The effectiveness of repeated intravenous ketamine on depressive symptoms, suicidal ideation and functional disability in adults with major depressive disorder and bipolar disorder: Results from the Canadian Rapid Treatment Center of Excellence

Jul 16, 2020Journal of affective disorders

Repeated intravenous ketamine and its effects on depression, suicidal thoughts, and daily functioning in adults with major depression and bipolar disorder

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Abstract

A significant improvement in total depressive symptoms severity (p < 0.0001) was observed after four infusions of IV ketamine 0.5-0.75 mg/kg.

The response rate for IV ketamine treatment was 27%, while the remission rate was 13%.
Anxiolytic effects were noted, with significant reductions in anxiety symptoms (p < 0.0001).
Overall psychosocial function showed significant improvement (p < 0.0001).
Suicidal ideation was significantly reduced (p < 0.0001).
Dissociation severity decreased in subsequent infusions compared to the baseline.

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BACKGROUND: The effectiveness, tolerability, and safety of intravenous (IV) ketamine in adults with treatment resistant depression (TRD) receiving care in real-word settings is insufficiently characterized. Herein, results from a naturalistic, retrospective study are presented from a Canadian outpatient IV ketamine clinic.

METHODS: Adults (N = 213; M = 45) with Major Depressive Disorder or Bipolar Disorder, with a minimum of Stage 2 antidepressant resistance, received IV ketamine at a community-based multi-disciplinary clinic. The primary outcome measure was change from baseline to post-infusion 4 on the Quick Inventory for Depression Symptomatology-Self Report-16 (QIDS-SR; n = 190). Secondary measures included QIDS-SR-measured response and remission rates, changes from baseline to endpoint in Generalized Anxiety Disorder-7 Scale (GAD-7; n = 188) and the Sheehan Disability Scale (SDS; n = 168). age16 16

RESULTS: Significant improvement in total depressive symptoms severity (p < 0.0001) was observed after four infusions of IV ketamine 0.5-0.75 mg/kg. Moreover, the response rate (QIDS-SRtotal score change ≥ 50%) was 27% and remission (QIDS-SRtotal score ≤5) rate was 13%. Patients receiving IV ketamine exhibited anxiolytic effects (p < 0.0001,), improved overall psychosocial function (p < 0.0001), and reduced suicidal ideation (p < 0.0001). Compared to the baseline infusion, dissociation severity significantly reduced in subsequent infusions. 16 16

LIMITATIONS: This was a naturalistic, retrospective study, without a control group.

CONCLUSIONS: IV ketamine was safe, well-tolerated, and effective at improving depressive, anxiety, and functional impairment symptoms in a well-characterized cohort of adults with TRD.

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The effectiveness of repeated intravenous ketamine on depressive symptoms, suicidal ideation and functional disability in adults with major depressive disorder and bipolar disorder: Results from the Canadian Rapid Treatment Center of Excellence

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