Repeated subcutaneous racemic ketamine in treatment-resistant depression: case series
Joseph C.W. Tham, André Do, Jason Fridfinnson, Reza Rafizadeh, Jacky T.P. Siu, George P. Budd, Raymond W. Lam
International Clinical Psychopharmacology September 1, 2022 DOI: 10.1097/yic.0000000000000409 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Clinical protocol with case series Case report Peer reviewed |
|---|---|
| Sample size | 10 |
| Population | Inpatients with treatment-resistant depression |
| Intervention | Subcutaneous racemic ketamine |
| Duration | Maximum six treatments, twice per week |
| Measures | Montgomery–Åsberg Depression Rating Scale (MADRS), Quick Inventory of Depressive Symptomatology, Self-Report (QIDS-SR16) |
| Topics | Depression Esketamine Ketamine |
| Key findings | Repeated subcutaneous racemic ketamine relieved treatment-resistant depression symptoms in a small inpatient series: 8/10 responded and 8/10 remitted on the MADRS, while 6/10 responded and 5/10 remitted on the QIDS-SR16. Side effects were transient blood pressure changes and dissociation. The authors propose subcutaneous ketamine as a safe, feasible, and effective alternative to intravenous infusions. |
Abstract
Interest in the use of parenteral ketamine has been increasing over the last 2 decades for the management of treatment-resistant depression (TRD). While intravenous (IV) ketamine has been the most common parenteral route of administration, subcutaneous (SC) and intramuscular options have been described. We developed a clinical treatment protocol for the use of repeated SC racemic ketamine (maximum six treatments, twice per week) in an inpatient psychiatric care setting with inclusion/exclusion criteria, dosing schedule, and description of treatment, assessment, and monitoring procedures. Results from the first 10 consecutive patients demonstrated the effectiveness of SC racemic ketamine in relieving symptoms of TRD as measured by the Montgomery–Åsberg Depression Rating Scale (MADRS) and Quick Inventory of Depressive Symptomatology, Self-Report (QIDS-SR16). Response (≥50% reduction in scores from baseline to endpoint) was achieved in 8/10 cases on the MADRS and 6/10 on the QIDS-SR16. Remission was achieved in 8/10 (based on MADRS ≤10) and 5/10 (based on QIDS-SR16 ≤6). Patients tolerated the treatments well with only transient blood pressure changes and dissociative side effects. Repeated SC ketamine treatments could be a safe, feasible, and effective alternative to IV ketamine infusions for patients with TRD.
Comparable studies
Other case reports and case series on ketamine for depression, most cited first.