Intravenous antidepressants: A review

Moukaddam, Nidal; Hirschfeld, Robert M. A.

doi:10.1002/da.10135

Cited by 27 publications

(18 citation statements)

References 20 publications

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“…The rapid pharmacologic action associated with IV administration may at least partially explain why studies conducted so far have shown a fast onset of antidepressant action. Previous research on monoaminergic antidepressants also suggests that the onset of antidepressant action may be more rapid with IV than with oral administration (5). Unlike with IV administration, with other modes of administration ketamine might only be efficacious in TRD after several doses.…”

Section: Discussionmentioning

confidence: 99%

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Ketamine for Depression: Where Do We Go from Here?

Rot

Zarate

Charney

et al. 2012

Biological Psychiatry

373

262

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Since publication of the first randomized controlled trial describing rapid antidepressant effects of ketamine, several reports have confirmed the potential utility of this dissociative anesthetic medication for treatment of major depressive episodes, including those associated with bipolar disorder and resistant to other medications and electroconvulsive therapy. These reports have generated several questions with respect to who might respond to ketamine, how, and for how long. To start answering these questions. We used PubMed.gov and ClinicalTrials.gov to perform a systematic review of all available published data on the antidepressant effects of ketamine and of all recently completed, ongoing, and planned studies. To date, 163 patients, primarily with treatment-resistant depression, have participated in case studies, open-label investigations, or controlled trials. All controlled trials have used a within-subject, crossover design with an inactive placebo as the control. Ketamine administration has usually involved an anaesthesiologist infusing a single, subanesthetic, intravenous dose, and required hospitalization for at least 24 hours postinfusion. Response rates in the open-label investigations and controlled trials have ranged from 25% to 85% at 24 hours postinfusion and from 14% to 70% at 72 hours postinfusion. Although adverse effects have generally been mild, some patients have experienced brief changes in blood pressure, heart rate, or respiratory rate. Risk–benefit analyses support further research of ketamine for individuals with severe mood disorders. However, given the paucity of randomized controlled trials, lack of an active placebo, limited data on long-term outcomes, and potential risks, ketamine administration is not recommended outside of the hospital setting.

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Section: Discussionmentioning

confidence: 99%

“…Second, are modes of ketamine administration other than IV equally efficacious? Although the onset of antidepressant action may be more rapid, RCTs on IV administration of conventional antidepressants do not support increased efficacy over oral administration (5). Third, might it be possible to predict who will respond to ketamine?…”

mentioning

confidence: 99%

Ketamine for Depression: Where Do We Go from Here?

Rot

Zarate

Charney

et al. 2012

Biological Psychiatry

373

262

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“…Anecdotal data have described earlier onset of antidepressant effects using ISA compared to standard administration; these effects are believed to be due to ISA’s superior plasma concentrations and long-lasting bioavailability [52]. For instance, the IV use of the TCA clomipramine produced significant antidepressant effects as early as the first week of treatment [53,54].…”

Section: Pharmacological and Non-pharmacological Approaches And Thmentioning

confidence: 99%

The Timing of Antidepressant Effects: A Comparison of Diverse Pharmacological and Somatic Treatments

et al. 2010

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Currently available antidepressants used to treat major depressive disorder (MDD) unfortunately often take weeks to months to achieve their full effects, commonly resulting in considerable morbidity and increased risk for suicidal behavior. Our lack of understanding of the precise cellular underpinnings of this illness and of the mechanism of action of existing effective pharmacological treatments is a large part of the reason that therapies with a more rapid onset of antidepressant action (ROAA) have not been developed. Other issues that need to be addressed include heterogeneous clinical concepts and statistical models to measure rapid antidepressant effects. This review describes the timing of onset of antidepressant effects for various therapies used to treat MDD. While several agents produce earlier improvement of depressive symptoms (defined as occurring within one week), the response rate associated with such agents can be quite variable. These agents include both currently available antidepressants as well as other pharmacological and non-pharmacological interventions. Considerably fewer treatments are associated with ROAA, defined as occurring within several hours or one day. Treatment strategies for MDD whose sustained antidepressant effects manifest within hours or even a few days would have an enormous impact on public health.

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“…These include amitriptyline, citalopram, and other antidepressants [3][4][5] . Overall these studies do not support increased effi cacy of intravenous over per os administration but there are suggestions of a faster onset of action [6] . Pharmacokinetic advantages of parenteral administration include the benefi t of greater bioavailability as well as a reduction of metabolite levels by circumvention of the fi rst-pass liver me-tabolism -in the case of oral mirtazapine, the absolute bioavailability is approximately 50% [7] .…”

Section: Introductionmentioning

confidence: 92%

Intravenous Mirtazapine Is Safe and Effective in the Treatment of Depressed Inpatients

et al. 2006

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Mirtazapine is a third-generation antidepressant with a dual mode of action. The oral administration has been shown to be effective and safe in the treatment of depressed patients. In this multicenter naturalistic study, we assessed the safety, tolerability, and therapeutic efficacy of intravenously administered mirtazapine in 80 moderately to severely depressed inpatients during a treatment period of 14 days. We found a significant decrease of the Hamilton Depression Rating Scale total score compared to baseline. Side effects were mild and transient. Our data indicate that intravenous mirtazapine is an effective, safe and well-tolerated treatment for depressed inpatients.

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Intravenous antidepressants: A review

Cited by 27 publications

References 20 publications

Ketamine for Depression: Where Do We Go from Here?

Ketamine for Depression: Where Do We Go from Here?

The Timing of Antidepressant Effects: A Comparison of Diverse Pharmacological and Somatic Treatments

Intravenous Mirtazapine Is Safe and Effective in the Treatment of Depressed Inpatients

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