Medical student Katherine Keith leads published study on intravenous ketamine as therapy for patients with depression – School of Medicine News

A student at Wayne State University School of Medicine was the principal investigator of a study that examined whether a patient’s vital signs while receiving intravenous ketamine could predict its effectiveness in treating major depressive disorder and bipolar depression.

Katherine Keith is a third year medical student at Wayne State University School of Medicine.

Katherine Keith, now in her third year of medical school, launched the retrospective study a few months before she was hired. She completed the work in her preclinical years.

“Vital Sign Changes During Intravenous Ketamine Infusions for Depression: An Exploratory Study of Prognostic Indications,” is published in the Journal of Clinical Psychopharmacology.

Ketamine is a drug mainly used for induction and maintenance of anesthesia. It induces a trance-like state and provides pain relief, sedation and amnesia. Among recreational users, it is also referred to as “Special K”.

“I am interested in ketamine research because much of its mechanism of action as an antidepressant is unknown. I was motivated by the prospect of identifying objective findings, such as vital signs, that could be used as predictors of response to ketamine and ultimately guide clinical practice,” Keith said.

She led the study with support from faculty in the Department of Psychiatry and Behavioral Neuroscience, including Nicholas Mischel, MD, Ph.D., an assistant professor and director of Interventional Psychiatry and Neuromodulation Research.

Nicholas Mischel, MD, Ph.D.

Rapid-acting drug infusions for treatment-resistant depression are a new modality. These treatments have acute physiological effects and are delivered in the office or hospital setting. Subanesthetic doses of ketamine have physiological effects on the cardiovascular system and antidepressant effects on neurobehavioral systems, but the relationship between these two phenomena is unknown,” said Dr. Michele.

The department treats patients with esketamine infusions, a derivative of generic ketamine, at its clinic in the WSU Tolan Park Medical Building in Detroit. dr. Mischel treats patients with the same IV in collaboration with Greenbrook Neurohealth, a network of outpatient clinics.

In the spring of 2020, Keith completed her master’s degree at Wayne State and worked at Michigan Progressive Health, a Royal Oak outpatient clinic that also offered ketamine therapy to patients with mood disorders.

“Dr. Mischel came to the clinic to meet with Dr. Megan Oxley, the medical director, and during this meeting we discussed the possibilities for research. I let Dr. Mischel know that I was a graduate student at WSU and interested in starting a project with him. It’s gone from there,” she said.

The study population was from the clinic, where treatments are led by Dr. Oxley, a WSU alumna and 2009 co-author. More than half of the study group — 51.7% — responded to treatment, according to the Patient Health Questionnaire. The same group showed a significantly greater increase in systolic blood pressure response during the first infusion compared to those who did not respond to treatment.

“I was surprised to see a marked difference in the response to vital signs between the groups of patients who had an antidepressant effect and those who did not,” said Dr. Michele.

No difference was seen in diastolic pressure, heart rate or velocity pressure product during the first treatment or after.

“Although the study population was relatively large, it is still challenging to resolve differences in physiological responses, even real ones, especially when measuring blood pressure in a clinical setting rather than in highly controlled laboratory settings,” he added. .

Since obtaining it from the US Food and Drug Administration in 2019, ketamine and related infusion therapies have been increasingly used. Treatments involving rapid-acting psychopharmacological agents in combination with psychotherapy are an active area of ​​current research, with agents such as MDMA — known recreationally as ecstasy or molly — being investigated for use to facilitate the treatment of post-traumatic stress disorder, according to a May 2021 article published. in Nature Medicine.

Keith led and conducted much of the work, including data acquisition, analysis, and writing. In addition to Drs. Mischel and Oxley, the research team included Jamarie Gellar, MD, a resident psychiatrist at the University of Michigan; Alexis Froelich, a medical student at WSU; and Cynthia Arfken, Ph.D., a WSU professor of psychiatry and behavioral neuroscience.

A follow-up study on the hemodynamic response to esketamine infusion in relation to neurobehavioral effects is now underway. The study is expected to provide data collected in a controlled laboratory setting with detailed non-invasive measurements of cardiac output.

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