Advertisement

Ketamine and Sleep: Bridging the Gap in the Treatment of Depressive Illness

  • Peter T. Morgan
    Correspondence
    Address correspondence to Peter T. Morgan, M.D., Ph.D., 365 Montauk Avenue, New London, CT 06320. .
    Affiliations
    Department of Psychiatry, Lawrence and Memorial Healthcare, New London

    Department of Psychiatry, Yale University, New Haven, Connecticut
    Search for articles by this author
      Two articles that provide the first clear evidence for a connection between the rapid antidepressant effects of ketamine and sleep appear in this issue of Biological Psychiatry (
      • Duncan Jr, W.C.
      • Slonena E.
      • Hejazi N.S.
      • Brutsche N.
      • Yu K.C.
      • Park L.
      • et al.
      Motor-activity markers of circadian timekeeping are related to ketamine’s rapid antidepressant properties.
      ,
      • Orozco-Solis R.
      • Montellier E.
      • Aguilar-Amal L.
      • Sato S.
      • Vawter M.P.
      • Bunney B.G.
      • et al.
      A circadian genomic signature common to ketamine and sleep deprivation in the anterior cingulate cortex.
      ). These articles are timely considering the explosion of interest in providing ketamine treatment for depression, and for the fast-growing knowledge base connecting circadian rhythm to depression and other psychiatric illnesses. These articles are also important because of their relation to a fundamental problem in the understanding and treatment of depressive illness more generally. This problem (which continues despite billions spent on the development of new pharmacotherapies) is the long delay between initiation of treatment and significant improvement in the illness. This apparent requirement for an incubation of treatment before achieving meaningful benefit distinguishes psychiatric disorders in general, and depressive disorders in particular, from diseases that are not brain related.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Biological Psychiatry
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Duncan Jr, W.C.
        • Slonena E.
        • Hejazi N.S.
        • Brutsche N.
        • Yu K.C.
        • Park L.
        • et al.
        Motor-activity markers of circadian timekeeping are related to ketamine’s rapid antidepressant properties.
        Biol Psychiatry. 2017; 82: 361-369
        • Orozco-Solis R.
        • Montellier E.
        • Aguilar-Amal L.
        • Sato S.
        • Vawter M.P.
        • Bunney B.G.
        • et al.
        A circadian genomic signature common to ketamine and sleep deprivation in the anterior cingulate cortex.
        Biol Psychiatry. 2017; 82: 351-360
        • Das G.
        Cocaine abuse in North America: A milestone in history.
        J Clin Pharmacol. 1993; 33: 296-310
        • Morgan C.J.
        • Curran H.V.
        • Independent Scientific Committee on Drugs
        Ketamine use: A review.
        Addiction. 2012; 107: 27-38
        • Morgan P.T.
        • Angarita G.A.
        • Canavan S.
        • Pittman B.
        • Oberleitner L.
        • Malison R.T.
        • et al.
        Modafinil and sleep architecture in an inpatient-outpatient treatment study of cocaine dependence.
        Drug Alcohol Depend. 2016; 160: 49-56
        • Veterans Administration Cooperative Study Group on Antihypertensive Agents
        Time course of antihypertensive effect of low-dose captopril in mild to moderate hypertension.
        Clin Pharmacol Ther. 1984; 36: 307-314
        • Wu J.C.
        • Bunney W.E.
        The biological basis of an antidepressant response to sleep deprivation and relapse: Review and hypothesis.
        Am J Psychiatry. 1990; 147: 14-21
        • Zarate C.A.
        • Singh J.B.
        • Carlson P.J.
        • Brutsche N.E.
        • Ameli R.
        • Luckenbaugh D.A.
        • et al.
        A randomized trial of an N-methyl-D-aspartate antagonist in treatment-resistant major depression.
        Arch Gen Psychiatry. 2006; 63: 856-864
        • Webb J.
        • Clark T.J.
        • Chilvers C.
        Time course of response to prednisolone in chronic airflow obstruction.
        Thorax. 1981; 36: 18-21
        • Nierenberg A.A.
        • Farabaugh A.H.
        • Alpert J.E.
        • Gordon J.
        • Worthington J.J.
        • Rosenbaum J.F.
        • Fava M.
        Timing of onset of antidepressant response with fluoxetine treatment.
        Am J Psychiatry. 2000; 157: 1423-1428

      Linked Article

      • A Circadian Genomic Signature Common to Ketamine and Sleep Deprivation in the Anterior Cingulate Cortex
        Biological PsychiatryVol. 82Issue 5
        • Preview
          Conventional antidepressants usually require several weeks to achieve a full clinical response in patients with major depressive disorder, an illness associated with dysregulated circadian rhythms and a high incidence of suicidality. Two rapid-acting antidepressant strategies, low-dose ketamine (KT) and sleep deprivation (SD) therapies, dramatically reduce depressive symptoms within 24 hours in a subset of major depressive disorder patients. However, it is unknown whether they exert their actions through shared regulatory mechanisms.
        • Full-Text
        • PDF
      • Motor-Activity Markers of Circadian Timekeeping Are Related to Ketamine’s Rapid Antidepressant Properties
        Biological PsychiatryVol. 82Issue 5
        • Preview
          The rapid clinical antidepressant effects of the glutamatergic modulator ketamine may be due to its ability to restore synaptic plasticity and related effects on sleep-wake and circadian systems. Preclinical studies indicate that ketamine alters expression of circadian clock–associated molecules, and clinical studies of ketamine on plasticity-related biomarkers further suggest an association with sleep slow waves and sleep homeostasis.
        • Full-Text
        • PDF