Serial infusions of low-dose ketamine for major depression

Rasmussen, Keith G.; Lineberry, Timothy W.; Galardy, Christine; Kung, Simon; Lapid, Maria I.; Palmer, Brian A.; Ritter, Matthew J.; Schak, Kathryn M.; Sola, Christopher L.; Hanson, A.J.; Frye, Mark A.

doi:10.1177/0269881113478283

Cited by 175 publications

(130 citation statements)

References 32 publications

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“…[56,57] In the first study of treatment-resistant depressed patients, 5 (50%) of 10 enrolled subjects eventually met predefined criteria for depressive symptom remission. [56] Cumulative remission rates after one, two, and four infusions were 10, 40, and 50%, respectively. Three of the five patients who remitted during the course of receiving serial ketamine infusions experienced depressive relapses over the next 4 weeks despite receiving ongoing treatment with oral antidepressants and, in one case, with ECT.…”

Section: Single Versus Serial Acute-phase Administration Of Ketaminementioning

confidence: 99%

Ketamine for Treatment-Resistant Unipolar and Bipolar Major Depression: Critical Review and Implications for Clinical Practice

et al. 2016

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There is an urgent need for more rapidly effective pharmacotherapies for major depressive disorder and bipolar disorder (BP) that are efficacious and tolerable for depressed patients who respond poorly to conventional treatments. Multiple controlled trials have now demonstrated a rapid, nonsustained antidepressive response to a single intravenous infusion of ketamine. Early controlled studies of intranasal or serial infusion therapy appear promising. The effective dose for depression is lower than the typical anesthetic doses, and side-effects are generally mild and transient. The data investigating the adjunctive use of concurrent ketamine in the course of electroconvulsive therapy (ECT) for depression do not suggest efficacy or tolerability. The therapeutic potential of ketamine has stimulated considerable excitement among clinicians, patients, and industry, and has led to the increasing use of ketamine as an off-label substitute for ECT and other antidepressive treatments. This clinical review of ketamine will assess the evidence-based use of ketamine and initial clinical implications of further development of a potentially novel treatment for rapid reduction of symptoms in depressed patients.

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Section: Single Versus Serial Acute-phase Administration Of Ketaminementioning

confidence: 99%

Ketamine for Treatment-Resistant Unipolar and Bipolar Major Depression: Critical Review and Implications for Clinical Practice

et al. 2016

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“…2(p68) A growing literature attests to ketamine's rapid but transient antidepressant actions in patients with treatment-resistant depression (TRD). 3,4 To extend the clinical applicability of ketamine, several open-label trials [4][5][6] have used ketamine as an augmenting agent, allowing participants to continue prestudy medications. Results from these studies enable characterization of potential drug interactions and shed light on the underlying mechanism of ketamine response.…”

Section: The Antidepressant Effect Of Repeat Dose Intravenous Ketaminmentioning

confidence: 99%

The Antidepressant Effect of Repeat Dose Intravenous Ketamine Is Delayed by Concurrent Benzodiazepine Use

Albott¹,

Shiroma²,

Cullen³

et al. 2017

J. Clin. Psychiatry

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“…This loss of parvalbuminpositive cell density is significantly associated with hippocampal volume loss, which in turn is closely associated with the pathophysiology of depression [31]. Considering the potential risk of neurotoxicity that is generally associated with chronic ketamine use at higher doses, we propose that repeated infusions of low doses of ketamine are safe and effective in sustaining an antidepressant response [32][33][34][35]. Further investigations of the optimal dose and route of administration that are safe for chronic ketamine treatment are required.…”

Section: Neurotoxic Effects Of Ketaminementioning

confidence: 99%

Risks Associated with Misuse of Ketamine as a Rapid-Acting Antidepressant

et al. 2016

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Major depression is a serious psychiatric disorder and remains a leading cause of disability worldwide. Conventional antidepressants take at least several weeks to achieve a therapeutic response and this lag period has hindered their ability to attain beneficial effects in depressed individuals at high risk of suicide. The non-competitive Nmethyl-D-aspartate glutamate receptor antagonist ketamine has been shown to have rapid antidepressant effects in both rodents and humans. The emergence of ketamine as a fastacting antidepressant provides promising new insights into the development of a rapid treatment response in patients with clinical depression. However, its safety and toxicity remain a concern. In this review, we focus on the limitations of ketamine, including neurotoxicity, cognitive dysfunction, adverse events associated with mental status, psychotomimetic effects, cardiovascular events, and uropathic effects. Studies have shown that its safety and tolerability profiles are generally good at low doses and with short-term treatment in depressed patients. The adverse events associated with ketamine usually occur with very high doses that are administered for prolonged periods of time and can be relieved by cessation. The antidepressant actions of its two enantiomers, S-ketamine (esketamine) and R-ketamine, are also discussed. R-ketamine has greater antidepressant actions than S-ketamine, without ketamine-related sideeffects. Future treatment strategies should consider using Rketamine for the treatment of depressed patients to decrease the risk of adverse events associated with long-term ketamine use.

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Serial infusions of low-dose ketamine for major depression

Cited by 175 publications

References 32 publications

Ketamine for Treatment-Resistant Unipolar and Bipolar Major Depression: Critical Review and Implications for Clinical Practice

Ketamine for Treatment-Resistant Unipolar and Bipolar Major Depression: Critical Review and Implications for Clinical Practice

The Antidepressant Effect of Repeat Dose Intravenous Ketamine Is Delayed by Concurrent Benzodiazepine Use

Risks Associated with Misuse of Ketamine as a Rapid-Acting Antidepressant

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