Frequency analysis of symptomatic worsening following ketamine infusions for treatment resistant depression in a real-world sample: Results from the canadian rapid treatment center of excellence.
Joshua D. Di Vincenzo, Orly Lipsitz, Nelson B Rodrigues, Brett D. M. Jones, Hartej Gill, Yena Lee, Leanna M.W. Lui, Kayla M Teopiz, Roger Ho, Kangguang Lin, Flora Nasri, Roger S McIntyre, Joshua D. Rosenblat
Psychiatry Research 2022 DOI: 10.1016/j.psychres.2021.114321 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Retrospective analysis Peer reviewed |
|---|---|
| Sample size | 164 |
| Population | Adults with treatment-resistant depression (unipolar and bipolar) |
| Dose | 0.5-0.75 mg/kg over 40 min |
| Duration | Four infusions over two weeks |
| Measures | Quick Inventory for Depression Symptomatology-Self Report-16 (QIDS-SR16) |
| Topics | Depression Ketamine Esketamine |
| Keywords | Bipolar Crtce Worsening |
| Citations | 11 |
| Key points | Clinically significant worsening of depressive symptoms occurred in 1.83% to 5.49% of patients across infusion time points, with no worsening observed in the bipolar subgroup. |
Abstract
Antidepressants are associated with symptomatic worsening in a subgroup of patients. Replicated evidence has demonstrated rapid and robust antidepressant effects with intravenous (IV) ketamine in treatment resistant depression (TRD); however, the risk of ketamine worsening depressive symptoms in a subgroup of patients remains unknown. Herein we report a retrospective analysis on the rates of symptomatic worsening during an acute course of IV ketamine in individuals with unipolar (n = 142) and bipolar (n = 22) TRD. Adults (N = 164; mean age = 45.97) with TRD underwent four sub-anesthetic infusions (0.5-0.75 mg/kg over 40 min) of IV ketamine over two weeks, and were assessed with the Quick Inventory for Depression Symptomatology-Self Report-16 (QIDS-SR16) at baseline and after each infusion. The primary outcome was the proportion of patients experiencing clinically significant worsening of depressive symptoms (≥20% increase on the QIDS-SR16) at each time point relative to baseline. Secondary analyses explored trends in the results. The frequency of clinically significant worsening fluctuated between 1.83% to 5.49%, with no identifiable trend across time. Zero individuals with bipolar TRD reported symptomatic worsening. Limitations include the single-centered, uncontrolled, retrospective nature of this study. Rates of symptomatic worsening associated with IV ketamine therapy for TRD appear to be very low and similar to conventional antidepressants.