<p>Metabolic Risk Factors and Cardiovascular Safety in Ketamine Use for Treatment Resistant Depression</p>

Abstract

Introduction Ketamine exhibits antidepressant properties in treatment-resistant depression (TRD) with some concern over its cardiovascular safety and tolerability issues. This paper reports on the cardiovascular safety in short-term intravenous ketamine treatment in TRD inpatients with major depressive disorder (MDD) and bipolar disorder (BP). Materials and Methods The observational study population comprises 35 MDD and 14 BP subjects treated with intravenous ketamine. Results Blood pressure (RR) and heart rate (HR) values returned to baseline within 1.5-hours post infusion with no sequelae for all study subjects. Six time points were analyzed for each infusion: 0’, 15’, 30’, 45’, 60’ and 90’ for RR and HR. After the infusion significant peaks in systolic (p = 0.004) and diastolic (p = 0.038) RR were seen. In concomitant medication with selective serotonin reuptake inhibitors (SSRIs), higher RR peaks (p = 0.020; p = 0.048) were seen as compared to other subjects. The decrease in HR was greater (p = 0.02) in the absence of concomitant medication with mood stabilizers as compared to subjects receiving mood stabilizing medication accompanied by the observation of a greater decrease in diastolic RR among those taking mood stabilizers (p = 0.009). Limitations The study may be underpowered due to the small sample size. The observations apply to an inhomogeneous TRD population in a single-site, pilot study, with no blinding and are limited to the acute administration. Conclusion The study demonstrates good safety and tolerability profile of intravenous ketamine as add-on intervention to current psychotropic medication in TRD, regardless of the MDD or BP type of mood disorders. The abatement of elevated RR and BP scores was observed in time with no sequelae nor harm. Still, cardiovascular risks appear to be more pronounced in subjects with comorbid arterial hypertension and diabetes mellitus.

Central nervous system-related safety and tolerability of add-on ketamine to antidepressant medication in treatment-resistant depression: focus on the unique safety profile of bipolar depression

“…The sample selection methods for this study have been described in detail elsewhere. 9 , 10 Briefly, the patient sample comprised subjects enrolled in a naturalistic observational safety and efficacy registry protocol for ketamine infusions in TRD. Inpatients diagnosed with TRD-MDD and TRD-BP were included.…”

Case Report: Repeated Series of Ketamine Infusions in Patients With Treatment-Resistant Depression: Presentation of Five Cases

“…The study had three phases: with a single infusion, succeeded by six infusions thrice weekly over 2 weeks, and the maintenance phase with four once-weekly infusions. Bryant et al (20) reported a series of six geriatric patients treated with acute (5-27) ketamine infusions followed by the long-term maintenance phase (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). Five of six patients showed a robust response including further improvement after the acute phase, but they lost the response over time.…”

Somatic Comorbidities and Cardiovascular Safety in Ketamine Use for Treatment-Resistant Depression

“…The study population selection has been described in detail elsewhere [8,9]. Briefly, the study population comprises subjects enrolled in a naturalistic observational safety and efficacy registry protocol for ketamine infusions in TRD.…”

“…The study design was discussed in detail elsewhere [8,9]. Briefly, the study followed an observational design with patients continuing baseline standard-of-care medication receiving eight ketamine infusions over 4 weeks.…”