Background
Ketamine is reported to have rapid antidepressant effects; however, there is limited
understanding of the time-course of ketamine effects beyond a single infusion. A previous
report including 10 participants with treatment-resistant major depression (TRD) found
that six ketamine infusions resulted in a sustained antidepressant effect. In the
current report, we examined the pattern and durability of antidepressant effects of
repeated ketamine infusions in a larger sample, inclusive of the original.
Methods
Participants with TRD (n = 24) underwent a washout of antidepressant medication followed by a series of up
to six IV infusions of ketamine (.5 mg/kg) administered open-label three times weekly
over a 12-day period. Participants meeting response criteria were monitored for relapse
for up to 83 days from the last infusion.
Results
The overall response rate at study end was 70.8%. There was a large mean decrease
in Montgomery–Åsberg Depression Rating Scale score at 2 hours after the first ketamine
infusion (18.9 ± 6.6, p < .001), and this decrease was largely sustained for the duration of the infusion
period. Response at study end was strongly predicted by response at 4 hours (94% sensitive,
71% specific). Among responders, median time to relapse after the last ketamine infusion
was 18 days.
Conclusions
Ketamine was associated with a rapid antidepressant effect in TRD that was predictive
of a sustained effect. Future controlled studies will be required to identify strategies
to maintain an antidepressant response among patients who benefit from a course of
ketamine.
Key Words
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Article Info
Publication History
Published online: July 30, 2012
Accepted:
June 20,
2012
Received in revised form:
June 13,
2012
Received:
May 3,
2012
Identification
Copyright
© 2013 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
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Access this article on ScienceDirectLinked Article
- Exploiting N-Methyl-D-Aspartate Channel Blockade for a Rapid Antidepressant Response in Major Depressive DisorderBiological PsychiatryVol. 74Issue 4
- PreviewIn the August 15 issue of this journal, two articles provide additional clinical support for the possibility of obtaining a rapid antidepressant response using pharmacologic means (1,2). In fact, the already documented antidepressant effect of the N-methyl-D-aspartate (NMDA) channel blocker ketamine using a quarter of its anesthetic dose can be qualified as immediate because it is often detectable within an hour or two, when the mild psychotomimetic effects of this agent have generally dissipated.
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