Use of ketamine for reversing acute depression in a critically ill pretransplant patient
Anna Bovill Shapiro, Mohit Chauhan, Archer Kilbourne Martin, Devang K. Sanghavi
JHLT Open September 22, 2023 DOI: 10.1016/j.jhlto.2023.100005 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case study Qualitative Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | A 68-year-old man with ischemic cardiomyopathy, chronic kidney disease, hypertension, and anxiety, admitted to the ICU in cardiogenic shock |
| Intervention | Ketamine |
| Dose | 0.5 mg/kg of intravenous ketamine |
| Duration | 3 days |
| Topics | Depression Esketamine Ketamine |
| Citations | 1 |
| Key findings | The authors report that intravenous ketamine at 0.5 mg/kg for three days produced rapid and significant mood improvement in a critically ill patient who had been considering hospice, after which he chose to pursue a heart transplantation workup. They raise questions about depression's influence on decision-making in critically ill patients and ketamine's potential role in rapid resolution of depressive symptoms and changes in care decisions. |
Abstract
A 68-year-old with a history of ischemic cardiomyopathy, chronic kidney disease, hypertension, and anxiety was admitted to the intensive care unit (ICU) in cardiogenic shock. After an intubation and several days in the ICU, he expressed hopelessness with further care and was considering a transition to hospice. The treatment team was concerned that clinical depression was influencing his decision. After obtaining consent, depression was treated with 0.5 mg/kg of intravenous ketamine for 3 days, with rapid and significant improvement in his mood. He made an informed choice to pursue a workup for heart transplantation. Besides improving his mood, ketamine led to vivid subjective experiences. This case provides a qualitative account of the patient's experience. It raises crucial questions about the influence of depressive symptoms in decision-making in critically ill patients and the potential role of ketamine in the rapid resolution of depressive symptoms and subsequent changes in care decisions.
Comparable studies
Other case reports and case series on ketamine for depression, most cited first.