Low-dose ketamine for treatment resistant depression in an academic clinical practice setting.
David Feifel, Benjamin Malcolm, Danielle Boggie, Kelly C. Lee
Journal of Affective Disorders October 15, 2017 DOI: 10.1016/j.jad.2017.06.043 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Retrospective chart review Peer reviewed |
|---|---|
| Sample size | 41 |
| Population | Adult treatment-resistant depression patients with major depressive disorder or bipolar disorder participating in a real-world treatment program at the University of California, San Diego; mean age 48.6 years, 78% white, 36.6% female, 82.9% with MDD, 73% with significant psychiatric comorbidity |
| Intervention | Ketamine |
| Dose | 0.5 mg/kg |
| Duration | IV infusion over forty minutes; outcomes assessed at 24 hours and 7 days |
| Measures | Beck Depression Inventory (BDI) |
| Topics | Depression Ketamine Esketamine |
| Keywords | Bipolar disorder Treatment-resistant |
| Key findings | In a naturalistic sample of 41 treatment-resistant depression patients, average Beck Depression Inventory scores dropped from 32.6 before infusion to 16.8 at 24 hours after a single sub-anesthetic ketamine infusion. At 24 hours, 53.7% met response criteria and 41.5% met remission criteria, and three-quarters of responders remained responders at 7 days. The authors suggest the treatment is effective and well tolerated in this broader population, while noting the retrospective design and lack of a control group. |
Abstract
Recent studies demonstrating a rapid, robust improvement in treatment resistant depression (TRD) following a single sub-anesthetic infusion of ketamine have generated much excitement. However, these studies are limited in their generalizability to the broader TRD population due to their subject exclusion criteria which typically limit psychiatric comorbidity, concurrent medication, and level of suicide risk. This paper describes the safety and efficacy of sub-anesthetic ketamine infusions in a naturalistic TRD patient sample participating in a real-world TRD treatment program within a major university health system. The effects of a sub-anesthetic dose (0.5mg/kg) of ketamine infused IV over forty minutes on TRD patients participating in a treatment program at the University of California, San Diego was investigated by retrospectively analyzing the medical charts of 41 adult TRD patients with a diagnosis of Major Depressive Disorder (MDD) or Bipolar Disorder (BD). Subjects were aged 48.6, 78% white, 36.6% female, and 82.9% had MDD. Significant psychiatric comorbidity existed in 73%. Average pre-infusion BDI score was 32.6 ± 8.4 (S.D) and dropped to 16.8 ± 3.1 at 24-h post-infusion (p < 0.001). The 24-h response (≥ 50% reduction from pre-infusion) and remission (BDI <13) rates were 53.7% and 41.5%, respectively. Three quarters of responders maintained responder status at 7-days. Ketamine infusions were well tolerated with occasional nausea or anxiety and mild hemodynamic effects during the infusion. Retrospective nature of this study, lack of control group and use of self-report depression ratings scales. This is the first published study of sub-anesthetic ketamine infusions in a real-world TRD population. The results suggest that this treatment is effective and well tolerated in this population.
Comparable studies
Other observational and cohort studies on ketamine for depression, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Concomitant BDNF and sleep slow wave changes indicate ketamine-induced plasticity in major depressive disorder Patients with treatment-resistant major depressive disorder | 2012 | Observational cohort | n = 30 |
| Altered peripheral immune profiles in treatment-resistant depression: response to ketamine and prediction of treatment outcome Healthy controls and actively depressed patients with treatment-resistant depression... | 2017 | Observational cohort | n = 59 |
| Clinical Predictors of Ketamine Response in Treatment-Resistant Major Depression Treatment-resistant inpatients with DSM-IV-TR-diagnosed major depressive disorder or... | 2014 | Post hoc analysis of pooled data from four studies | n = 108 |
| An investigation of amino-acid neurotransmitters as potential predictors of clinical improvement to ketamine in depression Drug-free patients with major depressive disorder | 2011 | Observational cohort | n = 14 |
| Efficacy of ketamine therapy in the treatment of depression Drug-free/naïve men with severe depression, no history of psychotic disorder, head... | 2019 | Observational cohort | n = 25 |
Citations in the library
Cited by 15
- A Phase 2 Open Label Study of Efficacy, Safety, and Tolerability of SLS-002 (Intranasal Racemic Ketamine) in Adults with MDD at Imminent Risk of Suicide. Psychopharmacology Bulletin March 4, 2024
- Efficacy of single and repeated administration of ketamine in unipolar and bipolar depression: a meta-analysis of randomized clinical trials Pharmacological Reports April 16, 2020
- Racemic Ketamine as an Alternative to Electroconvulsive Therapy for Unipolar Depression: A Randomized, Open-Label, Non-Inferiority Trial (KetECT) The International Journal of Neuropsychopharmacology December 4, 2021
- Neuropharmacological modulation of the aberrant bodily self through psychedelics Neuroscience & Biobehavioral Reviews December 6, 2019
- A longitudinal case series of IM ketamine for patients with severe and enduring eating disorders and comorbid treatment‐resistant depression Clinical Case Reports April 4, 2021
and 10 more in the library
Cites 14
- A Randomized Trial of an N-methyl-D-aspartate Antagonist in Treatment-Resistant Major Depression Archives of General Psychiatry August 1, 2006
- Antidepressant Efficacy of Ketamine in Treatment-Resistant Major Depression: A Two-Site Randomized Controlled Trial American Journal of Psychiatry August 28, 2013
- A Randomized Add-on Trial of an N-methyl-D-aspartate Antagonist in Treatment-Resistant Bipolar Depression Archives of General Psychiatry August 1, 2010
- A Double-Blind, Randomized, Placebo-Controlled, Dose-Frequency Study of Intravenous Ketamine in Patients With Treatment-Resistant Depression American Journal of Psychiatry April 8, 2016
- The use of ketamine as an antidepressant: a systematic review and meta‐analysis Human Psychopharmacology: Clinical and Experimental April 7, 2015
and 9 more in the library