In a 55-year-old man with treatment-resistant major depression and co-occurring alcohol and benzodiazepine dependence, a single intravenous infusion of ketamine (0.5 mg/kg) produced a pronounced improvement in depression symptoms, peaking two days later (Hamilton Depression Rating Scale down 56.6%, Beck Depression Inventory down 65.4%). Positive effects began fading by day 7 and returned to baseline by day 35. A second infusion six weeks later was less effective, reducing symptoms by 43% and 35% respectively, with effects lasting only 7 days. Repeated ketamine administration can be beneficial, but the diminished response to the second dose suggests that optimal dosing and scheduling require further investigation.
Thomas De Quincey's 1821 autobiographical work, 'Confessions of an English Opium-Eater,' offers a subjective and objective account of his opium use and dependence, recorded before psychiatry was established. His self-analysis foreshadows psychoanalytic methods and psychopharmacology. The text raises questions for medical humanities about the patient's voice, therapeutic creativity, and literature as a record of lived experience, underscoring literature's relevance for psychiatric practitioners.