Journal of Clinical Psychiatry
February 1, 2023
Balwinder Singh, S. Kung, Vanessa K. Pazdernik et al.
64 citations
In adults with treatment-resistant depression, intravenous (IV) ketamine and intranasal (IN) esketamine produced similar rates of symptom improvement and remission, but remission was reached in fewer treatment sessions with IV ketamine. Over up to six IV or eight IN treatments, depressive symptoms were measured before and 24 hours after each session. Among 62 participants (median age 50, 65% female), neither the change in symptom scores nor the proportion achieving response or remission differed significantly between groups. However, time to remission—adjusting for age, sex, body mass index, and baseline severity—was five times faster with IV ketamine than with IN esketamine. A randomized controlled trial is needed to confirm these results.
Pharmaceuticals
August 1, 2023
B. Joseph, N. Nuñez, S. Kung et al.
14 citations
For adults with treatment-resistant depression, taking lamotrigine alongside intravenous ketamine or intranasal esketamine does not significantly reduce the antidepressant effect of the treatments. In a historical cohort study, response and remission rates were similar whether patients were on lamotrigine or not. There was a trend toward lower dissociation scores among those taking lamotrigine, especially with IV ketamine. The study was limited by only 13 patients on lamotrigine, so the evidence is insufficient to conclude that lamotrigine attenuates the antidepressant effect, but it may reduce dissociation.
International Psychogeriatrics
October 1, 2021
J. Leal, M. Lapid, S. Kung
Ketamine, particularly intranasal esketamine, is FDA-approved for treatment-resistant depression, but evidence in older adults remains scarce. Two cases of older individuals with treatment-resistant depression treated with intranasal ketamine are described: one improved, one did not. The scarce available literature suggests ketamine is well tolerated and effective in the geriatric population, with remission rates of 46.5%, 57%, and 69.5% reported in three separate studies. The presentation reviews ketamine's mechanism of action as a novel antidepressant, the mixed evidence for its role in late-life treatment-resistant depression, and practical aspects of running a ketamine clinic.