Safety and Efficacy of Repeated-Dose Intravenous Ketamine for Treatment-Resistant Depression

This form allows you to add a document from your local machine or a link to an article on the Internet. It is helpful to cut and paste a snippet from the article into the document excerpt field.


Open file
Related website link http://www.biologicalpsychiatryjournal.com/article/S0006-3223(09)01097-X/pdf
Description
Abstract Background:
A single subanesthetic (intravenous) IV dose of ketamine might have rapid but transient antidepressant effects in patients with treatment-resistant depression (TRD). Here we tested the tolerability, safety, and efficacy of repeated-dose open-label IV ketamine (six infusions over 12 days) in 10 medication-free symptomatic patients with TRD who had previously shown a meaningful antidepressant response to a single dose.

Methods:
On day 1, patients received a 40-min IV infusion of ketamine (.5 mg/kg) in an inpatient setting with continuous vital-sign monitoring. Psychotomimetic effects and adverse events were recorded repeatedly. The primary efficacy measure was change from baseline in the Montgomery-Åsberg Depression Rating Scale (MADRS) score. If patients showed a 50% reduction in MADRS scores on day 2, they received five additional infusions on an outpatient basis(days 3, 5, 8, 10, and 12). Follow-up visits were conducted twice-weeklyfor 4 weeks or until relapse.

Results:
Ketamine elicited minimal positive psychotic symptoms. Three patients experienced significant but transient dissociative symptoms. Side effects during and after each ketamine infusion were generally mild. The response criterion was met by nine patients after the first infusion as well as after the sixth infusion. The mean (SD) reduction in MADRS scores after the sixth infusion was 85% (12%). Postketamine, eight of nine patients relapsed, on average, 19 days after the sixth infusion (range 6 days– 45 days). One patient remained antidepressant-free with minimal depressive symptoms for 3 months.

Conclusions:
These pilot findings suggest feasibility of repeated-dose IV ketamine for the acute treatment of TRD
Unless otherwise stated, the content of this page is licensed under Creative Commons Attribution-ShareAlike 3.0 License