Intravenous ketamine for treatment-resistant depression patients who have failed to respond to transcranial magnetic stimulation: A case series.
Olivier Payette, Paul Lespérance, V. D. Jodoin, Christophe Longpré-poirier, Laurent Elkrief, Maxime Richard, Nicolas Garel, J. Miron
Journal of Affective Disorders April 1, 2023 DOI: 10.1016/j.jad.2023.04.019 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case series Open-label Case report Peer reviewed |
|---|---|
| Sample size | 21 |
| Population | Adults with treatment-resistant depression who had failed to respond to TMS |
| Intervention | Ketamine |
| Dose | 0.5 mg/kg over 60 min |
| Duration | 2-week intervention period |
| Measures | MADRS |
| Topics | Depression Esketamine Ketamine |
| Citations | 7 |
| Key findings | Intravenous racemic ketamine reduced depression severity in patients with treatment-resistant depression after TMS failure, with 19% responding and 9.5% achieving remission. |
Abstract
Background: For individuals with treatment-resistant depression (TRD), transcranial magnetic stimulation (TMS) has become a well-established approach. In the past decade, intravenous (IV) racemic ketamine has also emerged as a potential treatment for TRD. Currently, little data is available on the clinical effects of IV racemic ketamine in TRD patients who experienced TMS-failure.
Methods: Twenty-one (21) TRD patients who had failed to respond to a standard course of high-frequency left-dorsolateral prefrontal cortex TMS were subsequently scheduled to received IV racemic ketamine infusions. The IV racemic ketamine protocol consisted of 0,5 mg/kg infusions over 60 min, 3 times a week over 2 weeks.
Results: Treatment was safe with minimal side-effects. Mean baseline MADRS score was 27.6 ± 6.4 (moderate depression), decreasing down to 18.6 ± 8.9 (mild depression) post-treatment. Mean percent improvement was 34.5 % ± 21.1 from baseline to post-treatment. Paired sample t-test showed significant MADRS score decrease pre- to post-treatment [t(20) = 7.212, p < .001]. Overall, four (4) patients (19.0 %) responded and two (2) of those achieved remission (9.5 %).
Limitations: Limitations of this case series include its retrospective and uncontrolled open-label nature, the lack of self-rating and standardized adverse events questionnaires, as well as follow-ups beyond the immediate treatment period.
Conclusions: Novel ways to increase the clinical effects of ketamine are being explored. We discuss potential combination approaches of ketamine with other modalities to augment its effects. Given the global burden of TRD, novel approaches are needed to curb the current mental health epidemic around the world.
Comparable studies
Other case reports and case series on ketamine for depression, most cited first.