How Intravenous Ketamine Use Helps Manage and Treat Depression

Patients with treatment resistant depression tolerate ketamine therapy well, with many recording improvements in their depressive symptomatology score (QIDS-SR16) A chart review was carried out among patients with treatment resistant depression who were being treated at the Massachusetts General Hospital Intravenous Ketamine Clinic for Depression, on an outpatient basis. The study results were then published in the “Journal of Affective Disorders.”

The researchers assessed the outcomes different outpatients experienced at the ketamine clinic between October 2018 and November 2019. The study involved 85 patients with treatment resistant depression. Before IV ketamine was administered during every visit, the severity of the participants’ symptoms was measured using the QIDS-SR16.

The initial ketamine dose was infused during a 40-minute period. Within the induction phase, IV ketamine was dispensed twice a week for a three-week period. This was followed up with a maintenance phase, which used an administration schedule and variable dose. The IV ketamine prompted an almost 50% decline in the total QIDS-SR19 score.

In general, 40 out of the 85 patients who had begun treatment discontinued immediately or during the induction phase. When the report was published, 3 of the 85 outpatients were still undergoing induction therapy while another 42 had moved into the maintenance phase after the induction phase was completed. Among these participants, 28 continued with maintenance therapy, and 16.5% discontinued the treatment before the second therapy phase was completed.

In the maintenance phase, the ketamine dosage was roughly 0.91 ± 0.28 milligrams per kilogram. 15 participants responded to induction therapy with 6 of them remaining in responder status throughout the maintenance phase, at the time when the data was being analyzed. In 3 unfortunate patients, ketamine therapy was discontinued due to side effects.

The study had a few limitations, starting with the high dropout rate, which may have been impacted by the cost of a ketamine infusion. This treatment is not covered by insurance at the moment. The study also followed the patients naturalistically, as it was a retrospective chart review, with the likelihood of patients changing their psychotherapy regimen or antidepressants based on recommendations from their treating psychiatrist.

The researchers noted that in spite of the QIDS-SR16 scores getting low response rates and the substantial costs incurred, almost half of all the outpatients with treatment resistant depression continued their ketamine treatment because of the significant improvement they experienced. Comparative effectiveness studies are allowed to help determine the frequency of treatment and the optimal dose that patients with treatment resistant depression need as well as to identify the role ketamine plays in the treatment process for depression.

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