Oral S-ketamine effective after deep brain stimulation in severe treatment-resistant depression and extensive comorbidities

Abstract

This case report describes successful maintenance treatment with oral S-ketamine in a patient with severe depression, who previously was resistant to electroconvulsive therapy and deep brain stimulation, and who also had comorbid psychotic and obsessive compulsive symptoms.

Therapeutic Potentials of Ketamine and Esketamine in Obsessive–Compulsive Disorder (OCD), Substance Use Disorders (SUD) and Eating Disorders (ED): A Review of the Current Literature

“…The findings are described in detail and organized in relation to the specific type of article and order of publication (see Table 1). Studies retrieved were represented by nine case series/case reports [13,[40][41][42][43][44][45][46][47][48], six randomized-controlled trials [49][50][51][52][53][54], ten open-label studies [55][56][57][58][59][60][61][62][63][64][65] and three double blind trials [66][67][68]. Most cases involved adult males (total M/F = 328/160= 2.1).…”

“…Most cases involved adult males (total M/F = 328/160= 2.1). Patients were mostly diagnosed with OCD [13,40,45,47,55,56,[60][61][62][63][64] or a SUD, such as opioid dependence [41,[43][44][45][46][57][58][59], cocaine dependence [49,50,52,[66][67][68] or alcohol dependence [51,54,65]. Only three studies focused on ED [42,46,48].…”

“…Only three studies focused on ED [42,46,48]. Ketamine was mostly intravenously administered [42][43][44][45][47][48][49][50][51][52][53][54][55][56][57][59][60][61][65][66][67], but intranasal [40,62], intramuscular [46,58,68] and oral [13,41] routes of administration were also recorded. Ketamine was administered together with Cognitive Behavioral Therapy (CBT) [40,43], or in the context of ketamine-assisted psychotherapy (KPT) sessions [58,68] or Trauma Interventions using Mindfulness Based Extinction and Reconsolidation of memories (TIMBER) [59].…”

“…Ketamine was administered together with Cognitive Behavioral Therapy (CBT) [40,43], or in the context of ketamine-assisted psychotherapy (KPT) sessions [58,68] or Trauma Interventions using Mindfulness Based Extinction and Reconsolidation of memories (TIMBER) [59]. Ketamine was generally well tolerated, with the exception of transient effects, including nausea [42,43], headache [42,46], dry mouth [45], sleepiness [46], feelings of unreality [45], dissociation [46,49,55,56,62], dizziness [13], hallucinations [40,42,43], gaps in memory [55,56], sensory distortions [55,56], anxiety [43] and increases in systolic blood pressure [55,56,58]. Interestingly, unexpected suicidal thinking was observed, together with delayed-onset dysphoria and anxiety, in some patients diagnosed with OCD, but these patients were not recorded as being depressed [55,56].…”

“…In addition, increasing evidence now points to its therapeutic efficacy in treatment-resistant depression (TRD), as well as a potential agent for reducing and preventing suicide in depressed patients, as it exerts rapid antidepressant properties as early as several hours after administration. This contrasts with traditional antidepressants (e.g., selective serotonin reuptake inhibitors [SSRIs]), that usually require several weeks for clinical responses [9][10][11][12][13][14][15]. An intranasal formulation of esketamine, currently branded as Spravato ® , was approved by the Food and Drug Administration (FDA) in the United States in March 2019, and by the European Commission in December 2019, for [16,17] the treatment of TRD, defined as the lack of response to two or more adequate trials of antidepressant medications in a current moderate to severe depressive episode [12,17,18].…”