Case Report: Repeated Series of Ketamine Infusions in Patients With Treatment-Resistant Depression: Presentation of Five Cases

Abstract

Purpose: Approximately 30% of patients with major depressive disorder (MDD) are treatment resistant. There is an unquestionable need for new treatment strategies. Subanesthetic doses of intravenous (IV) ketamine have a rapid antidepressant effect in treatment-resistant depression (TRD). This paper describes the efficacy of repeated series of intravenous ketamine infusions as an add-on treatment in five TRD inpatients.Methods: Eligible patients aged 43–63 were given eight ketamine infusions as an add-on treatment for patients with MDD. The subjects have readministered the intervention due to worsening depressive symptoms.Results: Of the five inpatients given ketamine as a series of eight infusions, one underwent three, and four had two treatment series. Four patients achieved remission after first series and three after the second series of ketamine infusions. The adverse reactions were mild and transient with no sequelae.Limitations: Presented case series applies to short-term intervention with IV ketamine as an add-on therapy. The results cannot be generalized to the long-term maintenance treatment nor other ketamine formulations as well as different administration schedules and dosing.Conclusions: This case series showed efficacy and safety of the repeated series of IV ketamine treatment in TRD in MDD and bipolar disorder type I. The subsequent interventions were safe and observed adverse events were mild and transient. Interestingly, the IV ketamine treatment at successive administrations seems to alter the major depression severity of the next affective episode. There is a critical need for further research regarding IV ketamine treatment effectiveness and long-term safety in future studies.

Ketamine Infusion in a Resistant Obsessive-Compulsive Disorder Patient in Bangladesh with Severe Suicidal Ideation: A Case Report

“…Regarding the minimization of depressive symptoms in the current case, it is in line with the findings of multiple recent research that repeated infusions of ketamine produced a more potent and sustained reduction in depressive symptoms [91][92][93][94][95]. The key findings of this case report are illustrated in Figure 1.…”

Beyond Therapeutic Potential: A Systematic Investigation of Ketamine Misuse in Major Depressive Disorder Patients

“…Bryant et al [27] characterized a group of six elderly patients who had received short and long-term maintenance phases of ketamine infusions. Five out of six patients demonstrated a signi cant reaction which indicates the promising effects of ketamine infusion [21].…”

“…0.5 mg/kg of arketamine indicated a decrease in MADRS scores with essentially no signs of dissociation. Researchers suggest that arketamine may cause quick-to-act and persistent human effects of antidepressants with an adequate safety pro le [21].…”

Beyond therapeutic potential: a systematic investigation of ketamine misuse in patients with depressive disorders

“…Bryant et al [ 27 ] characterized a group of six elderly patients who had received short and long-term maintenance phases of ketamine infusions. Five of six patients demonstrated a significant reaction, indicating the promising effects of ketamine infusion [ 28 ].…”

“…Administration of 0.5 mg/kg arketamine resulted in a decrease in the Montgomery-Asberg Depression Rating Scale (MADRS) scores with minimal signs of dissociation. This distinction between esketamine (S)-ketamine and arketamine is essential, as both enantiomers may offer unique therapeutic benefits and safety profiles in the treatment of MDD [ 28 ]. Wei et al asserted that NMDAR is frequently involved in the mechanism by which antidepressants function with arketamine.…”