Three consecutive daily infusions of intravenous ketamine did not produce a greater antidepressant effect than the active placebo midazolam in adults aged 18–64 with treatment-resistant depression. By day 10, the ketamine group showed an average reduction of 12.55 points on the Montgomery-Åsberg Depression Rating Scale, while the midazolam group decreased by 17.22 points; by day 31, reductions were 13.73 and 12.44 points, respectively. Both treatments were well tolerated, and dissociative symptoms from ketamine were temporary. The findings indicate that this specific dosing schedule offers no notable advantage over midazolam, emphasizing the need for further research on effective treatment regimens.
Ketamine therapy can reduce suicide risk and depression in treatment-resistant patients, but its adverse effects include blurred vision, nausea, hepatotoxicity, headache, and cystitis. The effect on blood glucose is unclear. A 36-year-old man with type 1 diabetes mellitus experienced recurrent hypoglycemia episodes after ketamine infusion for treatment-resistant depression, despite no severe hypoglycemia in the prior 20 years. His depression improved with ketamine, but clinicians should monitor for hypoglycemia when initiating ketamine infusion in patients with type 1 diabetes.