Ketamine has been linked to reduced suicidal thoughts, depression, and anxiety

ketamine Injections can help reduce symptoms of suicidal ideation, depressionand anxiety in patients with treatment-resistant depression (TRD), a new study suggests.

Results from a retrospective chart review analysis, which included more than 400 participants with TRD, demonstrate that ketamine is a safe and rapid treatment for real-world patients, lead author Patrick A. Oliver, MD, founder and medical director, MindPeace Clinics Richmond, Virginia, said Medscape Medical News.

The effect, he said, was perhaps the most significant in reducing suicidal thoughts.

“Within two weeks, we can convert someone from being suicidal to non-suicidal. It’s a complete game-changer,” Oliver added.

Every year in the United States, about 12 million people think about it suicide3.2 million devised a plan to kill themselves, and more than 46,000 succeeded, investigators note.

The results were Posted online September 12 in The Journal of Clinical Psychiatry.

molecule mixture

Primarily used as a file anesthetic In hospitals, ketamine is also taken illegally as a recreational drug. Users may aim for intense euphoria or a feeling of detachment, or an out-of-body experience.

Ketamine is a combination of two mirror image molecules. An intranasal version of one of these molecules (esketamine) has been approved by the U.S. Food and Drug Administration for TRD. Both esketamine and ketamine are thought to increase nerve signals that affect synaptic function.

The study included 424 patients (median age, 41.7 years) with major depressive disorder or another mood disorder who received at least one dose of ketamine in a specialized clinic. Most of the participants failed previous drug trials.

Patients typically started the study with a dose of 0.5 mg/kg ketamine, with the dose titrated to achieve symptoms of partial dissociation. The mean dose administered after titration was 0.93 mg/kg over 40 minutes.

The main treatment course of at least six injections was completed within 21 days by 70% of patients.

At each clinic visit, all participants completed the Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder-7 (GAD-7).

The primary outcome was a total PHQ-9 score, which the researchers looked at seven time periods: 1 week, 2–3 weeks, 4–6 weeks, 7–12 weeks, 13–24 weeks, 25–51 weeks, and over 52 weeks.

“Blow it out of the water”

The results showed an overall decrease of PHQ-9 scores by 50% throughout treatment, with much improvement gained within 4-6 weeks. There was a significant difference between the first week and all subsequent time periods (all s values ​​<.001) and between weeks 2 and 3 and all subsequent periods (all s Values ​​< .001).

Other measures included treatment response, defined as at least a 50% improvement in PHQ-9, and relieving depression, defined as a PHQ-9 score of less than 5. After three doses, 14% of patients and 7% responded They were. in remission. After 10 injections, 72% responded and 38% were in remission.

These results compare favorably with other depression treatments, Oliver said. “Honestly, except for ECT [electroconvulsive therapy]This blows everything out of the water.”

Oliver noted that the success rate of RTMS is 40%-60% depending on the method; For selective serotonin reuptake inhibitors, the success rate is “somewhere between the mid-20s and as low as the 30th percentile.”

Another outcome measure was the self-harm/suicidal ideation component of the PHQ-9 questionnaire, which asks about “thoughts you’d be better off dead, or hurting yourself in some way.” About 22% of study participants no longer reported suicidal thoughts after three infusions, 50% with six injections, and 75% with 10 infusions.

With 15 injections, 85% no longer report these thoughts. “Nothing else has ever shown that,” Oliver said.

Symptoms of generalized anxiety were also significantly improved. There was an approximately 30% reduction in GAD-7 score during treatment, and again, most response occurred within 4-6 weeks.

Study restrictions

Gender, age, and other demographic characteristics did not predict response or remission, but planning for suicide tended toward higher response rates (s = .083). The researchers note that this suggests that a more depressed subgroup may achieve greater benefit from treatment compared to less symptomatic patients.

History of psychosis also tends toward better response to treatment (s = .086) but not remission.

The researchers note that the study’s limitations include that it was retrospective, lacked a control group, and did not require patients to be hospitalized – so the study sample may have been less risky than in other studies.

In addition, most patients paid out of pocket the treatment at $495 per injection, and reported their symptoms.

Also, the researchers did not evaluate adverse events, although nurses did make follow-up calls to patients. Oliver notes that the most common side effects of ketamine are nausea, vomiting, and anxiety.

Oliver said previous research has indicated that ketamine treatment is not associated with long-term side effects, such as impotence, weight gain, lethargy, or cognitive problems.

The investigators note that another limitation of the study was the lack of detailed demographic information, such as race, income, and education, which might affect its generalizability.

Concerns and questions

Comment on Medscape Medical NewsBoya Movahd Rad, MD, senior consultant and researcher in psychiatry, Lund University, Sweden, noted several concerns, including that clinics treating study participants with ketamine benefit.

He also speculated about who could afford the treatment because only a few patients in the study were compensated through insurance.

Mohed Rad was not a participant in the current research but was the principal investigator for another study which compared intravenous ketamine to electric shocks.

He wondered if the number of patients in the new study was really “a real world”. Well-designed randomized controlled trials were conducted in a “natural setting, [which] Get closer to real life patients.”

He also noted that the average dose after physician titration (0.93 mg/kg/40 m) “may be considered too high.”

Regarding doses that are titrated to achieve dissociative symptoms, “there is no clear evidence to my knowledge that patients need to develop dissociative symptoms in order to have an antidepressant effect,” said Muwahid Rad.

Finally, he noted that finding that 28% of participants were using drugs was “disturbing” and questioned what medications they were taking; He also asked why 81 percent of the study population needed to take antidepressants.

The study did not receive external funding. Oliver is the founder of MindPeace Clinics that specialize in ketamine treatments. united rad No related financial relationships were reported.

J Clin Psychiatry. Posted online September 12, 2022. Summary

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