Safety and tolerability of IV ketamine in adults with major depressive or bipolar disorder: results from the Canadian rapid treatment center of excellence

Rodrigues, Nelson B.; McIntyre, Roger S.; Lipsitz, Orly; Lee, Yena; Danielle, S.; Nasri, Flora; Gill, Hartej; Lui, Leanna M.W.; Subramaniapillai, Mehala; Kratiuk, Kevin; Lin, Kangguang; Ho, Roger; Mansur, Rodrigo B.; Rosenblat, Joshua D.

doi:10.1080/14740338.2020.1776699

Cited by 32 publications

(16 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Compared to conventional antidepressants, IV ketamine is differentiated by (1) efficacy in patients with TRD, (2) a relatively rapid onset of therapeutic effect, and (3) preliminary evidence for reducing suicidality [10,15]. From a tolerability and safety perspective, an additional, albeit not treatment-limiting concern with ketamine is the potential for dissociation, as well as vasopressor effects [16][17][18]. Evaluating the long-term effectiveness of ketamine is limited by a dearth of long-term controlled trial data [13,19].…”

Section: Introductionmentioning

confidence: 99%

Strategies to Prolong Ketamine’s Efficacy in Adults with Treatment-Resistant Depression

et al. 2021

Self Cite

View full text Add to dashboard Cite

Introduction Ketamine treatment is capable of significant and rapid symptom improvement in adults with treatment-resistant depression (TRD). A limitation of ketamine treatment in TRD is the relatively short duration of time to relapse (e.g., median 2–4 weeks). The objective of the systematic review herein is to identify strategies capable of prolonging the acute efficacy of ketamine in adults with TRD. Methods PubMed/MEDLINE databases were searched from inception to December 2020 for clinical studies written in English using the following key terms: ketamine, prolong, and depression. A total of 454 articles were identified from the literature search which included all clinical studies regarding prolonging the antidepressant effects of ketamine. Twenty-two articles were included: ten randomized controlled trials (RCTs), eight prospective open-label trials, one retrospective chart review, and three case reports. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for data extraction. The primary outcome was prolonged effect, defined as statistically significant antidepressant effects following acute ketamine treatment. Results A total of 454 articles were identified, and 22 articles were included. Different treatment modalites including pharmacological interventions, manualized-based psychotherapies, electroconvulsive therapy, transcranial magnetic stimulation, and intravenous monotherapy were examined to determine their impact on the prolongation of antidepressant effects following acute ketamine treatment. No treatment modality, other than repeat-dose IV ketamine, has demonstrated ability to significantly prolong the acute efficacy of IV ketamine in TRD. Conclusion Hitherto, available open-label data and controlled trial data support repeat administration of IV ketamine as an effective strategy to prolong the efficacy of ketamine’s antidepressant effects (although not the focus of the study herein, maintenance repeat-dose esketamine treatment is proven effective in esketamine responders). There is a need to identify multimodality strategies that are safe and capable of prolonging the efficacy of ketamine in adults with TRD.

show abstract

Section: Introductionmentioning

confidence: 99%

Strategies to Prolong Ketamine’s Efficacy in Adults with Treatment-Resistant Depression

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…Cardiovascular and psychomimetic side effects were mild, attenuated by subsequent infusions and did not cause treatment discontinuation. 18,[47][48][49] We also did not observe treatment for emergent psychiatric conditions like psychosis or mania. This observation confirms that ketamine treatment is safe in bipolar disorder patients with comorbidities.…”

Section: Discussionmentioning

confidence: 99%

Intravenous Ketamine Infusions in Treatment-Resistant Bipolar Depression: An Open-Label Naturalistic Observational Study

