Treatment-resistant depression patients with baseline suicidal ideation required more treatments to achieve therapeutic response with ketamine/esketamine

Singh, Balwinder; Vande Voort, Jennifer L.; Pazdernik, Vanessa K.; Frye, Mark A.; Kung, Simon

doi:10.1016/j.jad.2024.01.262

Cited by 7 publications

(2 citation statements)

References 29 publications

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“…Sumner et al stated that ketamine's antidepressant properties were related to GABA A and AMPA receptors rather than the traditionally assumed NMDA receptor antagonism (Sumner et al, 2024). In a historical cohort study (n=52), Singh et al suggested that patients with baseline suicidal ideation required more treatments to achieve a therapeutic response with ketamine or esketamine (Singh et al, 2024). Intravenous ketamine and intranasal esketamine did not differ in this aspect.…”

Section: Introductionmentioning

confidence: 99%

Ketamine in severe, highly treatment-resistant depression—a retrospective case study and a perspective

Turkia

2024

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Ketamine is a well-known and widely available general anesthetic from the 1960s that, in sub-anesthetic doses, has been adopted in a limited manner for the treatment of acute suicidality and treatment-resistant depression. Its short onset time and short duration of action make it feasible for use at outpatient clinics. In the US, it has a long history of off-label use and was officially approved for depression treatment in 2019. In Finland, it has been administered to selected hospitalized patients in the public healthcare system since 2010 and became available at a private outpatient clinic very recently. In Norway, it has been administered off-label at a private clinic for approximately 500 patients since mid-2010s and at a public clinic for approximately 300 patients since 2020, with plans on opening more clinics in 2024. In the US, the treatment has been administered to hundreds of thousands of patients. The retrospective ethnographic inquiry part of this study features a Finnish woman in her twenties who suffered from treatment-resistant depression, rooted in her insecure childhood and having been bullied at school, as well as income insecurity and excessive workload in adulthood. Eventually, she was violently raped, which induced an obvious post-traumatic stress disorder and exacerbated her depression, incapacitating her. In the course of approximately five years, she was prescribed ten different anti-depressive medications and seventeen other medications, including various antipsychotic medications and lithium. These failed to provide an anti-depressive effect but resulted in 'massive' adverse effects instead, including 60% weight gain and psychotic hallucinations. Eventually, esketamine spray treatment at a private outpatient clinic resolved her depression in a single session. A weekly re-administration process was ongoing. In this case, repeated esketamine administration alleviated depression by producing accumulating corrective emotional experiences without the need to re-experience previous traumatizing events. In a few months to a year, the transient but accumulating anti-depressive effect typically leads to the resolution of depression in most cases, if the patients' living conditions no longer constantly re-traumatize them. It is necessary to adopt ketamine more widely as an emergency measure while more effective, non-addictive alternatives and complements are prepared for adoption. The cost of this specific pilot program implementation was unscalable, but costs can be reduced by approximately 90% by modifying the implementation details. Ketamine and its more effective alternative, 5-MeO-DMT, can serve a major role in facilitating a rebirth of public and private mental healthcare systems, with treatment efficacy multiplied and treatment costs simultaneously reduced.

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Section: Introductionmentioning

confidence: 99%

Ketamine in severe, highly treatment-resistant depression—a retrospective case study and a perspective

Turkia

2024

Preprint

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“…However, the subcutaneous route has not been extensively studied in regard of its putative antisuicidal effects. This is a very important topic, since ketamine’s antisuicidal profile, although demonstrated in various clinical trials, is not universally consistent throughout the literature, and have previously yielded mixed results, sometimes attributed to the route of administration, the enantiomer used, or the chronicity of the suicidal ideation ( 2 ). Anzolin et al.…”

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confidence: 99%