A rapid positive influence of S-ketamine on the anxiety of patients in palliative care: a retrospective pilot study

Abstract

Background: Patients in palliative care need rapid-acting pharmacological options for psychological distress. Nmethyl-D-aspartate antagonist ketamine is known to have a fast onset of anti-depressant and anxiolytic action. Its Senantiomer S-ketamine (or esketamine) is an analgesic used as a routine treatment for refractory pain as an intravenous infusion (0.25 mg/kg over 45 min). This study investigates whether S-ketamine pain therapy has a positive impact on psychological distress caused by anxiety and depression in palliative care. Methods: Patient routine data from a palliative care unit of a tertiary care hospital were used in a retrospective analysis after positive ethics approval. Eight patients, who received analgesic S-ketamine treatment, were compared to a control group matched by gender and age. The main analysis was conducted using three-way mixed MANOVA followed by two-way mixed ANOVA. Target variables were the values for anxiety and depression in the state-trait anxiety-depression inventory STADI. The predictor variables were the time of measurement before (T1) and after (T2) S-ketamine application and group membership. Results: Comparison of the S-ketamine group (n = 8; 4 male, 4 female; average age 52 years) with the control group (n = 8; 3 male, 5 female; average age 55 years) revealed a significant multivariate effect on anxiety and depression F(1, 14) = 4.78; p = 0.046; r = 0.50. The univariate comparisons showed a significant reduction of the anxiety scores from T1 to T2 in the S-ketamine group compared to the control group F(1, 14) = 10.14; p = 0.007; r = 0.65. With regard to depression, there was no significant reduction from T1 to T2 in the group comparison F(1, 14) = 1.60; p = 0.23; r = 0.32. No long-lasting effects on pain were found. Conclusions: Our findings show that psychological distress of patients in palliative care may improve after a single administration of S-ketamine, which mainly alleviates anxiety in those patients. Limitations of this study arise from non-randomization, retrospective analysis and low sample size. Therefore, further prospective and ideally randomized studies are necessary.

A meta-ethnographic study of fathers’ experiences of caring for a child with a life-limiting illness

“…496 fathers were interviewed in total through a range of interviews and focus groups (not including 8 studies that did not specify number of fathers. 60 , 78 – 84 The majority of included studies interviewed both parents ( n = 41, 66%), with only 22 focusing solely on fathers’ experiences of caregiving. 1 , 3 – 5 , 23 , 24 , 27 , 71 , 75 , 77 , 85 – 95 Children’s life-limiting conditions mainly included cancer, 5 , 8 , 10 , 21 , 56 , 70 , 71 , 75 – 77 , 80 , 83 , 84 , 87 – 89 , 93 , 95 – 98 cerebral palsy, 24 , 99 cystic fibrosis 81 , 94 , …”

“… 51 If studies reported data on both parents, only findings relating to fathers’ experiences were extracted. In studies where data collection took place after the child’s death, 4 , 55 – 61 only data relating to fathers’ experiences of illness and caregiving were extracted.…”

“…Fathers experienced practical barriers to support including difficulty gaining financial support 9 , 60 , 99 and travel insurance, 72 and feeling unsupported at work. 88 There was limited flexibility to take time off work, which reduced opportunities to engage in caregiving or support wives.…”

The effectiveness of intravenous ketamine in adults with treatment-resistant major depressive disorder and bipolar disorder presenting with prominent anxiety: Results from the Canadian Rapid Treatment Center of Excellence

“…For example, it has been reported that individuals meeting the criteria for anxious depression ( n = 84) exhibited significantly higher response and remission rates with six repeated doses of IV ketamine (Wang et al, 2019). It has also been reported that IV ketamine and its enantiomer esketamine are able to significantly reduce severe anxiety symptoms after a single infusion (Falk et al, 2020; Ionescu et al, 2015; Salloum et al, 2019).…”

What should we report? Lessons learnt from the development and implementation of serious adverse event reporting procedures in non-pharmacological trials in palliative care

“…The potential for serious adverse events to occur is something that should be explicitly explored earlier in their development and conduct. For example, in the feasibility/piloting stage, one of the trial’s objectives should be to determine the type and consequences of any serious adverse events related to the intervention or study procedures prior to a definitive trial [ 41 ]. Reviews of feasibility/pilot studies, however, show that this is not always the case [ 42 , 43 ].…”