At-home, sublingual ketamine telehealth is a safe and effective treatment for moderate to severe anxiety and depression: Findings from a large, prospective, open-label effectiveness trial

Hull, Thomas D.; Malgaroli, Matteo; Gazzaley, Adam; Akiki, Teddy J.; Madan, Alok; Vando, Leonardo; Arden, Kristin; Swain, Jack; Klotz, Madeline; Paleos, Casey

doi:10.1016/j.jad.2022.07.004

Cited by 29 publications

(11 citation statements)

References 68 publications

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“…Por outro lado, confere-se ao efeito dissociativo da cetamina os rápidos e satisfatórios resultados sobre os sintomas. (Hull et al, 2022), a qual pode variar conforme o esquema terapêutico proposto. A administração de uma única dose de 0,5mg/kg de cetamina diluída em solução salina a 0,9% em via endovenosa atinge seu efeito antidepressivo máximo em até 24 horas após a infusão, quando é possível verificar, ainda que não majoritariamente, redução pontuação na EDMA em até 50% do valor pré-teste.…”

Section: Resultsunclassified

Potencial terapêutico da cetamina em transtornos depressivos

Mendes

Bezerra²,

Piauilino

et al. 2023

RSD

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Introdução: Um terço dos indivíduos que convivem com transtorno depressivo maior não respondem ao tratamento à base de antidepressivos. A ideação suicida é um agravante frequentemente presente e que é possivelmente letal se não abordado. O difícil controle da ampla sintomatologia relacionada à depressão em determinados pacientes demonstra a necessidade de novas e eficientes estratégias terapêuticas. Verificou-se que a cetamina, apresenta resultados antidepressivos quando administrada em doses subanestésicas. Este trabalho tem como objetivo verificar o potencial antidepressivo da cetamina sobre o transtorno depressivo maior e transtorno depressivo resistente nas produções científicas publicadas entre 2017 a 2022. Metodologia: Trata-se de uma revisão integrativa da literatura. Após busca na base de dados Biblioteca Virtual em Saúde, foram encontradas 100 publicações, mas apenas12 artigos atendiam aos critérios de inclusão. Resultados e discussão: Indica-se como causa da rápida atenuação dos sintomas depressivos o bloqueio dos receptores NDMA promovido pela cetamina, que restabelece a dinâmica sináptica de algumas vias glutamatérgicas desajustadas nos transtornos depressivos, restaura a atividade neural de importantes circuitos relacionados ao stress, à resiliência e à regulação do humor, essencialmente modulando a função de controle cognitivo emocional. Além disso, atua regulando reações imunoinflamatórias disfuncionais envolvidas na fisiopatologia da depressão. Conclusão: A utilização da cetamina para tratamento de transtorno depressivo maior e transtorno depressivo resistente tem demonstrado resultados relevantes que a elencam como forte candidata para compor o arsenal adotado por guidelines internacionais.

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Section: Resultsunclassified

Potencial terapêutico da cetamina em transtornos depressivos

Mendes

Bezerra²,

Piauilino

et al. 2023

RSD

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“…Our rapid dissolving tablets dissolve in 1–2 min. One product supported study found a median absorption of 29% of the administered dose ( 55 ), with another 17–27% ( 56 ). Our estimate is of a 15–30% absorption over the duration of exposure.…”

Section: Methodsmentioning

confidence: 99%

Ketamine-assisted psychotherapy in adolescents with multiple psychiatric diagnoses

Wolfson¹,

Andries²,

Ahlers³

et al. 2023

Front. Psychiatry

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Ketamine-assisted psychotherapy is a promising new treatment for a variety of mental disorders of adolescence. There is currently an adolescent mental health crisis, with a high prevalence of disorders, diagnostic complexity, and many adolescents failing to respond to conventional treatments. While there is strong evidence for the use of ketamine in adults for a variety of treatment-refractory mental illnesses, research in adolescents is in its early stages. Ketamine-assisted psychotherapy (KAP) has been described in adults with promising results and here we present the first published cases of the use of KAP in adolescents. The four cases include adolescents aged 14–19 at the initiation of treatment, each with a variety of comorbid diagnoses including treatment-resistant depression, bipolar disorder, eating disorders, anxiety, panic, and trauma-related symptoms. They each initially received sublingual ketamine, followed by sessions with intramuscular ketamine. Their courses varied, but each had symptomatic and functional improvements, and the treatment was well-tolerated. Subjective patient reports are included. Rapid resolution of symptomatology and suffering often occurs within months as the result of the application of KAP to adolescent psychiatric care but is not inevitable. Family involvement in the treatment process appears to be essential to success. The development of this modality may have a singularly positive impact that will expand the psychiatric toolbox and its healing potency.

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“…Specifically, oral ketamine has been shown to undergo extensive first-pass metabolism and consequently has approximately 10–20% bioavailability, while SL ketamine has a bioavailability of approximately 30% ( 42 , 43 ), a fact which must be taken into account when designing outpatient oral or SL ketamine treatment regimens. A recently published manuscript has reported similar effectiveness and safety of at-home SL ketamine using a prospective study design ( 44 ). The authors found that SL ketamine (three treatments with doses ranging 300–450 mg/kg) in combination with telehealth produced approximately 60% reduction in PHQ-9 and GAD scores at the 4-weeks timepoint compared to baseline scores, roughly comparable with our study.…”

Section: Introductionmentioning

confidence: 90%

Safety, effectiveness and tolerability of sublingual ketamine in depression and anxiety: A retrospective study of off-label, at-home use

Hassan¹,

Struthers

Sankarabhotla³

et al. 2022

Front. Psychiatry

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Intravenous and intranasal ketamine have been shown to be effective therapeutic options in patients suffering from treatment-resistant depression (TRD). The use of sublingual (SL), rapid dissolve ketamine tablets (RDT) offers a novel approach for delivery for mental health indications. This study assessed the effectiveness and safety of self-administration of off-label, SL, rapid dissolve ketamine tablets (RDT) at-home for depression and anxiety. Intake scores on the Generalized Anxiety Disorder Screener (GAD-7) and Patient Health Questionnaire (PHQ-9) were compared to scores after treatments of three doses of ketamine RDT, and after six doses of ketamine RDT. After three doses of SL ketamine, 47.6% of patients showed a significant decrease in PHQ-9 scores, and 47.6% of patients showed a significant reduction in GAD-7 scores. Reduction rates were higher in those patients who completed a clinically recommended six doses of RDT ketamine. This study demonstrates that SL ketamine is a novel, safe, and effective treatment for TRD and treatment-resistant anxiety. SL ketamine offers an alternative therapeutic approach to IV ketamine when treating those with TRD.

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At-home, sublingual ketamine telehealth is a safe and effective treatment for moderate to severe anxiety and depression: Findings from a large, prospective, open-label effectiveness trial

Cited by 29 publications

References 68 publications

Potencial terapêutico da cetamina em transtornos depressivos

Potencial terapêutico da cetamina em transtornos depressivos

Ketamine-assisted psychotherapy in adolescents with multiple psychiatric diagnoses

Safety, effectiveness and tolerability of sublingual ketamine in depression and anxiety: A retrospective study of off-label, at-home use

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