Maintenance Ketamine Therapy for Treatment-Resistant Depression

Archer, Shaina; Chrenek, Carson; Swainson, Jennifer

doi:10.1097/jcp.0000000000000894

Cited by 24 publications

(14 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our findings reflect those from case report studies of a similar number of individuals with TRD who were tried on maintenance ketamine therapy, 24,25 which also showed that most patients experienced initial but not ongoing improvement.…”

Section: Discussionsupporting

confidence: 87%

Ketamine treatment for individuals with treatment-resistant depression: longitudinal qualitative interview study of patient experiences

et al. 2020

View full text Add to dashboard Cite

Background Ketamine has recently received considerable attention regarding its antidepressant and anti-suicidal effects. Trials have generally focused on short-term effects of single intravenous infusions. Research on patient experiences is lacking. Aims To investigate the experiences over time of individuals receiving ketamine treatment in a routine clinic, including impacts on mood and suicidality. Method Twelve fee-paying patients with treatment-resistant depression (6 females, 6 males, age 21–70 years; 11 reporting suicidality and 6 reporting self-harm) who were assessed as eligible for ketamine treatment participated in up to three semi-structured interviews: before treatment started, a few weeks into treatment and ≥2 months later. Data were analysed thematically. Results Most participants hoped that ketamine would provide respite from their depression. Nearly all experienced improvement in mood following initial treatments, ranging from negligible to dramatic, and eight reported a reduction in suicidality. Improvements were transitory for most participants, although two experienced sustained consistent benefit and two had sustained but limited improvement. Some participants described hopelessness when treatment stopped working, paralleled by increased suicidal ideation for three participants. The transient nature and cost of treatment were problematic. Eleven participants experienced side-effects, which were significant for two participants. Suggestions for improving treatment included closer monitoring and adjunctive psychological therapy. Conclusions Ketamine treatment was generally experienced as effective in improving mood and reducing suicidal ideation in the short term, but the lack of longer-term benefit was challenging for participants, as was treatment cost. Informed consent procedures should refer to the possibilities of relapse and associated increased hopelessness and suicidality.

show abstract

Section: Discussionsupporting

confidence: 87%

Ketamine treatment for individuals with treatment-resistant depression: longitudinal qualitative interview study of patient experiences

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Retrospective case series have reported benefit from ongoing maintenance ketamine given at varying intervals for longer durations. 91,92 Acute dissociative effects have been reported to be more mild or noted to dissipate with repeated infusions during maintenance. 46 Anecdotal reports suggest that some patients may be able to transition to intranasal or sublingual formulations of racemic ketamine for maintenance after ketamine infusions.…”

Section: Resultsmentioning

confidence: 99%

The Canadian Network for Mood and Anxiety Treatments (CANMAT) Task Force Recommendations for the Use of Racemic Ketamine in Adults with Major Depressive Disorder: Recommandations Du Groupe De Travail Du Réseau Canadien Pour Les Traitements De L’humeur Et De L’anxiété (Canmat) Concernant L’utilisation De La Kétamine Racémique Chez Les Adultes Souffrant De Trouble Dépressif Majeur

et al. 2020

Self Cite

View full text Add to dashboard Cite

Objective: Patients with major depressive disorder often have limited response to first-line and second-line medications; hence, novel pharmacological treatments are needed for treatment-resistant depression (TRD). Ketamine, an N-methyl-d-aspartate (NMDA) receptor antagonist, has demonstrated rapid antidepressant effects in patients with TRD. The Canadian Network for Mood and Anxiety Treatments (CANMAT) convened a task force to review the evidence for efficacy and safety of racemic ketamine and to provide recommendations for its use in clinical practice. Methods: A systematic review was conducted with computerized search of electronic databases up to January 31, 2020 using combinations of search terms, inspection of bibliographies, and review of other ketamine guidelines and consensus statements. The level of evidence and lines of treatment were assigned according to CANMAT criteria. Recommendations were given in question–answer format. Results: Intravenous (IV) racemic ketamine given as a single infusion has Level 1 evidence for efficacy in adults with TRD. The evidence for multiple infusions, given as an acute series or as ongoing maintenance treatment, is limited to Level 3. Adverse events associated with ketamine infusions include behavioral (e.g., dissociative symptoms) and physiological (e.g., hypertension) events. There is only Level 3 or 4 evidence for non-IV formulations of racemic ketamine. Consensus recommendations are given for clinical administration of IV ketamine including patient selection, facility and personnel issues, monitoring, and maintaining response. Conclusions: Single-dose IV racemic ketamine is a third-line recommendation for adults with TRD. The need for repeated and maintenance ketamine infusions should be carefully assessed on a case-by-case basis with consideration of potential risks and benefits. Because of limited evidence for efficacy and risk for misuse and diversion, the use of oral and other formulations of racemic ketamine should be limited to specialists with ketamine-prescribing expertise and affiliations with tertiary or specialized centers.

show abstract

“…As for neurocognition, they found significant improvements in speed of processing and verbal learning, and no deterioration in the other cognitive domains. Archer et al [ 22 ] conducted a chart review identifying 11 patients who received between 10 and 51 ketamine infusions (0.5 mg/kg over 40 min) over a period 6 to 49 weeks. They found no serious adverse events.…”

Section: Resultsmentioning

confidence: 99%

Safety of Repeated Administration of Parenteral Ketamine for Depression

2020

View full text Add to dashboard Cite

The objective of this study was to investigate the safety of repeated parenteral ketamine for depression. An electronic survey inquiring about the frequency of adverse events was distributed to providers of parenteral ketamine for depression. In addition, the investigators conducted a search of published studies describing six or more repeated parenteral ketamine treatments administered to individuals for depression, and extracted reported adverse events. The survey was sent to 69 providers, of which 36 responded (52% response rate); after eliminating those that were incomplete, 27 were included in the analysis. The providers in the analysis collectively reported treating 6630 patients with parenteral ketamine for depression, one-third of whom received more than 10 treatments. Only 0.7% of patients experienced an adverse effect that required discontinuation of ketamine. Psychological distress during the treatment was the most frequent cause. Other adverse events were extremely rare (such as bladder dysfunction (0.1%), cognitive decline (0.03%) and psychotic symptoms (0.03%)). Among the 20 published reports of repeated parenteral ketamine treatments, rates of significant adverse events resulting in discontinuation were low (1.2%). The rate of adverse effects reported in the survey and the published literature is low, and suggests that long-term treatment of depression with ketamine is reasonably safe.

show abstract

Maintenance Ketamine Therapy for Treatment-Resistant Depression

Abstract: Maintenance ketamine treatments may be an effective way of maintaining treatment response in some ketamine responders. Future research is required to determine optimal length of treatment in those who respond to ketamine and to track adverse effects over a longer time.

Cited by 24 publications

References 30 publications

Ketamine treatment for individuals with treatment-resistant depression: longitudinal qualitative interview study of patient experiences

Ketamine treatment for individuals with treatment-resistant depression: longitudinal qualitative interview study of patient experiences

Safety of Repeated Administration of Parenteral Ketamine for Depression

Contact Info

Product

Resources

About