Is Ketamine the Future Clozapine for Depression? A Case Series and Literature Review on Maintenance Ketamine in Treatment-resistant Depression With Suicidal Behavior.
Journal of psychiatric practice July 1, 2018 Lai Fong Chan, Choon Leng Eu, Shean Yih Soh et al. 18 citations
In a series of 13 patients with treatment-resistant depression and significant suicide risk, serial maintenance ketamine infusions helped some achieve long-term functional recovery. Two cases reached functional remission: one sustained response for 7 months through a possible synergy with lamotrigine, and another continued treatment for 5 years—possibly the longest reported. In seven other cases, ketamine acutely reduced suicidal ideation but did not produce lasting antidepressant effects. Factors linked to poor long-term response included inadequate mood stabilization in bipolar spectrum disorders, concurrent benzodiazepine use, complex comorbidities, and adverse effects like severe hypertension or dissociation. Controlled studies are needed to confirm safety and efficacy of long-term ketamine maintenance therapy.