Research Article

Concomitant BDNF and sleep slow wave changes indicate ketamine-induced plasticity in major depressive disorder

Wallace C. Duncan Jr^a1 *, Simone Sarasso^a2 *, Fabio Ferrarelli^a2, Jessica Selter^a1, Brady A. Riedner^a2, Nadia S. Hejazi^a1, Peixiong Yuan^a3, Nancy Brutsche^a1, Husseini K. Manji^a4, Giulio Tononi^a2 and Carlos A. Zarate Jr^a1 c1

^a1 Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA

^a2 Department of Psychiatry, University of Wisconsin, Madison, Wisconsin, USA

^a3 Clinical Brain Disorders Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA

^a4 Johnson and Johnson Pharmaceutical Research and Development, Titusville, NJ, USA

Abstract

The N-methyl-d-aspartate (NMDA) receptor antagonist ketamine has rapid antidepressant effects in treatment-resistant major depressive disorder (MDD). In rats, ketamine selectively increased electroencephalogram (EEG) slow wave activity (SWA) during non-rapid eye movement (REM) sleep and altered central brain-derived neurotrophic factor (BDNF) expression. Taken together, these findings suggest that higher SWA and BDNF levels may respectively represent electrophysiological and molecular correlates of mood improvement following ketamine treatment. This study investigated the acute effects of a single ketamine infusion on depressive symptoms, EEG SWA, individual slow wave parameters (surrogate markers of central synaptic plasticity) and plasma BDNF (a peripheral marker of plasticity) in 30 patients with treatment-resistant MDD. Montgomery–Åsberg Depression Rating Scale scores rapidly decreased following ketamine. Compared to baseline, BDNF levels and early sleep SWA (during the first non-REM episode) increased after ketamine. The occurrence of high amplitude waves increased during early sleep, accompanied by an increase in slow wave slope, consistent with increased synaptic strength. Changes in BDNF levels were proportional to changes in EEG parameters. Intriguingly, this link was present only in patients who responded to ketamine treatment, suggesting that enhanced synaptic plasticity – as reflected by increased SWA, individual slow wave parameters and plasma BDNF – is part of the physiological mechanism underlying the rapid antidepressant effects of NMDA antagonists. Further studies are required to confirm the link found here between behavioural and synaptic changes, as well as to test the reliability of these central and peripheral biomarkers of rapid antidepressant response.

(Received February 09 2012)

(Reviewed March 21 2012)

(Revised March 30 2012)

(Accepted April 19 2012)

(Online publication June 07 2012)

Key words

• biomarker;
• brain derived neurotrophic factor;
• major depressive disorder;
• N-methyl-d-aspartate receptor;
• sleep slow wave activity

Correspondence:

^c1 Address for correspondence: Dr C. A. Zarate Jr. 10 Center Dr. CRC, Unit 7 Southeast, Room 7-3445, Bethesda, Maryland 20892, USA. Tel.: (301) 451-0861 Fax: (301) 402-9360 Email: zaratec@mail.nih.gov

Footnotes

^*  These authors contributed equally to this work.