Pharmacogenetics Associated With IV Ketamine

Study Overview
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Brief Summary
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The Canadian Rapid Treatment Center of Excellence (CRTCE) is a healthcare facility principally focused on providing best practices of intravenous ketamine treatment to adult patients suffering from treatment resistant depression. Patients who have received IV ketamine at the clinic are eligible to participate in this study where genetic biomarkers are correlated with response to IV ketamine.

Official Title
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Genetic Markers Associated With Response to Intravenous Ketamine

Conditions
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Treatment Resistant Depression

Intervention / Treatment
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* Genetic: Saliva Genetic Samples


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Must have received IV ketamine previously to treat Treatment-Resistant Depression Between the ages of 18-65 years old. Clinical diagnosis of MDD Individuals may have had comorbid psychiatric conditions (e.g., anxiety), but the comorbid psychiatric condition cannot be the primary clinical concern. Ability to provide informed consent Exclusion Criteria: Individuals who meet DSM 5 criteria for a substance use and/or alcohol use disorder in the past 3 months. Individuals who are currently experiencing psychotic symptoms as part of an MDE (mood congruent/mood incongruent). Individuals who are unable to consent to the procedure. Individuals who are unable to adhere to the protocol in its totality

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Treatment-Resistant Depression<br>Patients, who previously received intravenous ketamine, will be asked to provide genetic samples in order to assess relationships between response and genetic markers. | Genetic: Saliva Genetic Samples<br>* Patients will provide two saliva swabs containing genetic materials.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Genetic Biomarkers | Genetic markers associated with metabolism of IV ketamine will be assessed | 1 month | 
| Quick Inventory of Depressive Symptomatology Self Report 16-Item | The QIDS-SR16 is a self-report assessment used to evaluate depression severity in patients with a Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, diagnosis of Major Depressive Episode. In total, there are 16 individual questions evaluating 9 DSM domains. The highest score is 27, indicating severe depression, while the lowest score is 0, which would suggest a complete absence of depressive symptoms. | Over 1-2 weeks | 
| Generalized Anxiety Disorder 7-item | The GAD-7 is a 7 item self-report assessment used to evaluate symptoms of anxiety. The scale ranges from 0 (not at all) to 3 (nearly every day). To total score ranges from 0 suggesting a lack anxiety symptoms to 21, indicating severe anxiety. | Over 1-2 weeks | 
| Snaith-Hamilton Pleasure Scale | The SHAPS assessment is a 14 item self report tool used to measure anhedonia. Each item can be have a response of 1 (Definitely agree), 2(Agree), 3(Disagree), and 4(definitely disagree). The total score ranges from 14 to 56, in which higher scores on the assessment indicate higher levels of anhedonia. | Over 1-2 weeks | 
| Sheehan Disability Scale | The SDS contains 3 items, each ranging between zero to ten. The SDS is a self-reported assessment of disability within the context of depression. The total score ranges from 0, indicating no impairment, to 30, indicating severe impairment. | Over 4 initial infusions | 
| Clinician Administered Dissociative States Scale | The CADSS is a 23-item assessment administered by a clinician in order to evaluate dissociative symptoms. Each item is evaluated on a scale from 0, suggesting no dissociative symptom, to 4, suggesting extreme dissociation. In total, patients can score between 0 to 92, indicating extreme dissociation. | Over 1-2 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Work Productivity and Activity Impairment Questionnaire (WPAI) | WPAI is a questionnaire used to evaluate lost productivity due to depression. scores are presented as percentages (multiplying the scores by 100), with 0% representing no impact on productivity and 100% representing complete impact on productivity. | 1 month | 
| Mystical Experience Questionnaire (MEQ) | Mystical Experience Questionnaire (MEQ) is a self-report measure that has been used to assess the effects of hallucinogens in laboratory studies. Some studies suggest that mysticism may be associated with a response to ketamine. The MEQ is a 30 item questionnaire, with each item ranging from 0 to 5. A higher score denotes a strong mystical experience. | 1 month | 
| Childhood Trauma Questionnaire (CTQ) | The CTQ assesses five types of childhood trauma: 1)Emotional neglect 2) physical abuse 3) emotional abuse 4)physical neglect 5) sexual abuse. Each item being rated in 5 answer choice from 1 to 5 (never, rarely, sometimes, often or very often) | 1 month | 
| UCLA Loneliness Scale (UCLA) | 20 item Self report scale measuring loneliness. Scales range from 0 to 60 with higher scores indicating a higher level of loneliness. | 1 month | 
| Diet Screener Questionnaire | Captures data regarding an individuals dietary habits over the past month | 1 month | 
| Quality of Life Questionnaire (EQ-3D-5L) | EQ-5D-5L measures health outcome self-completed by respondents. It consists of EQ-5D-5L descriptive system and EQ visual analogue scale (EQ-VAS). The descriptive system comprises of 5 dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Each has 5 levels (1-no problem, 2-slight problems, 3-moderate problems, 4-severe problems, 5-extreme problems). The responses are used to generate Health Status Index (HSI). HSI range is -0.148 to 0.949, is anchored at 0 (dead) and 1 (full health). | 1 month | 
| Perceived Health Questionnaire (PHQ) | PHQ-9 is 9-item, self-reported scale assessing 9 symptom domains of Diagnostic and Statistical Manual of Mental Disorders, Major Depressive Disorder criteria. Each item is rated on 4-point scale (0 = Not at all, 1 = Several Days, 2 = More than half days, 3 = Nearly every day). The scores are summed for a total score ranging from 0-27. Higher score indicates greater severity of depression. Severity of PHQ-9 categorized as follows: None-minimal (0-4), Mild (5-9), Moderate (10-14), Moderately Severe (15-19), Severe (20-27). The recall period is 2 weeks. | 1 month |