Ketamine: What Every General Psychiatrist Should Know and How to Integrate it Into Your Practice

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Presenting Author(s): Dr. Jennifer Swainson, MD, FRCPC

Date and time: 21 Mar 2020 from 13:30 to 14:30

Location: Wildrose Salon C  

Learning Objectives:

1. Review evidence for use of Ketamine in depression;
2. Present options and practical aspects of prescribing various modalities of Ketamine; and
3. Discuss cautions, controversies, and future directions.

Abstract:

Evidence for efficacy of ketamine to treat depression has accumulated, yet, for various reasons, it has only found its place on thefringes of psychiatry. While an area of interest for both patients and psychiatrists, many psychiatrists find themselves ill-prepared to prescribe this treatment safely and appropriately. This talk will provide a practical overview, with the aim to equip the general psychiatrist with the necessary knowledge to incorporate ketamine prescribing into their clinical practice. Literature reviewing safety and efficacy of intravenous ketamine, as well as other modalities of ketamine be presented. Processes for accessing intravenous ketamine remain under development in Alberta, and the status of provincial guidelines will be discussed. Alternate modes of offering ketamine treatments, including sublingual, oral, and intranasal formulations will be discussed, including discussion on intranasal esketamine, which may soon be available for use in Canada. Examples of community prescribing of sublingual ketamine will be presented. Practical aspects will be discussed including patient selection, side effects, cautions, controversies, and future directions.

Literature References:

1. Gálvez V, Li A, Li A, Huggins C, Glue P , Martin D, Somogyi AA, Alonzo A, Rodgers A, Mitchell P, Loo CK. (2018) Repeated intranasal ketamine for treatment-resistant depression - the way to go? Results from a pilot randomised controlled trial. J Psychopharmacol (Oxford).
2. Lee V, Archer S, Chrenek C, and Swainson J. (2018) A response to: repeated intranasal ketamine for treatment resistant depression: the way to go? Results from a pilot randomised controlled trial. J Psychopharmacology.
3. Matveychuk D, Thomas RK, Swainson J, Khullar A, MacKay M, Baker GB, Dursun SM. Ketamine as an Antidepressant: Overview of its Mechanisms of Action and Potential Predictive Biomarkers. submitted as invited review to Therapeutic Advances in Psychopharmacology
4. Rong C, Park C, Rosenblat JD, Subramaniapillai M, Zuckerman H, Fus D, Lee YL, Pan Z, Brietzke E, Mansur RB, Cha DS, Lui LMW,McIntyre RS. (2018) Predictors of response to ketamine in treatment resistant major depressive disorder and bipolar disorder. Int. J. Enviornm Res and Pub Health.
5. Swainson, J and Khullar A (2020 in press) Sublingual Ketamine: An Option For Increasing Access to Ketamine Treatments for Depression? Journal of Clinical Psychiatry
6. Swainson J, Thomas RK, Archer S, Chrenek C, MacKay M, Baker G, Dursun S, Klassen LJ, Chokka P & Demas ML (2019): Esketamine for treatment resistant depression, Expert Review of Neurotherapeutics
7. Thomas RK, Baker G, Lind J & Dursun S (2018). Rapid effectiveness of intravenous ketamine for ultraresistant depression in a clinical setting and evidence for baseline anhedonia and bipolarity as clinical predictors of effectiveness. J Psychopharmacol.