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Open AccessFeature PaperArticle

The Impact of Childhood Maltreatment on Intravenous Ketamine Outcomes for Adult Patients with Treatment-Resistant Depression

1
Research Service Line, Michael E DeBakey VA Medical Center, Houston, TX 77030, USA
2
Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA
3
Lone Star Infusion, PLLC, Houston, TX 77079, USA
4
Mental Health Care Line, Michael E DeBakey VA Medical Center, Houston, TX 77030, USA
*
Author to whom correspondence should be addressed.
These authors contributed equally.
Pharmaceuticals 2019, 12(3), 133; https://doi.org/10.3390/ph12030133
Received: 30 July 2019 / Revised: 2 September 2019 / Accepted: 6 September 2019 / Published: 11 September 2019
(This article belongs to the Special Issue Antidepressants: Mechanistic Insights and Future Directions)
Childhood maltreatment is associated with a poor treatment response to conventional antidepressants and increased risk for treatment-resistant depression (TRD). The N-methyl-D-aspartate receptor (NDMAR) antagonist ketamine has been shown to rapidly improve symptoms of depression in patients with TRD. It is unknown if childhood maltreatment could influence ketamine’s treatment response. We examined the relationship between childhood maltreatment using the Childhood Trauma Questionnaire (CTQ) and treatment response using the Quick Inventory of Depressive Symptoms–Self Report (QIDS-SR) in TRD patients receiving intravenous ketamine at a community outpatient clinic. We evaluated treatment response after a single infusion (n = 115) and a course of repeated infusions (n = 63). Repeated measures general linear models and Bayes factor (BF) showed significant decreases in QIDS-SR after the first and second infusions, which plateaued after the third infusion. Clinically significant childhood sexual abuse, physical abuse, and cumulative clinically significant maltreatment on multiple domains (maltreatment load) were associated with better treatment response to a single and repeated infusions. After repeated infusions, higher load was also associated with a higher remission rate. In contrast to conventional antidepressants, ketamine could be more effective in TRD patients with more childhood trauma burden, perhaps due to ketamine’s proposed ability to block trauma-associated behavioral sensitization. View Full-Text
Keywords: ketamine; depression; childhood trauma; childhood maltreatment; treatment schedule behavioral sensitization ketamine; depression; childhood trauma; childhood maltreatment; treatment schedule behavioral sensitization
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O’Brien, B.; Lijffijt, M.; Wells, A.; Swann, A.C.; Mathew, S.J. The Impact of Childhood Maltreatment on Intravenous Ketamine Outcomes for Adult Patients with Treatment-Resistant Depression. Pharmaceuticals 2019, 12, 133.

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