So for my one assignments this quarter of school I had to take a research article I find relevant and put it into a PowerPoint. I got an A so I’m super pumped. I found it super interesting so I’m going to break it down here.
The article is called Ketamine for Social Anxiety Disorder: A Randomized, Placebo Controlled Crossover Trial by Jerome H Taylor, Angeli Landeros-Weisenberger, Catherine Coughlin, Jillian Mulqueen, Jessica A Johnson, Daniel Gabriel, Margot O Reed, Ewgeni Jakubovski, & Michael H Bloch. It was originally published August 29, 2017. It isimportant to reference these articles because I did not do any of this research so they deserve the credit.
I started with some definitions.
Social Anxiety Disorder: marked and persistent fear of one or more social situations causing impairment and distress. Causes a negative impact on academic achievement, work productivity, social relationships, and quality of life. It is associated with development of depression, alcoholism, and cardiovascular disease.
Liebowitz Social Anxiety Scale (LSAS): an Assessment of the way social phobia affects a person’s life across a variety of situations.
Visual Analog Scale (VAS): Psychometric response scale used in conjunction with subjective characteristics or attitudes that cannot be directly measured.
Wilcxon Signed Rank Test: statistical hypothesis test used to compare two related samples, matched samples, or repeated measurements on a single sample to assess whether their population mean ranks differ.
Ketamine: Glutamate receptor in the brain, routinely used for anesthetic induction because of its dissociative properties. It also has anxiolytic effects.
Structured Clinical Interview (SCID): Semi Structured interview for making major DSM-5 diagnoses
Diagnostic and Statistical Manual of Mental Disorders (DSM-5): Manual for assessment and diagnosis of mental disorders.
The group hypothesized that ketamine as a potent N-methyl-D-aspartate receptor mechanism can be used as a treatment for social anxiety order. All this means is they think that ketamine can be used for social anxiety disorder.
The participants in the study were double blind, randomized, placebo-controlled crossover trial of 18 adults with DSM-5 Social Anxiety Disorder. They investigated the efficacy and time course of action of intravenous ketamine in the treatment of SAD.
The requirements for participation were the following: Male or female (post-menopausal, surgically sterile or negative pregnancy test at screening and agreement to utilize an established birth control including complete abstinence during the test period) between the ages of 18 and 65 years old. They must meet DSM-5 criteria for SAD by clinical interview for DSM-5 and Leibowitz Social Anxiety Score of greater than 60. Have no other lifetime DSM-5 axis I diagnosis by SCID allowed with the exception of comorbid anxiety and mood disorders. They have had stable doses of psychiatric medications for the month prior to treatment and have been on stable doses of SSRIs, SNRIs, and clomipramine for at least 2 months prior to study enrollment. Discontinue as needed anxiety medications for duration of trial. Not currently receiving cognitive behavioral therapy. They must be medically and neurologically healthy and be on no current substance use disorder diagnosis by SCID and urine toxicology screen negative for drugs of abuse.
The basis of the study was to compare the effects between intravenous ketamine at 0.5 milligrams per kilogram over 40 minutes and the saline placebo on social phobia symptoms.
The scientists were looking for a Leibovitz Social Anxiety Scale score that is greater than 35% and Visual Analog Scale reduction of 50% or more.
The participants had to meet requirements for the Diagnostic Manual of Mental Disorders for Social Anxiety Disorder to move forward in 2014 to 2016. The study was conducted at Yale University in New Haven, Connecticut. The infusions were administered in a random order with a 28 day interval in between treatments. The patient either received placebo or ketamine as original infusion followed by the opposite for the day 28 infusion.
The assessments on the patient occured as follows: Before Infusion, 3 hours post-infusion, days 1, 2, 3, 5, 7,10, and 14 post-infusion. The patients were to self report how they felt on a scale from 0 – 100 on the visual analog scale. Each patient met with a clinician who rated them on the Leibowitz Social Anxiety Scale from 0 -144 where more than 60 is moderate social anxiety and more than 90 is severe social anxiety. These tests were given at a different location than the infusion site as to not interfere with their location association. Everything was analyzed using the statistical analysis system with the version 9.4 which was the most updated version at the time.
Carryover was significantly studied to see if there was a difference in the baseline readings of all the scale tests. This was based on which infusion was given first.
The results showed that patients who had ketamine first had lower carryover rates than those who got saline first. Ketamine was seen to reduce anxiety symptoms on the Leibowitz Social Anxiety Scale by 35%. This is great however on the visual analog scale there was no change. The use of ketamine as a treatment was safe but showed some side effects like numbness, confusion, and dizziness.
Although the results showed something positive, the scientists discussed that blinding the study was hard because the patients were able to tell the difference between a saline infusion and a ketamine one. Their goal for future studies is to determine the optimal dosage for Ketamine infusion and to determine the genotype that shows greater affinity for ketamine to be used to reduce depression symptoms.
Here is a video of a person getting ketamine infusions to combat his social anxiety disorder. https://www.youtube.com/watch?v=Rux4d-32fUQ
I hope this gives you a glimpse into what I do Tuesday and Thursday nights in class!! If you like this kind of post I can keep up with them and show you what I’m learning!!
Xoxo, Z
