Repeated Neurocognitive Measurements in Depressed Patients

Phase 1

Completed

Brief Summary: In this project, we will A) track the functioning of a collection of potential neurobiological targets for depression over time, B) examine how fluctuations in the functioning of those targets relates to real-world functioning, and C) in a subset of the sample, determine how the functioning in those targets is altered by a single dose of ketamine.

Recruitment & Eligibility

Inclusion Criteria

All participants will:

be between the ages of 18 and 60 years,
score ≥ 14 on the Hamilton Depression Rating Scale (Ham-D)
possess a level of understanding sufficient to agree to all tests and examinations required by the protocol and must sign an informed consent document

Exclusion Criteria

All participants:

Presence of lifetime bipolar, psychotic, or autism spectrum; current problematic substance use (e.g., ongoing moderate-to-severe substance use disorder);
Failure to meet standard MRI inclusion criteria: those who have cardiac pacemakers, neural pacemakers, cochlear implants, metal braces, or other non-MRI-compatible metal objects in their body. History of significant injury or surgery to the brain or spinal cord that would impair interpretation of results.
Acute suicidality or other psychiatric crises requiring treatment escalation. We will use the Columbia Suicide Severity Rating Scale (CSSRS) as both an initial exclusion criteria (CSSRS "Baseline/Screening" Version for past 1month period) and as grounds for rescue/removal (CSSRS "Since Last Visit" form). The CSSRS will be administered using a paper form by an experienced and thoroughly trained clinical assessor on the study team. Subjects with CSSRS suicide ideation scores scored "yes" on items 4 (active suicidal ideation with some intent to act) and/or 5 (active suicidal ideation with specific plan and intent) will be excluded from the study, and if enrolled, will be exited from the study and referred immediately to the nearest emergency mental health facility for additional thorough assessment and appropriate treatment referral.
Changes made to treatment regimen within 4 weeks of baseline assessment.
Reading level <6th grade as per patient self-report.
Patients who have received ECT in the past 2 months prior to Screening.

Ketamine phase subsample additional exclusion criteria:

Patients currently taking any psychotropic medication.
Lifetime recreational ketamine or PCP use
Current pregnancy or breastfeeding
For ketamine phase entry, patients must be reasonable medical candidates for ketamine infusion, as determined by a physician co-investigator. Serious, unstable medical illnesses including respiratory [obstructive sleep apnea, or history of difficulty with airway management during previous anesthetics], cardiovascular [including ischemic heart disease and uncontrolled hypertension], and neurologic [including history of severe head injury] will be exclusions.
Clinically significant abnormal findings of laboratory parameters [including urine toxicology screen for drugs of abuse], physical examination, or ECG.
Uncontrolled or poorly controlled hypertension, as determined by a physician co-investigator's review of vitals collected during screening and any other relevant medical history/records.
Patients with one or more seizures without a clear and resolved etiology.
Patients starting hormonal treatment (e.g., estrogen) in the 3 months prior to Screening.
Past intolerance or hypersensitivity to ketamine.
Patients taking medications with known activity at the NMDA or AMPA glutamate receptor [e.g., riluzole, amantadine, lamotrigine, memantine, topiramate, dextromethorphan, Dcycloserine], or the mu-opioid receptor.
Patients taking any of the following medications: St John's Wort, theophylline, tramadol, metrizamide.

Arm && Interventions

Group	Intervention	Description
Intravenous Ketamine	Intravenous Ketamine	Open-label ketamine infusion

Primary Outcome Measures

Name	Time	Method
fMRI Intrinsic Connectivity: Limbic Network	24hrs post-intervention	functional connectivity normalized correlation values within limbic network (range: -1 to +1; larger value = stronger connectivity, smaller value = weaker connectivity)
fMRI Intrinsic Connectivity: Frontoparietal Control Network	24hrs post-intervention	functional connectivity normalized correlation values within frontoparietal control network (range: -1 to +1; larger value = stronger connectivity, smaller value = weaker connectivity)
fMRI Intrinsic Connectivity: Salience Network	24hrs post-intervention	functional connectivity normalized correlation values within salience ventral attentional network (range: -1 to +1; larger value = stronger connectivity, smaller value = weaker connectivity)
fMRI Intrinsic Connectivity: Default Mode Network	24hrs post-intervention	functional connectivity normalized correlation values within default mode network (range: -1 to +1; larger value = stronger connectivity, smaller value = weaker connectivity)

Secondary Outcome Measures

Name	Time	Method
Quick Inventory of Depressive Symptoms	12 days post-intervention	Self-reported depression (range: 0-27; higher scores = worse outcome)
fMRI Intrinsic Connectivity: Dorsal Attention Network	24hrs post-intervention	functional connectivity normalized correlation values within dorsal attention network (range: -1 to +1; larger value = stronger connectivity, smaller value = weaker connectivity)
fMRI Intrinsic Connectivity: Somatosensory Motor Network	24hrs post-intervention	functional connectivity normalized correlation values within somatosensory motor network (range: -1 to +1; larger value = stronger connectivity, smaller value = weaker connectivity)
fMRI Intrinsic Connectivity: Visual Network	24hrs post-intervention	functional connectivity normalized correlation values within visual network (range: -1 to +1; larger value = stronger connectivity, smaller value = weaker connectivity)
Montgomery-Asberg Depression Rating Scale	12 days post-intervention	Clinician-rated depression (range: 0-60; higher scores = worse outcome)
Hamilton Depression Rating Scale (Modified Score)	12 days post-intervention	Clinician-rated depression (range: 0-52; higher scores = worse outcome)