Ketamine and Depression / Suicidal Ideation
1) Oliver PA, et al. “Clinical Effectiveness of Intravenous Racemic Ketamine Infusions in a Large Community Sample of Patients With Treatment-Resistant Depression, Suicidal Ideation, and Generalized Anxiety Symptoms: A Retrospective Chart Review”. Journal of Clinical Psychiatry. 2022 Nov/Dec; 83:6.
SUMMARY: A review of a community ketamine clinic found the treatment to be “excellent” for Depression and suicidal ideation, and demonstrated significant effectiveness for Generalized Anxiety. Among responders, after 6 infusions 50% of clients had achieved a clinically significant response (50% reduction in symptoms) and 20% had complete remission of Depression. Response rate increased with the number of infusions; with 10 infusions 72% of clients had at least a 50% decrease in symptoms, and 38% were in complete remission from depression. If clients saw a significant response within 10 infusions, the researchers found enough clients went on to full remission that further infusions were warranted. Additionally after 6 infusions, 50% of clients no longer had suicidal ideation, with continued improvement in suicidal ideation up to 15 infusions, at which point 85% of clients no longer had any suicidal ideation. Anxiety was also impacted by the treatment, with an average reduction of 30%. Clients with a history of psychosis and suicide planning trended towards higher response rates. The authors suggest ketamine could be a good alternative for ECT with its significant risk of long term side effects, as clinical ketamine has no long-term side effects.
2) Mcinnes, L and Q, et al. “A retrospective analysis of ketamine intravenous therapy for depression in real-world care settings”. Journal of Affective Disorders. 2022.
SUMMARY: Real world ketamine clinics are achieving significant and sustained improvements for clients with depression. The study looked at 537 clients at 178 clinics administering ketamine for depression. After an initiation series the median reduction in depression scores was 52%, an effectiveness of up to 5x that of conventional antidepressants (1). 53% of clients reduced their depression score by half or more, and 28.9% had their depression enter full remission. The durability of antidepressant effects were 60% at 8 weeks after infusions. 73% of clients with suicidal thoughts experienced a decrease in suicidal thinking, with 42% experiencing no suicidal thinking after infusions. The study suggests more severe depression responds slightly better to treatment, while 8% of clients have their depression get worse. Clients received an average of 2.6 maintenance infusions after their initial series, with an average of 46 days to first maintenance dose. Clients who responded to ketamine treatment received a higher number of maintenance infusions with a longer time to first maintenance dose. (1) Hengartner MP, Plöderl M. “Statistically Significant Antidepressant-Placebo Differences on Subjective Symptom-Rating Scales Do Not Prove That the Drugs Work: Effect Size and Method Bias Matter!” Front Psychiatry. 2018 Oct 17;9:517.
3) Murrough, Perez, et al. “Rapid and Longer-Term Antidepressant Effects of Repeated Ketamine Infusions in Treatment-Resistant Major Depression” Biological Psychiatry 2013 Aug 15; 74(4): 250–256.
SUMMARY: In this article, there were 24 patients treated with six IV infusions of ketamine (.5mg/kg) over 12 days. The overall response rate was 71% as defined as a reduction in the MADRS scale by greater than 50%. The median time to relapse after the last ketamine infusion was 18 days. 25% were symptom free at 90 days, 75% of patients had symptoms free days between 11-27 days. Side effects were reported to be a mild significant increase in dissociative symptoms. One patient had to discontinue therapy due to an increase in blood pressure that did not respond to medications (highest BP 180/115).
4) Shiroma, Johns et al. “Augmentation of response and remission to serial intravenous subanesthetic ketamine in treatment resistant depression” Journal of Affective Disorders. 2014 Feb;155:123-9.
SUMMARY: In this article, there were 14 patients treated with six IV infusions during a 12 day period. 12 subjects finished all six infusions with 92% response rate and 66% went into remission. 5 out of 11 responders remained in “response status” during the next 28 days. For the 6 out of 11 responders that relapsed, the mean time was 16 days. Response was defined as ≥50% improvement in baseline MADRS score and remission was defined as MADRS score ≤9. No subject experienced severe dissociative symptoms or hemodynamic changes that required stopping the infusions.
5) Sanacora, Frye, McDonald, et al. “A Consensus Statement on the Use of Ketamine in the Treatment of Mood Disorders” JAMA Psychiatry. April 2017;74(4):399-405.
SUMMARY: This review and consensus statement provides a general overview of the data on the use of ketamine for the treatment of mood disorders and highlights the limitations of the existing knowledge. The suggestions provided are intended to facilitate clinical decision making and encourage an evidence-based approach to using ketamine in the treatment of psychiatric disorders considering the limited information that is currently available. This article provides information on potentially important issues related
6) Calabrese, L. Titrated Serial Ketamine Infusions Stop Outpatient Suicidality and Avert ER Visits and Hospitalizations. Int J Psychiatr Res. 2019; 2(6): 1-12
SUMMARY: This community based clinic found 79% of clients achieving substantial reduction in their suicidality, and 59% with complete remission of their suicidal ideation. Clients were able to achieve remission with an average of 4.1 infusions. These results were obtained with a population that was severely depressed with a significant history of mental health challenges; 80% had failed at least 4 anti-depressants, and 53% had a previous mental health hospitalization.