Introduction: Ketamine has emerged as a rapid-acting antidepressant. While ongoing treatment can prevent relapse, concerns exist regarding long-term exposure. Objective: We conducted a randomized trial to examine the feasibility and efficacy of cognitive behavioral therapy (CBT) following intravenous ketamine in treatment-resistant depression (TRD). Methods: Subjects with TRD were recruited and treated with 6 intravenous infusions of ketamine over 3 weeks. Subjects who experienced a clinical response (≥50% improvement in depression severity) were then randomized to receiving CBT or treatment as usual (TAU) for an additional 14 weeks, using a sequential treatment model. Results: Of the 42 patients who signed consent, 28 patients achieved a response and were randomized to CBT or TAU. When measured using the Montgomery-Asberg Depression Rating Scale (primary outcome measure), the effect size at the end of the study was moderate (Cohen d = 0.65; 95% CI –0.55 to 1.82), though the group-by-time interaction effect was not significant. There was a significant group-by-time interaction as measured by the Quick Inventory of Depressive Symptomatology (F = 4.58; p = 0.033), favoring a greater sustained improvement in the CBT group. This corresponded to a moderate-to-large effect size of the Cohen d = 0.71 (95% CI –0.30 to 1.70) at the end of the study (14 weeks following the last ketamine infusion). In a subset of patients (N = 20) who underwent cognitive testing using the emotional N-back assessments before and after ketamine, ketamine responders showed improvement in the accuracy of emotional N-back (t[8] = 2.33; p #x3c; 0.05) whereas nonresponders did not (t[10] #x3c;1; p ns). Conclusions: This proof-of-concept study provides preliminary data indicating that CBT may sustain the antidepressant effects of ketamine in TRD. Further study and optimization of this treatment approach in well-powered clinical trials is recommended.
Psychother Psychosom

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维持氯胺酮在难治性抑郁症中的抗抑郁作用的认知行为疗法：一项随机临床试验

简介：氯胺酮已成为一种速效抗抑郁药。虽然持续治疗可以防止复发，但对长期暴露存在担忧。目的：我们进行了一项随机试验，以检查静脉注射氯胺酮后认知行为疗法 (CBT) 治疗难治性抑郁症 (TRD) 的可行性和有效性。方法：招募了 TRD 受试者，并在 3 周内接受了 6 次氯胺酮静脉输注。然后，使用序贯治疗模型将出现临床反应（抑郁症严重程度改善≥50%）的受试者随机分配接受 CBT 或常规治疗 (TAU) 额外 14 周。结果：在签署同意书的 42 名患者中，28 名患者获得了缓解，并被随机分配至 CBT 或 TAU。当使用蒙哥马利-阿斯伯格抑郁量表（主要结果测量）进行测量时，研究结束时的效果大小适中（Cohen d = 0.65；95% CI –0.55 至 1.82），尽管按时间分组的交互作用效果并不显着。根据抑郁症状快速清单 ( F = 4.58; p = 0.033)测量，存在显着的按时间分组的交互作用，有利于 CBT 组的持续改善。这对应于 Cohen d 的中到大效应量= 0.71（95% CI –0.30 至 1.70）在研究结束时（最后一次氯胺酮输注后 14 周）。在使用氯胺酮前后使用情绪 N-back 评估进行认知测试的一部分患者 ( N = 20) 中，氯胺酮反应者显示情绪 N-back 的准确性有所提高 ( t [8] = 2.33; p #x3c; 0.05) 而无反应者没有 ( t [10] #x3c;1; p ns)。结论：这项概念验证研究提供了初步数据，表明 CBT 可能维持氯胺酮在 TRD 中的抗抑郁作用。建议在强有力的临床试验中进一步研究和优化这种治疗方法。
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