Objective: The aim of this paper is to present the clinical data analysis results from a service delivering ketamine infusion, repetitive transcranial magnetic stimulation (rTMS) and electroconvulsive therapy for people with treatment resistant depression (TRD). Methods: The study was a retrospective investigation of routinely collected data on patients receiving ketamine infusion between 2017 and 2019. Measures used were the clinician-rated Clinical Global Impression (CGI) and self-reported Beck Depression Inventory (BDI) and Quick Inventory of Depressive Symptomatology (QIDS-SR). The outcome data of 28 patients with TRD were analysed. A minimum course of treatment was defined as three ketamine infusions. Results: Response combined with partial response, response, and remission rates respectively were 42.3%, 23.1% and 4.2% for the BDI; 18.2%, 9.1% and 0% for the QIDS-SR; 50%, 18.2% and 4.6% for the CGI. There was a statistically significant improvement on the BDI with a medium effect size (0.63). There was not a significant improvement in the CGI or QIDS-SR. Conclusions: The results show a mixed picture the impact ketamine on symptoms of depression in TRD over the course of multiple infusions. The results need to be viewed in the context of clinical outcome data collection: outcome scores are taken prior to treatment and so are at a point when ketamine is not having an active effect. The findings can inform the availability of ketamine infusion as a treatment option for TRD where treatment adhering to national guidelines has not succeeded. A qualitative investigation of the experience of people receiving ketamine would provide further insights.
Purpose This study aims to evaluate the effect of Alpha-Stim Anxiety, Insomnia and Depression (AID) cranial electrotherapy stimulation (CES) on anxiety, depression and health-related quality of life for primary care social prescribing service patients with anxiety symptoms. Design/methodology/approach Open-label patient cohort design with no control group. A total of 33 adult patients (average age 42 years) completed six weeks of Alpha-Stim AID use. Pre- and post-intervention assessment with participant self-report measures: Patient Health Questionnaire (PHQ-9), Generalised Anxiety Disorder (GAD-7) and European Quality of Life Five Dimension (EQ-5D-5L). Findings Reliable improvement and remission rates, respectively, were 53.39% and 33.3% for GAD-7; 46.7% and 29.5% for PHQ-9. There was a significant improvement in GAD-7 and PHQ-9 with large effect sizes. EQ-5D-5L results showed significant improvements in health-related quality of life. Perceived quality of life increased by 0.17 on the health index score, with the intervention adding 1.68 quality-adjusted life years (QALYs). Practical implications Alpha-Stim AID can be delivered through a primary health-care social prescribing service and most patients will use as prescribed and complete treatment course. Alpha-Stim AID CES may be an effective anxiety and depression treatment for people with anxiety symptoms. The widespread roll-out of Alpha-Stim AID in health-care systems should be considered. Originality/value To the best of the authors’ knowledge, this is the first study to respond to the UK’s National Institute for Health and Care (NICE) request for the collection of real-world data to understand better Alpha-Stim AID in relation to people’s treatment uptake, response rates and treatment completion rates (NICE, 2021).
Background: Symptoms of anxiety disorders are highly common and can have a severe impact on people's lives; they are typically treated with psychotherapy and/or anti-anxiety medication. These treatments are not suitable for, acceptable to, or effective for everyone. Alpha-Stim AID is a cranial electrotherapy stimulation (CES) device with evidence of effectiveness in treating symptoms of anxiety. In this study, Alpha-Stim AID was offered through a United Kingdom (UK) universal community healthcare provider, Intermediate Care Team (ICT) community healthcare service to patients who reported signs of anxiety. Objective: The aim of this paper is to present feasibility findings and outcomes on anxiety, health status, and quality of life. Methods: Open-label patient cohort design, with no control group. Participants were adults who reported symptoms of anxiety and were under the care of universal national health service (NHS) Intermediate Care Team (ICT) community healthcare service in the United Kingdom (UK). Pre-and post-intervention assessment used participant self-report measures: generalised anxiety disorder (GAD-7) and health related quality of life (EQ-5D-5L). The three ICT staff members who offered the Alpha-Stim AID to patients completed a questionnaire on their experience. Results: Eighteen patients used the Alpha-Stim and completed outcome measures. GAD-7 scores significantly improved from 13.9 (SD = 4.3) to 7.3 (SD = 5.7) (p < 0.001), with a large effect size of 0.88. Analysis of EQ-ED-5L health index score conversions indicated perceived quality of life increased from 0.31 (SD = 0.25) to 0.48 (SD = 0.28) at end (p = 0.036), with a small effect size of 0.12. EQ-VAS scores at baseline improved from 49.2 (SD = 24.0) to 64.4 (SD = 26.2) at the end (p = 0.05), with a small effect size of 0.
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