RESIDENT: Maintenance Intranasal Ketamine for Treatment-Resistant Depression: A Case Series

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Presenting Author(s): Shaina Archer, Vincent Lee

Co-Author(s): Carson Chrenek, Dr. Jennifer Swainson

Date and time: 24 Mar 2018 from 13:45 to 14:00

Location: Hawthorn C  Floor Map

Learning Objectives:

  1. Understand the rationale for maintenance intranasal ketamine for treatment resistant depression
  2. Report on the clinical response and tolerability of maintenance intranasal ketamine

Literature References:

Berlim MT, Turecki G. Definition, assessment, and staging of treatment-resistant refractory major depression: A review of current concepts and methods. The Canadian Journal of Psychiatry. 2007;52(1):46-54.

Berman RM, Cappiello A, Anand A, Oren DA, Heninger GR, Charney DS, Krystal JH. Antidepressant effects of ketamine in depressed patients. Biological Psychiatry. 2000;47(4):351-4.

 Coyle CM, Laws KR. The use of ketamine as an antidepressant: A systematic review and meta-analysis. Human Psychopharmacology: Clinical & Experimental. 2015;30(3):152-63.

 Fond G, Loundou A, Rabu C, Macgregor A, Lançon C, Brittner M, Micoulaud-Franchi J, Richieri R, Courtet P, Abbar M, Roger M, Leboyer M, Boyer L. Ketamine administration in depressive disorders: A systematic review and meta-analysis. Psychopharmacology. 2014;231(18):3663-76.

 Serafini G, H. Howland R, Rovedi F, Girardi P, Amore M. The role of ketamine in treatment-resistant depression: A systematic review. Current Neuropharmacology. 2014;12(5):444-61.

 Romeo B, Choucha W, Fossati P, Rotge J. Meta-analysis of short- and mid-term efficacy of ketamine in unipolar and bipolar depression. Psychiatry Research. 2015;230(2):682-8.

 Xu Y, Hackett M, Carter G, Loo C, Galvez V, Glozier N, Glue P, Lapidus K, McGirr A, Somogyi AA, Mitchell PB, Rodgers A. Effects of low-dose and very low-dose ketamine among patients with major depression: A systematic review and meta-analysis. The International Journal of Neuropsychopharmacology. 2016;19(4):pyv124.

 Kishimoto T, Chawla JM, Hagi K, Zarate CA, Kane JM, Bauer M, Correll CU. Single-dose infusion ketamine and non-ketamine N-methyl-d-aspartate receptor antagonists for unipolar and bipolar depression: A meta-analysis of efficacy, safety and time trajectories. Psychological Medicine. 2016;46(7):1459-72


Treatment Resistant Depression (TRD) is a challenging presentation within psychiatry and occurs in approximately 15% of patients with depression (1). These patients do not achieve remission of symptoms despite multiple trials of pharmacotherapy, psychotherapy, and neurostimulation treatments such as ECT. The finding that ketamine results in a rapid antidepressant effect in some patients with TRD is promising (2-7). Although the response has been shown to be robust, the duration of effect is unfortunately short-lived (8). Few reports have looked at maintaining the antidepressant effects of ketamine for a more sustained time period. At the Misericordia Community Hospital, select patients who have shown a good clinical response to acute treatment with intravenous (IV) ketamine have been offered to continue with maintenance treatment with IV ketamine. While some patients have had a positive clinical response to maintenance IV ketamine, this treatment remains very resource-intensive as it must be done in a hospital setting. To ease this burden on both the patient and the hospital resources, some psychiatrists have elected to offer maintenance intranasal (IN) ketamine, which the patient can self administer at home. The case series will review 16 patients with TRD who have received maintenance IN ketamine in the 2017 year.

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