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The following is a summary of “Ketamine and chronic treatment-resistant depression: real-world practice and after relapse,” published in the October 2024 issue of Psychiatry by Jobnah et al.
Chronic treatment-resistant depression (TRD) presents significant challenges for clinicians, with ketamine showing a rapid but brief antidepressant effect in diverse patient studies.
Researchers conducted a prospective study to assess the antidepressant effects of serial ketamine infusions in patients with chronic TRD and evaluate symptom severity and overall psychiatric health after relapse.
They administered 6 infusions of ketamine at 0.5 mg/kg to patients with chronic TRD over 2 weeks in this single-arm open-label study, evaluating response rates, side effects, and after-relapse symptoms over 3 months.
The results showed that 23 patients underwent at least 1 infusion, with 18 completing 6 sessions. About 12 (66.67%) patients responded, and 11 (61.11%) maintained response afterward, 1 infusion was insufficient for a response (P > 0.9999, z = 1.81), while over half of responders met criteria after the third infusion. Only 1 patient (5.56%) achieved remission, and all but 1 responder relapsed within 1 month. No statistical difference was found between baseline and after-relapse Montgomery-Åsberg Depression Rating Scale (MADRS) scores (P = 0.7886, 95% CI=-5.512-4.312, R2 = 0.008411). A high incidence of serious suicidality-related adverse events (AEs) was noted, with 1 non-responder attempting suicide and 2 responders experiencing suicidal thoughts or attempts.
The study concluded that further investigation is needed on the use of rapid-acting antidepressants for TRD, particularly concerning the benefit-to-harm ratio and suicidality risks.
Source: bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-024-06203-2#Abs1
