Frequency analysis of symptomatic worsening following ketamine infusions for treatment resistant depression in a real-world sample: Results from the canadian rapid treatment center of excellence.
Joshua D Di Vincenzo, Orly Lipsitz, Nelson B Rodrigues, Brett D M Jones, Hartej Gill, Yena Lee, Leanna M W Lui, Kayla M Teopiz, Roger Ho, Kangguang Lin, Flora Nasri, Roger S McIntyre, Joshua D Rosenblat
Psychiatry research January 1, 2022 Peer reviewed DOI: 10.1016/j.psychres.2021.114321 via PubMed
Summary
The analysis found that rates of clinically significant worsening of depressive symptoms during IV ketamine treatment for treatment-resistant depression (TRD) were low, ranging from 1.83% to 5.49%, with no worsening reported in patients with bipolar TRD. A total of 164 adults received four infusions of ketamine and were assessed for changes in symptoms. The study suggests that the risk of worsening symptoms with ketamine is comparable to that associated with conventional antidepressants.
Study at a glance
| Design | retrospective analysis |
|---|---|
| Sample size | 164 |
| Population | adults with treatment-resistant depression, including unipolar and bipolar |
| Key finding | Rates of symptomatic worsening associated with IV ketamine therapy for TRD appear to be very low and similar to conventional antidepressants. |
Abstract
Antidepressants are associated with symptomatic worsening in a subgroup of patients. Replicated evidence has demonstrated rapid and robust antidepressant effects with intravenous (IV) ketamine in treatment resistant depression (TRD); however, the risk of ketamine worsening depressive symptoms in a subgroup of patients remains unknown. Herein we report a retrospective analysis on the rates of symptomatic worsening during an acute course of IV ketamine in individuals with unipolar (n = 142) and bipolar (n = 22) TRD. Adults (N = 164; mean age = 45.97) with TRD underwent four sub-anesthetic infusions (0.5-0.75 mg/kg over 40 min) of IV ketamine over two weeks, and were assessed with the Quick Inventory for Depression Symptomatology-Self Report-16 (QIDS-SR16) at baseline and after each infusion. The primary outcome was the proportion of patients experiencing clinically significant worsening of depressive symptoms (≥20% increase on the QIDS-SR16) at each time point relative to baseline. Secondary analyses explored trends in the results. The frequency of clinically significant worsening fluctuated between 1.83% to 5.49%, with no identifiable trend across time. Zero individuals with bipolar TRD reported symptomatic worsening. Limitations include the single-centered, uncontrolled, retrospective nature of this study. Rates of symptomatic worsening associated with IV ketamine therapy for TRD appear to be very low and similar to conventional antidepressants.