Is Ketamine the Future Clozapine for Depression? A Case Series and Literature Review on Maintenance Ketamine in Treatment-resistant Depression With Suicidal Behavior.
Lai Fong Chan, Choon Leng Eu, Shean Yih Soh, Thambu Maniam, Zuri Shahidii Kadir, Benedict Tak Wai Chong, Jiann Lin Loo, Shalisah Sharip, Vincent Choong Wai Wong, Tsui Huei Loo, Yin Ping Ng, David Kahn
Journal of Psychiatric Practice July 1, 2018 DOI: 10.1097/pra.0000000000000316 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case series Case report Peer reviewed |
|---|---|
| Sample size | 13 |
| Population | Patients with treatment-resistant unipolar and bipolar (mixed) depression with significant suicide risk and multiple comorbidities, including alcohol dependence |
| Intervention | adjunctive serial maintenance ketamine infusions |
| Duration | 7 months for one case; 5 years for another case |
| Topics | Depression Esketamine Ketamine |
| Citations | 18 |
| Key findings | Serial maintenance ketamine infusions led to functional remission in two cases of treatment-resistant depression, but in seven other cases only acutely reduced suicidal ideation without sustained antidepressant effect. |
Abstract
Ketamine has shown effectiveness as a rapid-acting antidepressant with antisuicidal effects in terms of reduction of suicidal ideation in the short term. However, the evidence for long-term maintenance ketamine therapy for treatment-resistant depression (TRD) and suicidal behavior is limited. This case series (N=13) highlights the role of adjunctive serial maintenance ketamine infusions in restoring functionality in treatment-resistant unipolar and bipolar (mixed) depression with significant suicide risk and multiple comorbidities, including alcohol dependence. Two cases of TRD achieved functional remission with long-term maintenance ketamine treatment. The first case illustrates the potential synergistic interaction between ketamine and lamotrigine to achieve a sustained antidepressant response in the patient for 7 months. The second case may possibly be the longest reported case of maintenance ketamine therapy, with treatment continuing for 5 years to date. Ketamine treatment showed acute effectiveness in another 7 cases, especially in terms of reduction of suicidal ideation, albeit without significant long-term antidepressant effect. Factors that may contribute to lack of effectiveness of serial ketamine include inadequate mood stabilization in TRD in bipolar spectrum diagnoses, concomitant benzodiazepine use, complex comorbidities, and adverse effects such as significant hypertension and severe dissociation. Future systematic controlled studies are warranted to establish the efficacy and safety profile of long-term ketamine as maintenance therapy for TRD with suicidal behavior.
Comparable studies
Other case reports and case series on ketamine for depression, most cited first.