Use of Intravenous Ketamine for Treatment Resistant Bipolar and Unipolar Depression : Sharing 3 years of Experience from the Misericordia Community Hospital

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Presenting Author(s): Meghan Carroll, Dr. Carson Chrenek, Dr. Jennifer Swainson, MD, FRCPC

Date and time: 23 Mar 2019 from 13:30 to 14:10

Location: Hawthorn A  

Objectives

1. Briefly review rationale for use of IV ketamine for Treatment Resistant Depression and Bipolar Depression;
2. Present the Misericordia Community Hospital's IV ketamine protocol and share practical experiences in program development and patient care; and
3. Discussion/Questions.

Literature References

1. Archer S, Chrenek C, Swainson J (2018) Maintenance Ketamine Therapy for Depression. J Clin Psychopharmacology. 38(4) 380-384
2. Kennedy SH, Lam RW, McIntyre RS, et al. Canadian network for mood and anxiety treatments (CANMAT) 2016 clinicalguidelines for the management of adults with major depressive disorder: Section 3. Pharmacological treatments. Can J Psychiatry. 2016;61: 540–560.
3. Lee V, Archer S, Chrenek C, Swainson J. Letter to the Editor Regarding “Repeated Intranasal Ketamine for Treatment Resistant
   Depression – The Way to Go? Results from a Pilot Randomised Controlled Trial” by Galvez et al. Accepted, J Psychopharmacology.
4. Sanacora G, Frye MA, McDonald W, et al. A consensus statement on theuse of ketamine in the treatment of mood disorders. JAMA
   Psychiatry. 2017;74:399–405.
5. Singh I, Morgan C, Curran V, et al. Ketamine treatment for depression: opportunities for clinical innovation and ethical foresight. Lancet Psychiatry. 2017;4:419–426.
6. Thomas RK, Baker G, Lind J, Dursun S (2018) Rapid effectiveness of intravenous ketamine for ultra resistant depression in a clinical
   setting and evidence for baseline anhedonia and bipolarity as clinical predictors of effectiveness. J Psychopharmacology.
   Oct;32(10):1110-1117
7. Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Bond DJ, Frey BN, Sharma V, Goldstein BI, Rej S, Beaulieu S, Alda M, MacQueen G,
   Milev RV, Ravindran A, O'Donovan C, McIntosh D, Lam RW, Vazquez G, Kapczinski F, McIntyre RS, Kozicky J, Kanba S, Lafer B,
   Suppes T, Calabrese JR, Vieta E, Malhi G, Post RM, Berk M. Canadian Network for Mood and Anxiety Treatments (CANMAT) and
   International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disord. 2018 Mar;20(2):97-170.

Abstract

Intravenous ketamine has recently been approved on formulary in Alberta for treatment resistant Depression and treatment resistant
Bipolar Depression. This session will briefly review rationale for ketamine treatment for depression, then present a practical approach
and considerations for clinical implementation of IV ketamine treatments for our patients. We will share our process for development of
the IV ketamine program at the Misericordia hospital and share our experiences in using both acute courses of IV ketamine and
maintenance ketamine treatments to those who have had a positive response. Systemic limitations have prevented this program from
taking referrals, but this session will present our program so other clinicians and sites may consider development of similar
programs/services. Ample time will be left for questions and discussion.