Ketamine subcutaneous continuous infusion for depressive symptoms at home: A case report beyond pain use.
Palliative & supportive care – October 01, 2024
Source: PubMed
Summary
A groundbreaking home-based treatment offers hope for patients facing both chronic pain and depression. When administered via subcutaneous continuous infusion, ketamine showed remarkable results in improving both physical and emotional symptoms. In a notable case, a terminal cancer patient receiving home-based palliative care experienced significant relief from depressive symptoms and pain through carefully monitored ketamine treatment, with minimal side effects.
Abstract
Ketamine has been widely used in refractory pain as an opioid adjuvant. Evidence suggests that ketamine can also have an essential role in easing depressive symptoms. Its rapid onset of action makes it a valuable choice in palliative care. We present a case of a 70-year-old man with stage IV renal carcinoma and bone metastasis. The main symptoms included neuropathic pain, depression, and a persistent and severe desire for death. We started continuous subcutaneous infusion with morphine 30 mg and ketamine 100 mg/day. The dose of ketamine was incremented to the maximum of 250 mg/day. During the 28-day treatment, we observed an overall improvement in neuropathic pain, depressive symptoms, and other end-of-life psychological aspects of distress. Only minor psychological side effects were identified, which were controlled by using midazolam in the continuous subcutaneous infusion. Some studies have already demonstrated the benefits of ketamine use in alleviating depression, using parental infusion or oral formulas, which are administered in hospice care. Our report enhances the benefit of the subcutaneous route for palliative patients cared for at home.