Cited by 49Treatment of Major DepressionElectroconvulsive Therapy StudiesTranscranial Magnetic Stimulation Studies

Brain-based correlates of antidepressant response to ketamine: a comprehensive systematic review of neuroimaging studies

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Medeiros, Gustavo C, Matheson, Malcolm, Demo, Isabella, Reid, Matthew J, Matheson, Sharaya, Twose, Claire, Smith, Gwenn S, Gould, Todd D +3 more·2023·The Lancet Psychiatry

Abstract

Ketamine is an effective antidepressant, but there is substantial variability in patient response and the precise mechanism of action is unclear. Neuroimaging can provide predictive and mechanistic insights, but findings are limited by small sample sizes. This systematic review covers neuroimaging studies investigating baseline (pre-treatment) and longitudinal (post-treatment) biomarkers of responses to ketamine. All modalities were included. We performed searches of five electronic databases (from inception to April 26, 2022). 69 studies were included (with 1751 participants). There was substantial methodological heterogeneity and no well replicated biomarker. However, we found convergence across some significant results, particularly in longitudinal biomarkers. Response to ketamine was associated with post-treatment increases in gamma power in frontoparietal regions in electrophysiological studies, post-treatment increases in functional connectivity within the prefrontal cortex, and post-treatment increases in the functional activation of the striatum. Although a well replicated neuroimaging biomarker of ketamine response was not identified, there are biomarkers that warrant further investigation.

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  • Clinical response to ketamine/esketamine is highly heterogeneous, and robust predictors are lacking.

    “Clinical response is highly heterogeneous, and robust predictors are lacking, underscoring the need for biomarkers and stratified treatment strategies [85,91,92,93].”

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Authors
Medeiros, G. C., Matheson, M., Demo, I., Reid, M. J., Matheson, S., Twose, C., Smith, G. S., Gould, T. D., Zarate, C. A., Barrett, F. S., & Goes, F. S.
Affiliations
  • University of Maryland, Baltimore (US)
  • Johns Hopkins University (US)
  • National Institutes of Health (US)
Corresponding author
Goes, Fernando S
Venue
The Lancet Psychiatry
Publisher
Elsevier BV
Published
2023-10
Volume
10
Issue
10
Pages
790-800
ISSN
2215-0366 (ISSN-L)
OpenAlex
W4386054271
Cited by
49
References
17
Citations by year
2026: 22 · 2025: 16 · 2024: 10 · 2023: 1
FWCI
1.65
Type
journal article
Language
en
Open access
Locations
  • The Lancet Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (R01-MH107615, RAI145211A)
  • National Institute of Mental Health (ZIAMH002857)
  • U.S. Department of Veterans Affairs (101BX003631-01A1, 1I01BX004062)
Topics
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
  • Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
Keywords
ketamine, antidepressant response, treatment response biomarkers, depression, neuroimaging biomarkers, gamma power, frontoparietal cortex, functional connectivity, prefrontal cortex, striatum, treatment-resistant depression
MeSH terms
Antidepressive Agents, Brain, Humans, Ketamine, Biomarkers, Neuroimaging

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