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Research updates - September 2019

Major Depressive Disorder

Major Depressive Disorder is a common psychiatric disorder and causes significant disability. About 30% of patients do not respond to antidepressants, even after multiple trials of medication with or without psychotherapies. Finding an effective antidepressant treatment for these patients remains a significant challenge.

Ketamine has been shown to produce rapid, though short-lived, antidepressant effects. One possibility is that the antidepressant effects of combined ketamine and Electroconvulsive Therapy (ECT) increase recovery in patients suffering from treatment-resistant depression. The KITE-Dep (Ketamine Interleaved with Electroconvulsive therapy for Depression, a pragmatic randomised controlled pilot trial) study will aim to ascertain the feasibility and tolerability of establishing a definitive clinical trial to assess the benefit of adjunctive ketamine with ECT for treatment-resistant depression.

Recruitment for this pilot trial commenced in September. Eligible patients will include those with Major Depression or Bipolar Depression who are referred for ECT in St Patrick’s Mental Health Services. Patients will be randomised to received twice-weekly infusions of sub-anaesthetic doses of ketamine or a comparator drug (Midazolam) along with ECT and their antidepressant treatment as usual. Depending on the results of the pilot trial, the aim is to run a large trial to determine whether ketamine as an adjunctive therapy, alongside ECT and routine care, will help accelerate recovery in patients with severe depression admitted to hospital.

AMBER-Dep

Meanwhile, recruitment for the AMBER-Dep (Autobiographical Memory and Depression) study has now finished, and participants are engaging in follow-up assessments with the Research Department. This study aims to investigate the effects of depression on autobiographical memory, the type of memory that refers to one’s personal life memories acquired in the past. It is well-recognised that autobiographical memory begins to fade with time and age; it is not clear, however, to what extent this loss differs between healthy and depressed people. Furthermore, it is not well-understood how treatments used for depression affect memory. In the AMBER-Dep study, three groups of participants were compared on clinical measures of mood and memory over the course of four months: healthy participants (a measure of the effect of time on memory), depressed participants not receiving ECT (a measure of the effect of low mood on memory) and depressed participants receiving ECT (a measure of the effect of ECT on memory). The results of this study will improve our understanding of memory, depression and ECT and will help advances in the treatment for severe depression.

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