RESIDENT: Rapid effectiveness of intravenous ketamine for ultraresistant depression in a clinical setting and evidence for baseline anhedonia as a clinical predictor of effectiveness
Presenting Author(s): Rejish K. Thomas
Co-Author(s): Glen B. Baker, Serdar Dursun, John Lind
Date and time: 24 Mar 2018 from 14:15 to 14:30
Location: Bluebell
Learning Objectives:
- To present findings from a local, retrospective, open label, database study on intravenous ketamine for ultraresistant depression
- To investigate the response rate of intravenous ketamine and clinical predictors of effectiveness in this study and in the literature
- To discuss future directions in clinical and in research settings for ketamine as an antidepressant
Literature References:
Abdallah CG, Adams TG, Kelmendi B, et al. (2016) Ketamine's mechanism of action: a path to rapid-acting antidepressants. Depression and Anxiety 33(8): 689–697.
Abdallah CG, Averill LA, Collins KA, et al. (2017) Ketamine treatment and global brain connectivity in major depression. Neuropsychopharmacology: Official Publication of the American College of Neuropsychopharmacology 42(6): 1210–1219.
Coyle CM and Laws KR (2015) The use of ketamine as an antidepressant: a systematic review and meta-analysis. Human Psychopharmacology 30(3): 152–163.
Duman RS (2014) Pathophysiology of depression and innovative treatments: remodeling glutamatergic synaptic connections. Dialogues in Clinical Neuroscience 16(1): 11–27.
Lally N, Nugent AC, Luckenbaugh DA, et al. (2014) Anti-anhedonic effect of ketamine and its neural correlates in treatment-resistant bipolar depression. Translational Psychiatry 4: e469.
Sanacora G, Frye MA, McDonald W, et al. (2017) A consensus statement on the use of ketamine in the treatment of mood disorders. JAMA psychiatry 74(4): 399–405.
Wilkinson ST, Ballard ED, Bloch MH, et al. (2017) The effect of a single dose of intravenous ketamine on suicidal ideation: a systematic review and individual participant data meta-analysis. American Journal of Psychiatry: appiajp201717040472.
Abstract:
Background Intravenous ketamine has been established as an efficacious and safe treatment, with transient effect, for treatment resistant depression. However, the effectiveness of intravenous ketamine in non-research settings and with ultraresistant depression patients remains understudied.
Aims: This study aims to measure the response and remission rates in ultraresistant depression patients in a clinical setting by means of a retrospective, open label, database study. Secondarily, the study will attempt to support previous findings of clinical predictors of effectiveness with intravenous ketamine treatment.
Methods: Fifty patients with ultraresistant depression were treated between May 2015 and December 2016, inclusive, in two community hospitals in Edmonton using six ketamine infusions of 0.5mg/kg over forty minutes over two to three weeks. Data were collected retrospectively from inpatient and outpatient charts. Statistical analysis to investigate clinical predictors of effectiveness included logistic regression analysis using a dependent variable of a 50% reduction in rating scale score at any point during treatment.
Results: At baseline, the average treatment resistance was severe, with a MSM score of 12.1 out of 15, 90.0% were resistant to ECT, and the average BDI score was 34.2. The response rate was 44% and remission rate was 16%. As a single predictor, moderate or severe anhedonia at baseline predicted a 55% increased likelihood of response.
Conclusion: In a clinical setting, intravenous ketamine showed effectiveness in a complex, severely treatment resistant, depressed population on multiple medication profiles concurrently. This study gave support to anhedonia as a clinical predictor of effectiveness.