Ketamine for the Treatment of Depression in Patients Receiving Hospice Care: A Retrospective Medical Record Review of Thirty-One Cases

Abstract

Background Depression is prevalent in patients receiving hospice care. Standard antidepressant medications do not work rapidly enough in this setting. Evidence suggests that ketamine rapidly treats treatment refractory depression in the general population. Ketamine’s role for treating depression in the hospice population warrants further study. Methods A retrospective chart review of 31 inpatients receiving hospice care who received ketamine for depression on a clinical basis was conducted. The primary outcome measure was the Clinical Global Impression Scale, which was used retrospectively to rate subjects’ therapeutic improvement, global improvement, and side effects from ketamine over 21 days. Additionally, time to onset of therapeutic effect was also analyzed. Results Using the CGI, ketamine was found to be significantly therapeutically effective through the first week after ketamine dosing (p < 0.05), with 93% of subjects showing positive results for days 0 – 3 and 80% for days 4 – 7 post ketamine dosing. Subjects experienced global improvement during all four time periods post ketamine dosing (all p-values < 0.05). Significantly more subjects had either no side effects or side effects that did not significantly impair functioning at each of the four assessed time periods post ketamine dosing (all p-values < 0.05). Additionally, significantly more subjects experienced their first therapeutic response during days 0–1 post ketamine dosing (p < 0.001) than during any other time period. Conclusions These data suggest that ketamine may be a safe, effective, and rapid treatment for clinical depression in patients receiving hospice care. Blinded, randomized, and controlled trials are required to substantiate these findings and support further clinical use of this medication in hospice settings.

Ketamine use in current clinical practice

“…Price and colleagues [94] conducted a randomized controlled trial in treatment-resistant depression, which showed that intravenous ketamine produces rapid reductions in suicidal cognition over and above active placebo. Additionally, a retrospective medical record review of thirty-one cases suggested that ketamine may be a safe, effective, and rapid treatment for clinical depression in patients receiving hospice care [95] . Overall, ketamine has potential as a rapid treatment for treatment-resistant depression and suicidal ideation and may be a possible model compound for future drug development.…”

Ketamine and Depression: A Review

“…The follow-up OLI included 12 additional patients and utilized daily dosing of 0.5mg/kg (Irwin et al, 2013), finding 57% response rate, mean time to response of 14.4 days, and maintenance of response for at least 28 days. Most recently the same authors published a retrospective chart review involving 31 patients finding 71% response at 24 hours after single oral doses of 0.5mg/kg (Iglewicz et al 2014). It is unclear why this study displayed such rapid response, while the other did not.…”

“…Mouth numbness was the only novel effect reported (Lara et al, 2013). In the 50 patients that received oral ketamine, essentially no adverse effects, including vital sign changes, were reported (Paslakis et al, 2010;Irwin & Iglewicz, 2010;Irwin et al, 2013), save for disorientation and hallucinations in a minority of a medically ill hospice population (Iglewicz et al, 2014). In fact, there were improvements in BPRS and adverse symptom checklists (Irwin & Iglewicz, 2010).…”

“…A significant limitation exists in that ketamine is only FDA-approved for intravenous (IV) or intramuscular (IM) use in induction or maintenance of anesthesia, making administration in less controlled settings difficult. While most studies on ketamine thus far have looked at longer IV infusions, other routes have shown promise for increasing patient access to ketamine (Larkin & Beautrais, 2011;Harihar, Dasari, & Srinivas, 2013;Lara, Bisol, & Munari, 2013;Lapidus et al, 2014;Iglewicz et al, 2014).…”

Luftnot, Jucken und Depression in der Palliativmedizin

“…Der Einsatz ist allerdings ein "off label use". Iglewicz et al [62] kommen in einer retrospektiven Analyse von 31 palliativmedizinischen Patienten zu dem Ergebnis, dass 93 % der Patienten eine rasche Stimmungsbesserung bereits in den ersten 3 Behandlungstagen zeigten.…”