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Ketamine as Add-On Treatment in Psychotic Treatment-Resistant Depression

Maria Gałuszko‐węgielnik, Zuzanna Chmielewska, Katarzyna Jakuszkowiak‐wojten, Mariusz S. Wiglusz, Wiesław Jerzy Cubała

Brain Sciences January 13, 2023 DOI: 10.3390/brainsci13010142 (opens in new tab)

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Study at a glance

AI-extracted from the abstract
Characteristics Case series Case report Peer reviewed
Sample size 4
Population Inpatients with treatment-resistant depression with psychotic features
Intervention 0.5 mg/kg intravenous infusion of ketamine
Dose 0.5 mg/kg
Topics Anxiety Depression Ketamine Esketamine
Keywords Depression economics Exacerbation Psychotic depression Antidepressant Mood disorders Pharmacotherapy Psychosis
Citations 20
Key findings Ketamine infusion did not exacerbate psychotic symptoms and was associated with stable remission and antisuicidal effects in four patients with treatment-resistant psychotic depression.

Abstract

Psychotic treatment-resistant depression is a complex and challenging manifestation of mood disorders in the clinical setting. Psychotic depression is a subtype of major depressive disorder characterized by mood-consistent hallucinations and/or delusions. Psychotic depression is often underdiagnosed and undertreated. Ketamine appears to have rapid and potent antidepressant effects in clinical studies, and the Federal Drug Agency approved the use of ketamine enantiomer esketamine-nasal spray for treatment-resistant depression pharmacotherapy in 2019. This study aimed to assess the usage of ketamine for major depressive disorder with psychotic features as an add-on treatment to the standard of care. Here we present four inpatients suffering from treatment-resistant depression with psychotic features, including one with severe suicidal crisis, all treated with 0.5 mg/kg intravenous infusion of ketamine. Subsequent monitoring revealed no exacerbation of psychotic symptoms in short and long-term observation, while stable remission was observed in all cases with imminent antisuicidal effect. Results suggest ketamine may benefit individuals with treatment-resistant depression with psychotic features.

Comparable studies

Other case reports and case series on ketamine for anxiety, most cited first.

Study Year Design Participants
Ketamine-Enhanced Psychotherapy: Preliminary Clinical Observations on its Effects in Treating Death Anxiety Terminally-ill people suffering death anxiety 2007 Review and case study n = 2
Treatment of a Complex Personality Disorder Using Repeated Doses of LSD—A Case Report on Significant Improvements in the Absence of Acute Drug Effects A 39-year-old female patient with severe, treatment-resistant depression and complex... 2020 Case study n = 1
Short term ketamine treatment in patient with bipolar disorder with comorbidity with borderline personality disorder: Focus on impulsivity Female patient diagnosed with both bipolar disorder and borderline personality disorder 2023 Case study n = 1
Suicide versus Accidental Death by Autoerotic Asphyxiation in a Patient Receiving Intravenous Ketamine for Depression 28-year-old man with major depressive disorder, generalized anxiety disorder, panic... 2022 Case study n = 1
Case Report: Successful management of psychogenic non-epileptic seizures with intranasal esketamine. Patient with treatment-resistant depression and psychogenic non-epileptic seizures 2025 Case report n = 1

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Anxiety Depression Ketamine Esketamine

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