Intramuscular ketamine in acute depression: A report on two cases

Chilukuri, Harihar; Dasari, Padmavathy; Srinivas, Jakka Sriramulu

doi:10.4103/0019-5545.111461

Cited by 29 publications

(33 citation statements)

References 1 publication

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This resulted in depression improvement, and, after months of intramuscular administration, there was an expected side-effect profile (irritability, headaches, nightmares and dissociation) without the medical sequelae seen in ketamine abusers, for example, cystitis. A follow-up case series in two Indian patients with depression also reported rapid antidepressant efficacy to intramuscular ketamine [Harihar et al 2013]. Finally, in a small (n = 9 in each group) randomized, open-label design, a separate Indian group reported antidepressant noninferiority (up to 3 days) with 0.25 mg/kg intramuscular ketamine compared with both 0.5 mg/kg intramuscular injection and 0.5 mg/kg intravenous infusion [Chilukuri et al 2014].…”

Section: Intramuscularmentioning

confidence: 89%

Ketamine and other N-methyl-D-aspartate receptor antagonists in the treatment of depression: a perspective review

Iadarola

Niciu

Richards

et al. 2015

Therapeutic Advances in Chronic Disease

179

117

View full text Add to dashboard Cite

Current pharmacotherapies for major depressive disorder (MDD) and bipolar depression (BDep) have a distinct lag of onset that can generate great distress and impairment in patients. Furthermore, as demonstrated by several real-world effectiveness trials, their efficacy is limited. All approved antidepressant medications for MDD primarily act through monoaminergic mechanisms, agonists or antagonists with varying affinities for serotonin, norepinephrine and dopamine. The glutamate system has received much attention in recent years as an avenue for developing novel therapeutics. A single subanesthetic dose infusion of the noncompetitive N-methyl-D-aspartate (NMDA) receptor antagonist ketamine has been shown to have rapid and potent antidepressant effects in treatment-resistant MDD and BDep. In a reverse translational framework, ketamine's clinical efficacy has inspired many preclinical studies to explore glutamatergic mechanisms of antidepressant action. These studies have revealed enhanced synaptic plasticity/synaptogenesis via numerous molecular and cellular mechanisms: release of local translational inhibition of brain-derived neurotrophic factor and secretion from dendritic spines, mammalian target of rapamycin activation and glycogen synthase kinase-3 inhibition. Current efforts are focused on extending ketamine's antidepressant efficacy, uncovering the neurobiological mechanisms responsible for ketamine's antidepressant activity in biologically enriched subgroups, and identifying treatment response biomarkers to personalize antidepressant selection. Other NMDA receptor antagonists have been studied both preclinically and clinically, which have revealed relatively modest antidepressant effects compared with ketamine but potentially other favorable characteristics, for example, decreased dissociative or psychotomimetic effects; therefore, there is great interest in developing novel glutamatergic antidepressants with greater target specificity and/or decreased adverse effects.

show abstract

Section: Intramuscularmentioning

confidence: 89%

Ketamine and other N-methyl-D-aspartate receptor antagonists in the treatment of depression: a perspective review

Iadarola

Niciu

Richards

et al. 2015

Therapeutic Advances in Chronic Disease

179

117

View full text Add to dashboard Cite

show abstract

“…Most of the subsequent studies have delivered ketamine as a constant infusion for 40 min at a rate of 0.5 mg/kg. Others have examined its efficacy after multiple infusions and observed similar results [8, 13, 16, 38]. Currently, it is recommended that ketamine be administered in a hospital setting [39].…”

Section: Discussionmentioning

confidence: 84%

“…Three of these studies were randomized controlled trials [4, 11, 18], three were open-label non-randomized studies [15–17], and three were case reports [10, 13, 14]. Similar to the findings of studies examining patients with TRD, a reduction in SI was seen as early as 40 min and lasted for an average of 3 days.…”

Section: Resultsmentioning

confidence: 95%

Ketamine as a Potential Treatment for Suicidal Ideation: A Systematic Review of the Literature

2015

View full text Add to dashboard Cite

ObjectiveTo review the published literature on the efficacy of ketamine for the treatment of suicidal ideation (SI).MethodsThe PubMed and Cochrane databases were searched up to January 2015 for clinical trials and case reports describing therapeutic ketamine administration to patients presenting with SI/suicidality. Searches were also conducted for relevant background material regarding the pharmacological function of ketamine.ResultsNine publications (six studies and three case reports) met the search criteria for assessing SI after administration of subanesthetic ketamine. There were no studies examining the effect on suicide attempts or death by suicide. Each study demonstrated a rapid and clinically significant reduction in SI, with results similar to previously described data on ketamine and treatment-resistant depression. A total of 137 patients with SI have been reported in the literature as receiving therapeutic ketamine. Seven studies delivered a dose of 0.5 mg/kg intravenously over 40 min, while one study administered a 0.2 mg/kg intravenous bolus and another study administered a liquid suspension. The earliest significant results were seen after 40 min, and the longest results were observed up to 10 days postinfusion.ConclusionConsistent with clinical research on ketamine as a rapid and effective treatment for depression, ketamine has shown early preliminary evidence of a reduction in depressive symptoms, as well as reducing SI, with minimal short-term side effects. Additional studies are needed to further investigate its mechanism of action, long-term outcomes, and long-term adverse effects (including abuse) and benefits. In addition, ketamine could potentially be used as a prototype for further development of rapid-acting antisuicidal medication with a practical route of administration and the most favorable risk/benefit ratio.

show abstract

“…Further, the risk of suicide was one of the reasons that warranted ketamine treatment (0.5 mg/kg infused intravenously over 40 min) in a patient who suffered severe chronic post-traumatic stress disorder (PTSD) and depression due to combat trauma [96]. A recent case report recommended an intramuscular administration of ketamine (0.5 mg/kg) for suicidal patients [97]. It is noteworthy that these patients had a history of suicidal ideation but the studies do not directly show a reduction in specific suicidal ideation scores.…”

Section: Ketamine and Suicidal Ideation In Clinical Studiesmentioning

confidence: 99%