A systematic review of ketamine for the treatment of depression among older adults

Abstract

Objective: To review the currently available data on the use of ketamine in the treatment of depression among older adults from randomized controlled studies. Design: Randomized controlled trials. Setting: Variable. Participants: 60 years and older with depression. Intervention: Ketamine. Measurements: Change in Montgomery–Asberg Depression Rating Scale (MADRS) scores. Results: Two studies met the inclusion criteria. The first study showed a significant reduction in depression symptoms with use of repeated subcutaneous ketamine administration among older adults with depression. The second study failed to achieve significance on its primary outcome measure but did show a decrease in MADRS scores with intranasal ketamine along with a higher response and remission rates in esketamine group compared with the placebo group. The adverse effects from ketamine generally lasted only a few hours and abated spontaneously. No cognitive adverse effects were noted in either trial from the use of ketamine. Conclusions: The current evidence for use of ketamine among older adults with depression indicates some benefits with one positive and one negative trial. Although one of the trials did not achieve significance on the primary outcome measure, it still showed benefit of ketamine in reducing depressive symptoms. Ketamine was well tolerated in both studies with adverse effects being mild and transient.

Anxiety Screening

“…None of the RCTs or existing systematic reviews of psychological treatment reported on adverse events, but there was no pattern of effects indicating an elevated risk of harm. For the harms of pharmacologic treatment, 3 RCTs (eTable 9 in the Supplement) and 8 existing systematic reviews addressing medications other than antidepressants (eTable 11 in the Supplement) were included . Harms of antidepressants are addressed in a separate publication .…”

“…Twenty-six trials (reported in 36 publications) among primary care patients (eTables 8-9 in the Supplement) and 18 existing systematic reviews (not limited to primary care populations) (eTables 10-11 in the Supplement) addressed treatment for anxiety. Twenty-four of the included RCTs (n = 5307) examined psychological interventions and 2 (n = 423) examined pharmacological interventions.…”

A case of treatment-resistant depression in an older adult and a discussion of treatment options

“…Despite this, with specialist assessment, this remains a viable treatment option. Others: there are several other possible treatment options that are either currently available or being investigated. These include transcranial magnetic stimulation, 23 ketamine, esketamine, 24 bupropion augmentation 25 (listed among first-line choices by the Maudsley prescribing guidelines 9 ), thyroid hormone, 26 deep brain stimulation, 27 vagus nerve stimulation, 28 psilocybin 29 and anti-inflammatories. 30 …”

The role of ketamine in the treatment of treatment-resistant bipolar depression

“…41 Όσον αφορά ασθενείς με κατάθλιψη με ηλικία μεγαλύτερη των 60 ετών φαίνεται πως η θεραπεία με κεταμίνη έχει συγκρίσιμη αποτελεσματικότητα με την αντίστοιχη του γενικού πληθυσμού, είναι καλά ανεκτή και οι αναμενόμενες ανεπιθύμητες ενέργειες ήπιες και παροδικές, ωστόσο το συμπέρασμα αυτό βασίζεται ακόμη σε μικρό αριθμό μελετών οι οποίες μάλιστα δεν είναι σχεδιασμένες αποκλειστικά για εκτίμηση ασθενών με ΔΚ. 42 Επαναλαμβανόμενες IV χορηγήσεις σε ασθενείς ηλικίας ίση ή μεγαλύτερη των 60 ετών με ανθεκτική στη θεραπεία κατάθλιψη συσχετίστηκαν με παροδική αλλά απαιτούσα επείγουσα αντιμετώπιση αρτηριακή υπέρταση (ΑΥ), ενώ η συχνότερη ανεπιθύμητη ενέργεια σε αυτήν την ηλικιακή ομάδα φαίνεται να είναι η υπνηλία. 43 Ανεπιθύμητες ενέργειες της κεταμίνης Από το φάσμα των ανεπιθύμητων ενεργειών της κεταμίνης ιδιαίτερες ανησυχίες έχουν ανακύψει αναφορικά με τον κίνδυνο κατάχρησης-εξάρτησης, τα αποσυνδετικά συμπτώματα καθώς και τον δυνητικό κίνδυνο τοξικής νευρωνικής διέγερσης με επακόλουθη νευρωνική βλάβη κατά τη χορήγηση υψηλότερων δόσεων σε επαναληπτική βάση.…”