Ketamine for the treatment of major depression: a systematic review and meta-analysis

Background: Intranasal esketamine has received regulatory approvals for the treatment of depression. Recently a large trial of repeated dose racemic ketamine also demonstrated efficacy in severe depression. However, uncertainties remain regarding comparative efficacy, dosage, and the time course of response. Methods: In this systematic review and meta-analysis, we searched Embase, Medline, Pubmed, PsycINFO, and CENTRAL up to April 13, 2023, for randomised controlled trials (RCTs) investigating ketamine for depression. Two investigators independently assessed study eligibility and risk of bias and extracted the data on depression severity scores, response and remission rates, and all-cause dropouts. Multivariable mixed-effects meta-regressions incorporated drug formulation (racemic (Rac) or esketamine (Esket)) and dose (Low or High) as covariates. Treatment effects were assessed: immediately following the first dose, during further repeated dosing, and follow-up after the final dose of a treatment course. This study is registered with PROSPERO (CRD42021221157). Findings: The systematic review identified 687 articles, of which 49 RCTs were eligible for analysis, comprising 3299 participants. Standardised mean differences (95% confidence intervals) immediately following the first/single treatment were moderate-high for all conditions (Rac-High: −0.73, −0.91 to −0.56; Esket-High: −0.48, −0.75 to −0.20; Rac-Low: −0.33, −0.54 to −0.12; Esket-Low: −0.55, −0.87 to −0.24). Ongoing effects during repeated dosing were significantly greater than the control for Rac-High (−0.61; −1.02 to −0.20) and Rac-Low (−0.55, −1.09 to −0.00), but not Esket-Low (−0.15, −0.49 to 0.19) or Esket-High (−0.22, −0.54 to 0.10). At follow-up effects remained significant for racemic ketamine (−0.65; −1.23 to −0.07) but not esketamine (−0.33; −0.96 to 0.31). All-cause dropout was similar between experiment and control conditions for both formulations combined (Odds Ratio = 1.18, 0.85–1.64). Overall heterogeneity varied from 5.7% to 87.6% Interpretation: Our findings suggested that effect sizes for depression severity, as well as response and remission rates, were numerically greater for racemic ketamine than esketamine. Higher doses were more effective than low doses. Differences were evident in initial effects, ongoing treatment, and lasting effects after the final dose. Funding: None

Data for: Prevalence of Substance Use Disorder Comorbidity among Individuals with Eating Disorders: A Systematic Review and Meta-Analysis

Prevalence of substance use disorder comorbidity in individuals with eating disorder

Data for: Prevalence of Substance Use Disorder Comorbidity among Individuals with Eating Disorders: A Systematic Review and Meta-Analysis

Prevalence of substance use disorder comorbidity in individuals with eating disordersTHIS DATASET IS ARCHIVED AT DANS/EASY, BUT NOT ACCESSIBLE HERE. TO VIEW A LIST OF FILES AND ACCESS THE FILES IN THIS DATASET CLICK ON THE DOI-LINK ABOV

Episodic Behavioural Regression in an 8-Year-Old Female: Sequelae of 22q11.2 Duplication Syndrome

22q11.2 duplication syndrome is a recently discovered genetic syndrome with unclear neuropsychiatric sequelae. While its connection to 22q11.2 deletion syndrome is actively investigated, case reports on the neuropsychiatric sequelae of affected individuals have been previously described, largely focusing on comorbid autism spectrum disorder. Here, we present the case of an 8-year-old female experiencing episodes of severe behavioural regression following medical illness. We analyze the case and relate it to the available literature and identify potential risk factors

Ketamine for Bipolar Depression: A Systematic Review

Abstract Background Ketamine appears to have a therapeutic role in certain mental disorders, most notably unipolar major depressive disorder. However, its efficacy in bipolar depression is less clear. This study aimed to assess the efficacy and tolerability of ketamine for bipolar depression. Methods We conducted a systematic review of experimental studies using ketamine for the treatment of bipolar depression. We searched PubMed, MEDLINE, Embase, PsycINFO, and the Cochrane Central Register for relevant studies published since each database’s inception. We synthesized evidence regarding efficacy (improvement in depression rating scores) and tolerability (adverse events, dissociation, dropouts) across studies. Results We identified 6 studies, with 135 participants (53% female; 44.7 years; standard deviation, 11.7 years). All studies used 0.5 mg/kg of add-on intravenous racemic ketamine, with the number of doses ranging from 1 to 6; all participants continued a mood-stabilizing agent. The overall proportion achieving a response (defined as those having a reduction in their baseline depression severity of at least 50%) was 61% for those receiving ketamine and 5% for those receiving a placebo. The overall response rates varied from 52% to 80% across studies. Ketamine was reasonably well tolerated; however, 2 participants (1 receiving ketamine and 1 receiving placebo) developed manic symptoms. Some participants developed significant dissociative symptoms at the 40-minute mark following ketamine infusion in 2 trials. Conclusions There is some preliminary evidence supporting use of intravenous racemic ketamine to treat adults with bipolar depression. There is a need for additional studies exploring longer-term outcomes and alterative formulations of ketamine. </jats:sec

Exclusion of the non-English-speaking world from the scientific literature: Recommendations for change for addiction journals and publishers

Background: While English is only the native language of 7.3% of the world's population and less than 20% can speak the language, nearly 75% of all scientific publications are English. Aim: To describe how and why scientific contributions from the non-English-speaking world have been excluded from addiction literature, and put forward suggestions for making this literature more accessible to the non-English-speaking population. Methods: A working group of the International Society of Addiction Journal Editors (ISAJE) conducted an iterative review of issues related to scientific publishing from the non-English-speaking world. Findings: We discuss several issues stemming from the predominance of English in the scientific addiction literature, including historical drivers, why this matters, and proposed solutions, focusing on the increased availability of translation services. Conclusion: The addition of non-English-speaking authors, editorial team members, and journals will increase the value, impact, and transparency of research findings and increase the accountability and inclusivity of scientific publications