Wilkowska¹,

Włodarczyk²,

Gałuszko-Węgielnik³

et al. 2021

NDT

View full text Add to dashboard Cite

Purpose Bipolar disorder is a chronic and recurrent condition often associated with treatment resistance and suicidality. There is an unmet need for effective treatment in this group of patients. Ketamine has been demonstrated to have antidepressant and antisuicidal properties in unipolar depression. Most of the available studies concern unipolar depression. Here, we present the efficacy and safety of IV ketamine as an add-on treatment in patients with bipolar I and bipolar II depression. Patients and Methods Thirteen patients with treatment-resistant bipolar depression (TRBD) received eight IV infusions of 0.5 mg/kg ketamine twice a week over four weeks. This is an open-label naturalistic observational study. Ketamine is an add-on treatment. Depressive symptoms were measured with the Montgomery–Asberg Depression Rating Scale (MADRS), and manic symptoms were measured with the Young Mania Rating Scale (YMRS). Psychomimetic symptoms were assessed with the Clinician-Administered Dissociative States Scale (CADSS) and the Brief Psychiatric Rating Scale (BPRS). Results The rates of response and remission after the seventh infusion of ketamine were 61.5% and 46.2%, respectively. A significant antisuicidal effect was observed in responders at the 7th infusion. Suicidality was measured with item 10 on the MADRS scale. The average time to respond was between 21.1 and 23.2 days to remission. There was an increase in the CADSS scores during the treatment compared to baseline and follow-up, but no differences between responders and non-responders were observed. No affective switch was observed according to the YMRS scale scores. Ketamine treatment was associated with a transient increase in arterial blood pressure. No serious adverse events, however, were observed. Conclusion This report presents the preliminary results of IV ketamine effectiveness and safety in treatment-resistant bipolar depression. The findings suggest that it is a feasible, safe and well-tolerated treatment option in this group of patients. There is a definite need for more studies in this field.

show abstract

“…The methods of this study as well as safety and tolerability of IV ketamine have been previously described in detail. 31,32 In brief, adults (18+) with TRD received four infusions of IV ketamine over 1 to 2 weeks at a community-based outpatient clinic, the Canadian Rapid Treatment Center of Excellence (CRTCE). In the initial two infusions, all patients received a dose of 0.5 mg/kg of ketamine hydrochloride diluted in 0.9% saline solution.…”

Section: Methodsmentioning

confidence: 99%

“…This study was registered at clinicaltrials.gov under the identifier NCT04209296 and was approved by a community institutional review board (IRB#00000971). The methods of this study as well as safety and tolerability of IV ketamine have been previously described in detail 31 32 …”

Section: Methodsmentioning

confidence: 99%

Does body mass index predict response to intravenous ketamine treatment in adults with major depressive and bipolar disorder? Results from the Canadian Rapid Treatment Center of Excellence

et al. 2020

Self Cite

View full text Add to dashboard Cite

Background Higher body mass index (BMI) has been found to predict greater antidepressant response to intravenous (IV) ketamine treatment. We evaluated the association between BMI and response to repeat-dose IV ketamine in patients with treatment-resistant depression (TRD). Methods Adults (N = 230) with TRD received four infusions of IV ketamine at a community-based clinic. Changes in symptoms of depression (ie, Quick Inventory for Depressive Symptomatology-Self-Report 16; QIDS-SR16), suicidal ideation (SI; ie, QIDS-SR16 SI item), anxiety (ie, Generalized Anxiety Disorder-7 Scale), anhedonic severity (ie, Snaith–Hamilton Pleasure Scale), and functioning (ie, Sheehan Disability Scale) following infusions were evaluated. Participants were stratified by BMI as normal (18.0-24.9 kg/m2; n = 72), overweight (25-29.9 kg/m2; n = 76), obese I (30-34.9 kg/m2; n = 47), or obese II (≥35.0 kg/m2; n = 35). Results Similar antidepressant effects with repeat-dose ketamine were reported between BMI groups (P = .261). In addition, categorical partial response (P = .149), response (P = .526), and remission (P = .232) rates were similar between the four BMI groups. Conclusions The findings are limited by the observational, open-label design of this retrospective analysis. Pretreatment BMI did not predict response to IV ketamine, which was effective regardless of BMI.

show abstract

Safety and tolerability of IV ketamine in adults with major depressive or bipolar disorder: results from the Canadian rapid treatment center of excellence

Cited by 32 publications

References 37 publications

Strategies to Prolong Ketamine’s Efficacy in Adults with Treatment-Resistant Depression

Strategies to Prolong Ketamine’s Efficacy in Adults with Treatment-Resistant Depression

Intravenous Ketamine Infusions in Treatment-Resistant Bipolar Depression: An Open-Label Naturalistic Observational Study

Does body mass index predict response to intravenous ketamine treatment in adults with major depressive and bipolar disorder? Results from the Canadian Rapid Treatment Center of Excellence

Contact Info

Product

Resources

About