The quest for optimal ketamine dosing formula in treatment-resistant major depressive disorder.
Julia Kwaśna, Wiesław Jerzy Cubała, Aleksander Kwaśny, Alina Wilkowska
Pharmacological reports : PR December 1, 2024 DOI: 10.1007/s43440-024-00637-x (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Retrospective analysis of an open-label study Peer reviewed |
|---|---|
| Sample size | 28 |
| Population | Inpatients with treatment-resistant major depressive disorder |
| Intervention | Intravenous ketamine |
| Dose | 0.5-1.0 mg/kg based on actual body weight |
| Topics | Depression Ketamine Esketamine |
| Keywords | Body surface area Dose calculation Ideal body weight Lean body mass Ketamine therapy Depression treatment Psychiatric dosing Antidepressant medication Pharmacology |
| Citations | 4 |
| Key points | Alternative ketamine dosing formulas (using lean body mass, ideal body weight, or body surface area) generally resulted in underdosing compared to the standard 0.5 mg/kg dose based on actual body weight. |
Abstract
Emerging evidence indicates that intravenous ketamine is effective in managing treatment-resistant unipolar and bipolar depression. Clinical studies highlight its favorable efficacy, safety, and tolerability profile within a dosage range of 0.5-1.0 mg/kg based on actual body weight. However, data on alternative dosage calculation methods, particularly in relation to body mass index (BMI) and therapeutic outcomes, remain limited. This retrospective analysis of an open-label study aims to evaluate dose calculation strategies and their impact on treatment response among inpatients with treatment-resistant major depressive disorder (MDD) (n = 28). The study employed the Boer and Devine formulas to determine lean body mass (LBM) and ideal body weight (IBW), and the Mosteller formula to estimate body surface area (BSA). The calculated doses were then compared with the actual doses administered or converted to a dosage per square meter for both responders and non-responders. Regardless of treatment response, defined as a reduction of 50% in the Montgomery-Åsberg Depression Rating Scale, the use of alternative ketamine dosing formulas resulted in underdosing compared to the standardized dose of 0.5 mg/kg. Only two participants received higher doses (102.7% and 113.0%) when the Devine formula was applied. This study suggests that ketamine dosing formulas, alternative to the standardized 0.5 mg/kg based on body weight, may lead to underdosing and potentially impact outcome interpretation. To enhance dosing accuracy, future studies should consider incorporating body impedance analysis and waist-to-hip ratio measurements, as this study did not account for body composition.