Case Report: Repeated Series of Ketamine Infusions in Patients With Treatment-Resistant Depression: Presentation of Five Cases
Maria Gałuszko‐węgielnik, Adam Włodarczyk, Wiesław Jerzy Cubała, Alina Wilkowska, Natalia Górska, Jakub Słupski
Frontiers in Psychiatry December 2, 2021 DOI: 10.3389/fpsyt.2021.705190 via OpenAlex
Summary
Repeated series of intravenous ketamine infusions, given as an add-on treatment, can be effective and safe for patients with treatment-resistant depression. In a case series of five inpatients aged 43–63 with major depressive disorder or bipolar I disorder, four achieved remission after the first series of eight infusions, and three after the second series. Adverse reactions were mild and transient. The results are limited to short-term, add-on intravenous ketamine and cannot be generalized to long-term maintenance or other formulations.
Study at a glance
| Characteristics | Case series Case report Peer reviewed |
|---|---|
| Sample size | 5 |
| Population | Inpatients aged 43–63 with treatment-resistant depression in major depressive disorder or bipolar disorder type I |
| Intervention | Intravenous ketamine |
| Duration | Eight infusions per series; readministered due to worsening symptoms |
| Topics | Depression Ketamine |
| Keywords | Depression economics Presentation obstetrics Medicine |
| Citations | 5 |
| Key finding | Repeated series of intravenous ketamine infusions as an add-on treatment led to remission in four of five patients after the first series and three after the second series, with mild and transient adverse events. |
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.