Cases Report: Intravenous Ketamine Infusion for Treatment-Resistant Depression

  • Munchukorn Leelatanon Department of Psychiatry, Faculty of Medicine, Chulalongkorn University
  • Teerayuth Rungnirundorn Department of Psychiatry, Faculty of Medicine, Chulalongkorn University
  • Pornpan Chalermkitpanit Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University
  • Paul Thisayakorn Department of Psychiatry, Faculty of Medicine, Chulalongkorn University
Keywords: Ketamine; treatment-resistant depression; major depressive disorder

Abstract

Objective : To report the results of intravenous ketamine infusion in treatment resistant
mood disorders.
Method : We report 2 patients (treatment resistant bipolar disorder, currently major
depressive episode, and major depressive disorder) who received ketamine infusion
treatment. The clinical data, ketamine infusion process, benefits and adverse effects
were described. Previous studies on ketamine mechanism and therapeutic use was
briefly reviewed.
Results : The depressive symptoms of both cases improved. Both patients reached
the criteria for treatment response within 1 week then remitted clinically within 3-4 weeks.
Significant decreasing of suicidal ideation was also reported. No remarkable adverse
effects from ketamine infusion occurred.
Conclusion : Intravenous ketamine infusion therapy for treatment resistant major
depressive episode was beneficial and safe in these 2 cases. Further researches
regarding its efficacy and safety should be conducted to support the efficacy and
safety of this novel treatment method in Thailand.

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References

Organization WH. Depression and other common mental disorders: global health estimates. World Health Organization; 2017.

Rush AJ, Trivedi MH, Wisniewski SR, Nierenberg AA, Stewart JW, Warden D, et al. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J Psychiatry 2006; 163: 1905-17.

Kennedy SH, Lam RW, McIntyre RS, Tourjman SV, Bhat V, Blier P, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical guidelines for the Management of Adults with Major Depressive Disorder: Section 3. Pharmacological Treatments. Can J Psychiatry 2016; 61: 540-60.

Napierala M, Bodnar A, Chlopocka-Wozniak M, Permoda-Osip A, Rybakowski J. Electroconvulsive therapy and autobiographical memory in patients with treatment-resistant depression. Psychiatr Pol 2019; 53: 589-97.

Lin CH, Yang WC. The Relationship between Symptom Relief and Psychosocial Functional Improvement during Acute Electroconvulsive Therapy for Patients with Major Depressive Disorder. Int J Neuropsychopharmacol 2017; 20: 538-45.

Kho KH, van Vreeswijk MF, Simpson S, Zwinderman AH. A meta-analysis of electroconvulsive therapy efficacy in depression. J ect 2003; 19: 139-47.

Phillips JL, Norris S, Talbot J, Birmingham M, Hatchard T, Ortiz A, et al. Single, Repeated, and Maintenance Ketamine Infusions for Treatment-Resistant Depression: A Randomized Controlled Trial. Am J Psychiatry 2019; 176: 401-9.

Wilkinson ST, Katz RB, Toprak M, Webler R, Ostroff RB, Sanacora G. Acute and Longer- Term Outcomes Using Ketamine as a Clinical Treatment at the Yale Psychiatric Hospital. J Clin Psychiatry 2018;79. pii: 17m11731. doi: 10.4088/JCP.17m11731.

Zhan Y, Zhang B, Zhou Y, Zheng W, Liu W, Wang C, et al. A preliminary study of anti-suicidal efficacy of repeated ketamine infusions in depression with suicidal ideation. J Affect Disord 2019; 251: 205-12.

McGirr A, Berlim MT, Bond DJ, Fleck MP, Yatham LN, Lam RW. A systematic review and meta-analysis of randomized, double-blind, placebo-controlled trials of ketamine in the rapid treatment of major depressive episodes. Psychol Med 2015; 45: 693-704.

Ionescu DF, Bentley KH, Eikermann M, Taylor N, Akeju O, Swee MB, et al. Repeat-dose ketamine augmentation for treatment-resistant depression with chronic suicidal ideation: A randomized, double blind, placebo controlled trial. J Affect Disord 2019; 243: 516-24.

Newport DJ, Carpenter LL, McDonald WM, Potash JB, Tohen M, Nemeroff CB. Ketamine and Other NMDA Antagonists: Early Clinical Trials and Possible Mechanisms in Depression. Am J Psychiatry 2015; 172: 950-66.

Fava M, Freeman MP, Flynn M, Judge H, Hoeppner BB, Cusin C, et al. Double-blind, placebo-controlled, dose-ranging trial of intravenous ketamine as adjunctive therapy in treatment-resistant depression (TRD). Mol Psychiatry 2018. doi: 10.1038/s41380-018- 0256-5.

Andrade C. Ketamine for Depression, 1: Clinical Summary of Issues Related to Efficacy, Adverse Effects, and Mechanism of Action. J Clin Psychiatry 2017; 78: e415-e9.

Andrade C. Ketamine for Depression, 2: Diagnostic and Contextual Indications. J Clin Psychiatry 2017; 78: e555-e8.

Andrade C. Ketamine for Depression, 3: Does Chirality Matter? J Clin Psychiatry 2017; 78: e674-e7.

Andrade C. Ketamine for Depression, 4: In What Dose, at What Rate, by What Route, for How Long, and at What Frequency? J Clin Psychiatry 2017; 78: e852-e7.

Sattar Y, Wilson J, Khan AM, Adnan M, Azzopardi Larios D, Shrestha S, et al. A Review of the Mechanism of Antagonism of N-methyl- D-aspartate Receptor by Ketamine in Treatment-resistant Depression. Cureus 2018; 10: e2652.

Hirota K, Lambert DG. Ketamine and depression. Br J Anaesth 2018; 121: 1198-202.

Fala L. Spravato (Esketamine) Nasal Spray First NMDA Receptor Antagonist Approved by the FDA for Adults with Treatment-Resistant Depression. Payer’s Guide Mid Year Addendum pushished on August 13, 2019 in select Drug Profile. Available from http://www.ahdbonlines. com/issuces/2019/

Kim J, Farchione T, Potter A, Chen Q, Temple R. Esketamine for Treatment-Resistant Depression- First FDA-Approved Antidepressant in a New Class. N Engl J Med 2019; 381: 1-4.

Ketamine treatment service Oxford 2018 [updated 15 November 2018; cited 2018 15 November]. Available from: https://www. oxfordhealth.nhs.uk/ketamine-service/.

Vichaikosol T, Ittasakul P, Lekprasert V. Effect of Ketamine Plus Electroconvulsive Therapy (ECT) in Treatment of Major Depresive Episode: A Pilot Study. Journal of the Psychiatric Association of Thailand 2017; 62: 83-94.

Prutipinyo C. Comparative Drug Control Law. Public Health and Health Laws Journal [Internet]. 21 May 2017 [cited 28 Jan. 2020]; 3(2): 148-66. Available from: https://tci-thaijo. org/index.php/journal_law/article/view/161621

Published
2020-03-30
How to Cite
Leelatanon, M., Rungnirundorn, T., Chalermkitpanit, P., & Thisayakorn, P. (2020). Cases Report: Intravenous Ketamine Infusion for Treatment-Resistant Depression. Journal of the Psychiatric Association of Thailand, 65(1), 63-74. Retrieved from https://he01.tci-thaijo.org/index.php/JPAT/article/view/240792