cortex, and post-treatment increases in the functional activation of the striatum. Although a well replicated neuroimaging biomarker of ketamine response was not identified, there are biomarkers that warrant further investigation.