Rapid Relief of Severe Major Depressive Disorder by Use of Preoperative Ketamine and Electroconvulsive Therapy

Goforth, Harold W.; Holsinger, Tracey

doi:10.1097/01.yct.0000263257.44539.23

Cited by 55 publications

(29 citation statements)

References 21 publications

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“…7 In addition to their positive effects on glutamate transmission, NMDA antagonists appear to have features associated with other antidepressant agents and electroconvulsive therapy (ECT), including the induction of neurogenesis and secondary effects on monoamines. 3,[8][9][10][11] We report on a case in which intravenous (IV) ketamine "bursts" were used to treat an intractable major depressive disorder in a patient with metastatic cancer.…”

Section: Ajor Depressive Disorder (Mdd) Is Common In Patientsmentioning

confidence: 99%

Intravenous Ketamine “Burst” for Refractory Depression in a Patient with Advanced Cancer

Stefanczyk-Sapieha

Oneschuk

Demas

2008

Journal of Palliative Medicine

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Major Depressive Disorder (MDD) is prevalent in patients with advanced cancer, and can have a negative impact on patients' quality of life. Available antidepressants, often have delayed benefits of several weeks, and therefore are of limited utility in the palliative care setting. Psychostimulants provide more rapid onset of action, but frequently require dose escalation because of problems with tolerance. There is a growing body of evidence that N-methyl-D-aspartate (NMDA) receptor antagonists, such as ketamine, signficantly and rapidly improve depressive symptoms in treatment resistant depression. However, studies conducted to date have not included advanced cancer patients. We report on a case where intravenous ketamine 'bursts' (0.5 mg/kg infused over 60 minutes) were used to treat an intractable MDD in a patient with metastatic prostate cancer. Initial positive response was not sustained, and response to a repeat treatment was even more transient. Adverse effects were mild and self-limiting. We conclude that a well-designed, randomized study of IV ketamine "bursts" in cancer patients suffering from depression is needed to further establish the role and appropriate dosing of ketamine in this patient population. Given that ketamine can be used as an adjuvant for difficult pain syndromes in cancer patients, it would be of interest to assess its impact on the mood in patients receiving this treatment for pain.

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Section: Ajor Depressive Disorder (Mdd) Is Common In Patientsmentioning

confidence: 99%

Intravenous Ketamine “Burst” for Refractory Depression in a Patient with Advanced Cancer

Stefanczyk-Sapieha

Oneschuk

Demas

2008

Journal of Palliative Medicine

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“…69 In 2 cases, dramatic mood improvements were observed after the use of ketamine anesthesia in ECT, suggesting synergistic antidepressant effects. 70,71 Potentially, the combination of ketamine and ECT could prove a highly potent antidepressant treatment. However, the use of ketamine at full anesthetic doses can lead to psychotogenic adverse effects (eg, hallucinations), 72 although there are clinical impressions that the incidence of these adverse effects is lower in the context of ECT.…”

Section: Ketaminementioning

confidence: 99%

Augmentation Strategies in Electroconvulsive Therapy

Loo¹,

Simpson²,

MacPherson³

2010

The Journal of ECT

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Electroconvulsive therapy (ECT) is a highly effective treatment, but strategies to enhance therapeutic outcomes are occasionally needed. This review examines the evidence for approaches used for enhancing seizure production: hyperventilation, pretreatment with xanthines, and use of remifentanil or ketamine in ECT anesthesia. Hyperventilation may be a useful strategy to enhance seizure production, but its effects on ECT outcomes have not been systematically studied and require further research. Pretreatment with caffeine, theophylline or aminophylline (xanthines) prolongs the duration of ECT seizures but has not been clearly shown in controlled trials to increase efficacy. Caution is also warranted because their use may be associated with significant adverse effects. There are case reports of the usefulness of remifentanil in assisting seizure induction by reducing the dose of barbiturate anesthetic required, but there are no controlled data on whether it independently enhances efficacy outcomes. Preliminary evidence suggests that ketamine and ECT may have synergistic antidepressant effects, although this needs to be further examined in randomized controlled trials.

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“…Recent observations in clinical settings suggest that at subanesthetic doses, ketamine produces therapeutic effects in depressed patients (Berman et al 2000;Ostroff et al 2005;Correll and Futter 2006;Zarate et al 2006;Goforth and Holsinger 2007). These antidepressant actions were characterized by a rapid (hours) onset of action (Berman et al 2000;Correll and Futter 2006), lasted for a significant time (1 week), appeared after a single dose, and were effective in treatment-resistant patients (Zarate et al 2006).…”

Section: Introductionmentioning

confidence: 98%