Intravenous ketamine "burst" for refractory depression in a patient with advanced cancer.
Lilianna Stefanczyk-Sapieha, Doreen Oneschuk, Michael Demas
Journal of Palliative Medicine November 2008 DOI: 10.1089/jpm.2008.9828 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case study Randomized Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | A patient with metastatic prostate cancer and intractable major depressive disorder |
| Intervention | Ketamine |
| Dose | 0.5 mg/kg infused over 60 minutes |
| Topics | Depression Esketamine Ketamine |
| Key findings | In a patient with metastatic prostate cancer and intractable major depressive disorder, intravenous ketamine 'bursts' produced an initial positive response that was not sustained, and a repeat treatment yielded an even more transient response; adverse effects were mild and self-limiting. The authors conclude that a randomized study is needed to establish ketamine's role and dosing in this population. |
Abstract
Major Depressive Disorder (MDD) is prevalent in patients with advanced cancer, and can have a negative impact on patients' quality of life. Available antidepressants, often have delayed benefits of several weeks, and therefore are of limited utility in the palliative care setting. Psychostimulants provide more rapid onset of action, but frequently require dose escalation because of problems with tolerance. There is a growing body of evidence that N-methyl-D-aspartate (NMDA) receptor antagonists, such as ketamine, signficantly and rapidly improve depressive symptoms in treatment resistant depression. However, studies conducted to date have not included advanced cancer patients. We report on a case where intravenous ketamine 'bursts' (0.5 mg/kg infused over 60 minutes) were used to treat an intractable MDD in a patient with metastatic prostate cancer. Initial positive response was not sustained, and response to a repeat treatment was even more transient. Adverse effects were mild and self-limiting. We conclude that a well-designed, randomized study of IV ketamine "bursts" in cancer patients suffering from depression is needed to further establish the role and appropriate dosing of ketamine in this patient population. Given that ketamine can be used as an adjuvant for difficult pain syndromes in cancer patients, it would be of interest to assess its impact on the mood in patients receiving this treatment for pain.
Comparable studies
Other case reports and case series on ketamine for depression, most cited first.
Citations in the library
Cited by 18
- Ketamine and Other NMDA Antagonists: Early Clinical Trials and Possible Mechanisms in Depression American Journal of Psychiatry October 1, 2015
- Side-effects associated with ketamine use in depression: a systematic review. The Lancet Psychiatry 2018
- Real-world effectiveness of ketamine in treatment-resistant depression: A systematic review & meta-analysis. Journal of Psychiatric Research May 1, 2022
- A Phase II, Open-Label Clinical Trial of Intranasal Ketamine for Depression in Patients with Cancer Receiving Palliative Care (INKeD-PC Study) Cancers January 7, 2023
- Ketamine and Ketamine-Assisted Psychotherapy for Psychiatric and Existential Distress in Patients with Serious Medical Illness: A Narrative Review. Journal of Palliative Medicine January 22, 2025
and 13 more in the library