Effects of Repeated Intravenous Ketamine in Treatment-Resistant Geriatric Depression
Kelly A. Bryant, Murat Altinay, Nora Finnegan, Kim Cromer, Roman M. Dale
Journal of Clinical Psychopharmacology March 1, 2019 DOI: 10.1097/jcp.0000000000001006 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case series Case report Peer reviewed |
|---|---|
| Sample size | 6 |
| Population | Geriatric patients aged 65 to 82 with treatment-resistant depression |
| Intervention | Ketamine |
| Dose | 0.5 mg/kg |
| Duration | Acute series of 2 to 4 infusions; maintenance infusions every 2 to 6 weeks, with a range of 8 to 22 maintenance infusions |
| Topics | Depression Esketamine Ketamine |
| Key findings | Among 6 elderly patients with treatment-resistant depression, only 1 did not respond acutely, 4 responded but lost the response over 8 to 22 maintenance infusions, and 1 relapsed into alcohol use and discontinued. The authors conclude that intravenous ketamine is relatively safe in this group but has low efficacy for maintaining antidepressant response in the elderly. |
Abstract
Abstract Purpose There is an immediate need for more sustainable, effective therapies for treatment-resistant depression in patients who do not respond to traditional psychopharmacology. The aim of this study was to determine the efficacy and safety of intravenous ketamine infusions on the elderly population by using a case series of 6 geriatric patients with treatment-resistant depression.
Methods: Eligible patients aged 65 to 82 were given a subanesthetic ketamine hydrochloride dose of 0.5 mg/kg delivered intravenously over 40 minutes twice weekly for an acute series. If patients reported a 50% decrease in depression symptoms after the acute series of 2 to 4 infusions, they would be moved to a maintenance series of infusions, which would occur every 2 to 6 weeks on an individual basis.
Results: Of the 6 patients given ketamine, 1 failed to respond to the acute treatment phase, 4 responded to the acute infusion phase but failed to sustain a response after a range of 8 to 22 maintenance infusions, and 1 responded to the infusions but relapsed into alcohol use; therefore, treatment was discontinued.
Conclusions: The relative safety of intravenous ketamine in the elderly was demonstrated by the mild, transient adverse effects seen by this patient group. The geriatric population is unable to maintain an antidepressant response to intravenous ketamine over time, signifying that ketamine has low efficacy for the elderly.
Comparable studies
Other case reports and case series on ketamine for depression, most cited first.