Administration of ketamine for unipolar and bipolar depression

Kraus, Christoph; Rabl, Ulrich; Vanicek, Thomas; Carlberg, Laura; Popović, Aleksandra; Spies, Marie; Bartova, Lucie; Gryglewski, Gregor; Παπαγεωργίου, Κ.; Willeit, Matthäus; Winkler, Dietmar; Rybakowski, Janusz; Kasper, Siegfried

doi:10.1080/13651501.2016.1254802

Cited by 91 publications

(61 citation statements)

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“…Adverse effects tend to be brief in acute treatment with low doses, but they are more problematic at higher doses or over longer periods of administration [53]. Although acute treatment with ketamine may be neuroprotective, a more prolonged exposure may predispose to neurotoxicity and drug dependence [30]; other long-term adverse effects are not known [45, 47]. …”

Section: What About Ketamine?mentioning

confidence: 99%

“…A single intravenous dose of ketamine as monotherapy for MDD produces a rapid antidepressant effect that peaks within 24 h, with an overall OR of 7.55 in controlled studies [49]. A review of 12 studies in unipolar depression and 7 in bipolar depression found an overall response rate of 61% at 24 h, with ketamine always being superior to placebo for symptom reduction and for response [47]. However, there has only been one dose-finding study [50], and the optimal dose for an individual patient remains to be determined [8].…”

Section: What About Ketamine?mentioning

confidence: 99%

“…Common adverse effects of ketamine include dizziness, neurotoxicity, cognitive dysfunction, blurred vision, psychosis, dissociation, restlessness, headache, nausea, vomiting, and cardiovascular and urological dysfunction [47, 53, 54]. Adverse effects tend to be brief in acute treatment with low doses, but they are more problematic at higher doses or over longer periods of administration [53].…”

Section: What About Ketamine?mentioning

confidence: 99%

“…However, as noted earlier, ketamine has a number of other actions, including antagonism of nicotinic and muscarinic cholinergic receptors [23], inhibition of GSK3β [24], increased release of norepinephrine and dopamine in the bed nucleus of the stria terminalis [44], and binding to μ-opioid receptors [30], among others. In subanesthetic doses, intravenous ketamine has been found to be rapidly effective for symptoms of treatment-resistant unipolar and possibly bipolar depression, and acute suicidal ideation [45-47], with other applications having a much smaller evidence base [48]. A single intravenous dose of ketamine as monotherapy for MDD produces a rapid antidepressant effect that peaks within 24 h, with an overall OR of 7.55 in controlled studies [49].…”

Section: What About Ketamine?mentioning

confidence: 99%

See 3 more Smart Citations

What Is New about New Antidepressants?

Dubovsky¹

2018

Psychother Psychosom

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Section: What About Ketamine?mentioning

confidence: 99%

Section: What About Ketamine?mentioning

confidence: 99%

Section: What About Ketamine?mentioning

confidence: 99%

Section: What About Ketamine?mentioning

confidence: 99%

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What Is New about New Antidepressants?

Dubovsky¹

2018

Psychother Psychosom

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“…13 Several trials of KIT have reported 25%-79% reductions in severity of depressive symptoms. 6,9,13 Ketamine also rapidly reduced suicidal thoughts in depressed patients within 1 day of treatment, which was partially independent of ketamine's effect on mood. 6,9,13 Ketamine also rapidly reduced suicidal thoughts in depressed patients within 1 day of treatment, which was partially independent of ketamine's effect on mood.…”

Section: Introductionmentioning

confidence: 91%

Intravenous ketamine infusion for a patient with treatment-resistant major depression: a 10-month follow-up

et al. 2018

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Ketamine for the Treatment of Depression

Kraus

Kasper

2017

JAMA Psychiatry

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COMMENT & RESPONSE Ketamine for the Treatment of DepressionTo the Editor We congratulate Sanacora et al 1 for the publication of their consensus statement in JAMA Psychiatry. The growing amount of literature on this topic has generated interest among patients and physicians, which called for such an important document as the basis for decision-making societies, health care professionals, and regulatory authorities. Until official approval of depression as an indication, offlabel uses by medical experts assuming legal, scientific, and medical hazards will increase. On the other hand, ketamine clinics or ketamine wellness centers already offer ketamine as outpatient treatment with unscientific and dangerous methods. To overcome the lack of regulation, consensus statements and their dissemination are of utmost importance.Off-label administration of psychopharmaceuticals is very common in adult psychiatric practice, eg, quetiapine as an augmentative antidepressant, and pivotal in child and adolescent psychiatry. A previous study in the United States estimated that around 21% of all prescriptions in 2001 were off-label, with the highest rates for anticonvulsants (74%), antipsychotics (60%), and antibiotics (41%). 2 Furthermore, figures showed that a substantial amount of off-label prescriptions (73%) lacked scientific support. Indeed, recommendations on off-label use have suggested that evaluation of evidence to justify an off-label use is of utmost importance for prescribers, and justification of offlabel prescriptions is strongest when rigorous research supports it. 3 While existing studies and this consensus statement on ketamine in treatment-resistant major depression warrant ethical standards in off-label treatment as far as short-term improvements are concerned, long-term use data on preventing relapses are missing. Hence, the suggestion by Sanacora et al 1 to discontinue ketamine based on lack of efficacy is crucial. Moreover, current literature is scarce in conditions other than major depression, so thorough patient evaluation is indispensable. Hence, close psychiatric examination and evaluation contradict ketamine administration by nonpsychiatric specialists.An ethical and legal framework for off-label use in the European Union shows that demonstration of a "careful physician," eg, in a courtroom, is crucial to avoid medical malpractice. 4 This includes standards in patient information and informed consent. Although explaining ketamine treatment to patients with acute depression might be a complicated task, ethi-cal and legal standards demand informed consent, which is well acknowledged in the preprocedural evaluation table in the article. 1 We recently published an informed consent form available for clinical use. 5 This might further promote high standards in antidepressant ketamine treatment and avoid clinical errors, which could be a potential setback to propagation of a beneficial treatment for treatment-resistant patients.

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Administration of ketamine for unipolar and bipolar depression

Cited by 91 publications

References 62 publications

What Is New about New Antidepressants?

What Is New about New Antidepressants?

Intravenous ketamine infusion for a patient with treatment-resistant major depression: a 10-month follow-up

Ketamine for the Treatment of Depression

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