A prospective open-label study to evaluate the effectiveness of intravenous ketamine as an adjunct in treating severe depression

Abstract

Background Ketamine, an emerging pharmacotherapeutic agent for depression, has demonstrated rapid and substantial improvement in mood and suicidal ideation, particularly in severe cases. While previous studies have established its efficacy, the current study aims to delve into the effectiveness of intravenous ketamine in treating severe depression. Methods An open-label prospective study enrolled 49 consecutive patients with severe depression. Baseline assessments using the Hamilton Depression Rating Scale (HAMD), Montgomery-Asberg Depression Rating Scale (MADRS), and Modified Scale for Suicidal Ideation (MSSI) were conducted. Intravenous (IV) ketamine, administered at 0.5 mg/kg in 100-ml normal saline over 40 min, was given during sessions spaced on alternate days. Each patient received at least five sessions alongside their regular antidepressants. Close monitoring occurred during the infusion, and disease rating scale scores were recorded. Data was analyzed; employed paired Student t-test and graphical were used for visual clarity. Results Following the initiation of IV ketamine, a significant reduction in scores was observed from baseline. Response rates were achieved in over half of the patients by the third session and in nearly all by the end of fifth session. Remission rates were attained in nearly half of the patients by the fourth session and in almost all by the fifth session. Conclusions IV ketamine could be considered as an adjunct to antidepressants in treating severe depression especially among those with suicidal ideations to obtain rapid improvement. However, the need for long-term studies is emphasized to determine the duration of its effect.