At-home, sublingual ketamine telehealth is a safe and effective treatment for moderate to severe anxiety and depression: Findings from a large, prospective, open-label effectiveness trial.
Thomas D Hull, Matteo Malgaroli, Adam Gazzaley, Teddy J. Akiki, A. Madan, Leonardo Vando, Kristin A Arden, J. Swain, M. Klotz, Casey Paleos
Journal of Affective Disorders July 1, 2022 DOI: 10.1016/j.jad.2022.07.004 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Prospective study Open-label Peer reviewed |
|---|---|
| Sample size | 1,247 |
| Population | Outpatients receiving at-home ketamine-assisted therapy |
| Intervention | Ketamine-assisted therapy |
| Duration | Four weeks |
| Topics | Anxiety Depression Esketamine Ketamine |
| Citations | 59 |
| Key points | At-home ketamine-assisted therapy produced rapid antidepressant and anxiolytic effects, with response and remission rates comparable to clinic-administered ketamine and low rates of adverse events. |
Abstract
Background: At-home Ketamine-assisted therapy (KAT) with psychosocial support and remote monitoring through telehealth platforms addresses access barriers, including the COVID-19 pandemic. Large-scale evaluation of this approach is needed for questions regarding safety and effectiveness for depression and anxiety.
Methods: In this prospective study, a large outpatient sample received KAT over four weeks through a telehealth provider. Symptoms were assessed using the Patient Health Questionnaire (PHQ-9) for depression, and the Generalized Anxiety Disorder scale (GAD-7) for anxiety. Demographics, adverse events, and patient-reported dissociation were also analyzed. Symptom trajectories were identified using Growth Mixture Modeling, along with outcome predictors.
Results: A sample of 1247 completed treatment with sufficient data, 62.8 % reported a 50 % or greater improvement on the PHQ-9, d = 1.61, and 62.9 % on the GAD-7, d = 1.56. Remission rates were 32.6 % for PHQ-9 and 31.3 % for GAD-7, with 0.9 % deteriorating on the PHQ-9, and 0.6 % on the GAD-7. Four patients left treatment early due to side effects or clinician disqualification, and two more due to adverse events. Three patient subpopulations emerged, characterized by Improvement (79.3 %), Chronic (11.4 %), and Delayed Improvement (9.3 %) for PHQ-9 and GAD-7. Endorsing side effects at Session 2 was associated with delayed symptom improvement, and Chronic patients were more likely than the other two groups to report dissociation at Session 4.
Conclusion: At-home KAT response and remission rates indicated rapid and significant antidepressant and anxiolytic effects. Rates were consistent with laboratory- and clinic-administered ketamine treatment. Patient screening and remote monitoring maintained low levels of adverse events. Future research should assess durability of effects.
Comparable studies
Other observational and cohort studies on ketamine for anxiety, most cited first.