Effects of repeated intravenous esketamine administration on affective biases.
Christine Reif-Leonhard, Shannon N Millard, Dorsa Ferdowssian, Ailidh Finlayson, Mareike Aichholzer, Jonathan Repple, Michael Stäblein, Sharmili Edwin Thanarajah, Xudong Wang, Gerard R Dawson, Andreas Reif, Asad Malik
The world journal of biological psychiatry : the official journal of the World Federation of Societies of Biological Psychiatry January 1, 2025 DOI: 10.1080/15622975.2024.2441304 via PubMed
Summary
AI-generated from the abstractRepeated intravenous esketamine infusions improved emotion recognition for all emotions except sadness, where accuracy decreased, particularly for low-intensity expressions. Misclassifications of other emotions as sad also decreased, indicating a reduced response bias towards sadness. This shift emerged after the first infusion and consolidated over time. Participants showed significant reductions in feelings of sadness and irritability, and cognitive functioning improved. Among those receiving at least five infusions, 66.7% showed significant improvement. The findings suggest that esketamine's antidepressant effects may involve changes in emotion processing and cognition, with acute mood-lifting effects distinguishable from longer-lasting responses that consolidate after repeated administration.
Study at a glance
| Characteristics | Observational cohort Peer reviewed |
|---|---|
| Sample size | 18 |
| Population | Treatment-resistant depression patients |
| Intervention | Esketamine |
| Keywords | Ema Rapid acting antidepressant Dosing Prediction #antidepressants depression medication |
| Citations | 3 |
| Key finding | Esketamine improved emotion recognition for all emotions except sadness, where accuracy decreased, and reduced response bias towards sadness, alongside improvements in mood and cognitive functioning. |
Abstract
While neuropsychological effects of conventional antidepressants are well-documented, more research is needed for rapid-acting antidepressants. This study examines the effects of esketamine on emotion processing and cognitive functioning, both acutely and sub-chronically. Eighteen treatment-resistant depression (TRD) patients received repeated intravenous esketamine infusions. Mood state was reported daily, and the Facial Expression Recognition Task was administered 1h before and 4h after each infusion. Other assessments included the Digit Symbol Substitution Task. 66.7% participants who received at least five infusions (n = 12) showed significant improvement. Emotion recognition improved for all emotions except sadness, where accuracy decreased, particularly for low-intensity expressions (p = .007, d = -1.09). Misclassifications of other emotions as sad also decreased (p = .035, d = -0.79), indicating a reduced response bias towards sadness. This shift in bias emerged after the first infusion and then consolidated over time. In parallel, participants showed significant reductions in feelings of sadness (p = .015, d = -0.89) and irritability (p = .001, d = -1.35). Symptomatic improvement negatively correlated with accuracy for and misclassifications of sadness, and cognitive functioning also improved (p = .001, d = 1.62). Improvement of TRD by esketamine may involve shifts in emotion processing and cognition, with the acute mood-lifting effects of esketamine being discernible from longer-lasting antidepressant response, which consolidates after repeated administration.