Ketamine for Depression

[wtbcrna, MSN, DNP, CRNA]

Arch Gen Psychiatry. 2006 Aug;63(8):856-64.

A randomized trial of an N-methyl-D-aspartate antagonist in treatment-resistant major depression.Zarate CA Jr, Singh JB, Carlson PJ, Brutsche NE, Ameli R, Luckenbaugh DA, Charney DS, Manji HK.

Source Mood and Anxiety Disorders Program, National Institute of Mental Health, National Institutes of Health, and Department of Health and Human Services, Bethesda, MD 20892, USA. [email protected]

Abstract CONTEXT: Existing therapies for major depression have a lag of onset of action of several weeks, resulting in considerable morbidity. Exploring pharmacological strategies that have rapid onset of antidepressant effects within a few days and that are sustained would have an enormous impact on patient care. Converging lines of evidence suggest the role of the glutamatergic system in the pathophysiology and treatment of mood disorders.

OBJECTIVE: To determine whether a rapid antidepressant effect can be achieved with an antagonist at the N-methyl-D-aspartate receptor in subjects with major depression.

DESIGN: A randomized, placebo-controlled, double-blind crossover study from November 2004 to September 2005.

SETTING: Mood Disorders Research Unit at the National Institute of Mental Health. Patients Eighteen subjects with DSM-IV major depression (treatment resistant).

INTERVENTIONS: After a 2-week drug-free period, subjects were given an intravenous infusion of either ketamine hydrochloride (0.5 mg/kg) or placebo on 2 test days, a week apart. Subjects were rated at baseline and at 40, 80, 110, and 230 minutes and 1, 2, 3, and 7 days postinfusion. Main Outcome Measure Changes in scores on the primary efficacy measure, the 21-item Hamilton Depression Rating Scale.

RESULTS:Subjects receiving ketamine showed significant improvement in depression compared with subjects receiving placebo within 110 minutes after injection, which remained significant throughout the following week. The effect size for the drug difference was very large (d = 1.46 [95% confidence interval, 0.91-2.01]) after 24 hours and moderate to large (d = 0.68 [95% confidence interval, 0.13-1.23]) after 1 week. Of the 17 subjects treated with ketamine, 71% met response and 29% met remission criteria the day following ketamine infusion. Thirty-five percent of subjects maintained response for at least 1 week.

CONCLUSIONS:Robust and rapid antidepressant effects resulted from a single intravenous dose of an N-methyl-D-aspartate antagonist; onset occurred within 2 hours postinfusion and continued to remain significant for 1 week.

http://archpsyc.ama-assn.org/cgi/content/full/63/8/856

[zoidberg, BSN, RN]

that is really cool. maybe a combination of said rapid onset and long term medication can be developed that can be started at the same time with minimal interaction to minimize the lag time that currently exists with depression meds.

[wtbcrna, MSN, DNP, CRNA]

that is really cool. maybe a combination of said rapid onset and long term medication can be developed that can be started at the same time with minimal interaction to minimize the lag time that currently exists with depression meds.

Right now this is just being used for refractory major depression patients.

[zoidberg, BSN, RN]

ah i see. i read it too quick. still cool

[Meriwhen, ASN, BSN, MSN, RN]

I heard about this...not at work, but at my local knitting circle where I am the only nurse :) I definitely want to research it more.

[Esme12, ASN, BSN, RN]

I'm going to read this a lot closer....interesting!

[Esme12, ASN, BSN, RN]

I heard about this...not at work, but at my local knitting circle where I am the only nurse :) I definitely want to research it more.

Interesting circle...

[Meriwhen, ASN, BSN, MSN, RN]

Interesting circle...

Definitely is an interesting group. They know I work at the psych hospital and one of them said, "Did you know they're using Special K for depression? It apparently works!"

I didn't ask what her experience, if any, with "Special K" was

[nurseprnRN, BSN, RN]

it's used in chronic regional pain syndrome, crps (what used to be called reflex sympathetic dystrophy, rsd) with good results. given the connection between chronic pain and depression, i found this very interesting. i love brains.

[Meriwhen, ASN, BSN, MSN, RN]

it's used in chronic regional pain syndrome, crps (what used to be called reflex sympathetic dystrophy, rsd) with good results. given the connection between chronic pain and depression, i found this very interesting. i love brains.

i don't think that's what she may have used special k for

[ClearBlueOctoberSky]

I agree with Meriwhen...I would like to see more research, peer review and if the trials are duplicable. However, if it works well, it might be a good adjunct or even alternative therapy to ECT.

[Guttercat, ASN, RN]

They're having a h3ll of a time up in Canuckistan with Ketamine abuse/trafficking.

Canada now has it listed as a Schedule 1 (same class as cocaine and heroin, even though it is only "psychologically" addicting). Very serious problems up there with abuse and international trafficking via crime rings).

Last I knew it was still Schedule 3 in USA (on par with Codeine)...but it's only just beginning to take hold as a party-drug here in the States.

Read some report that they're beginning over the last few years to see some ugly side effects of Ketamine abuse...disintegrated bladders and renal failure.

Yay.