Brain-based correlates of antidepressant response to ketamine: a comprehensive systematic review of neuroimaging studies
Open accessAbstract
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].”
From Synaptic Plasticity—Intrinsic Excitability and Antidepressant Discovery (2026) · cites this paper as [92]
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Synaptic Plasticity—Intrinsic Excitability and Antidepressant Discovery
Tanaka, M. (2026) · Biomedicines · doi:10.3390/biomedicines14061265
- 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
- ORCID
- Venue
- The Lancet Psychiatry
- Publisher
- Elsevier BV
- Published
- 2023-10
- Volume
- 10
- Issue
- 10
- Pages
- 790-800
- ISSN
- 2215-0366 (ISSN-L)
- PMC
- PMC11534374
- 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
- green
- www.ncbi.nlm.nih.gov
- Licence
- 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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