In reviewing the use of ketamine for Rapid Sequence Intubation, I became aware of ketamine’s use in treatment resistant depression.
[The American College of Emergency Physicians has the best guidelines on the use of Ketamine in the Emergency Department and I have linked to it in my post, Ketamine Use In The Emergency Department (ACEP Guideline).]
Here is the website with information on the use of ketamine in depression, Ketamine Advocacy Network.
And here is their web page, Volunteer for a Ketamine Clinical Trial, and on this page is information how to find a clinical trial to volunteer for:
As of 2015, there are dozens of ketamine trials underway across the US at any given time. Some are large-scale studies conducted at world-class institutions like NIH, while others are smaller in scope. They vary widely in their purpose. The earliest studies simply measured the depression relief patients experienced (or didn’t) after a single infusion. Later studies looked at the effect of multiple infusions, or focused on more narrowly-defined conditions, like bipolar, PTSD, or social anxiety; or specific symptoms like suicidality. There have been ketamine depression studies that focus just on adolescents, or patients who also suffer from alcohol dependence, and many other variations.
Today, ketamine has no equal in rapidly relieving extreme treatment-resistant depression, bipolar, and PTSD.
NIH runs a website called ClinicalTrials.gov that tracks studies around the world. This is the best way to find a clinical trial that suits you. The search box on the home page makes it easy to find studies on any topic, and you can optionally view results on a map to find the ones nearest you. Note that some studies are conducted in multiple locations. For example, with large NIH studies it’s common for several universities to participate and aggregate their data.
Each ClinicalTrials.gov entry explains the purpose of the study and how it’s conducted. It also shows the drug and dosage that will be administered, eligibility criteria you must meet, and criteria that would exclude you. Finally, it will provide a contact who can answer your questions and take your application.
Below are some resources for the use of ketamine in depression.
The first resource is a good brief overview of the use of ketamine in depression. (1)
Reference (2) is a case report of a woman with severe treatment resistant depression who was treated with ketamine infusions while still recieving her oral anti-depressant treatment.
The patient received six i.v. infusions of ketamine (0.5 mg/kg) during 40 min on a Monday-Thursday schedule over an 18-day period. This treatment was administered at the Post Anaesthesia Care Unit (PACU) under the supervision of a staff anaesthesiologist. Ketamine was very well tolerated and no changes in vital signs, including heart rate or blood pressure, were observed. Furthermore, no psychotomimetic or dissociative symptoms were experienced during all the infusions and cognitive complaints related to ECT did not get worse. All the psychotropic regimen was maintained with similar doses and there was no adverse effect associated with them. A robust improvement in mood was gradually observed after the third infusion allowing her to be discharged and gradually resuming her daily life activities. Six months later she is still in clinical remission and on the same medication regimen.
Reference (3) is a study that showed that there is a prolonged response to ketamine in patients with a positive family history of alcohol abuse:
Ketamine’s extended antidepressant durability in FHP [Family History Positive] TRD [Treatment Resistant Depression] should be considered in the design and analysis of ketamine depression trials.
References (4) through (8) are more articles on ketamine for depression.
Reference (9) is a site for a commercial ketamine clinic in Los Angeles. I have included it just for completeness. I believe that persons interested in ketamine treatment should first see if they qualify for a clinical trial of ketamine as suggested on Volunteer for a Ketamine Clinical Trial.
Resources:
(1) World Psychiatry. 2015 Oct;14(3):348-50. doi: 10.1002/wps.20269.
Ketamine for depression: evidence, challenges and promise. [PubMed Link] [Full Text HTML] [Full Text PDF]
Zarate CA Jr, Niciu MJ.
(2) Case Rep Psychiatry. 2015;2015:815673. doi: 10.1155/2015/815673. Epub 2015 Mar 4.
Robust and sustained effect of ketamine infusions coadministered with conventional antidepressants in a patient with refractory major depression. [PubMed Abstract] [Full Text HTML] [Full Text PDF]
Montes JM, Luján E, Pascual F, Beleña JM, Perez-Santar JL, Irastorza LJ, Saiz-Ruiz J.
(3) Int J Neuropsychopharmacol. 2014 Oct 31;18(1). pii: pyu039. doi: 10.1093/ijnp/pyu039. Ketamine’s antidepressant efficacy is extended for at least four weeks in subjects with a family history of an alcohol use disorder. [PubMed Abstract] [Full Text HTML] [Full Text PDF]
Niciu MJ, Luckenbaugh DA, Ionescu DF, Richards EM, Vande Voort JL, Ballard ED, Brutsche NE, Furey ML, Zarate CA Jr
(4) Am J Psychiatry. 2015 Oct 1;172(10):950-66. doi: 10.1176/appi.ajp.2015.15040465.
Ketamine and Other NMDA Antagonists: Early Clinical Trials and Possible Mechanisms in Depression. [PubMed Abstract]
Newport DJ1, Carpenter LL1, McDonald WM1, Potash JB1, Tohen M1, Nemeroff CB1; APA Council of Research Task Force on Novel Biomarkers and Treatments.
(5) Cochrane Database Syst Rev. 2015 Sep 23;9:CD011612. doi: 10.1002/14651858.CD011612.pub2.
Ketamine and other glutamate receptor modulators for depression in adults. [PubMed Abstract]
Caddy C1, Amit BH, McCloud TL, Rendell JM, Furukawa TA, McShane R, Hawton K, Cipriani A.
(6) Ther Adv Chronic Dis. 2015 May;6(3):97-114. doi: 10.1177/2040622315579059.
Ketamine and other N-methyl-D-aspartate receptor antagonists in the treatment of depression: a perspective review. [PubMed Abstract] [Full Text HTML] [Full Text PDF]
Iadarola ND, Niciu MJ, Richards EM1, Vande Voort JL, Ballard ED1, Lundin NB, Nugent AC, Machado-Vieira R1, Zarate CA Jr.
(7) Psychopharmacology (Berl). 2014 Sep;231(18):3663-76. doi: 10.1007/s00213-014-3664-5. Epub 2014 Jul 20. Ketamine administration in depressive disorders: a systematic review and meta-analysis. [PubMed Abstract]
Fond G, Loundou A, Rabu C, Macgregor A, Lançon C, Brittner M, Micoulaud-Franchi JA, Richieri R, Courtet P, Abbar M, Roger M, Leboyer M, Boyer L.
(8) J Affect Disord. 2014 Mar;156:24-35. doi: 10.1016/j.jad.2013.11.014. Epub 2013 Dec 10. A review of ketamine in affective disorders: current evidence of clinical efficacy, limitations of use and pre-clinical evidence on proposed mechanisms of action. [PubMed Abstract] Naughton M, Clarke G, O’Leary OF, Cryan JF, Dinan TG.
(9) And finally, here is a link to a commercial for profit ketamine clinic [As the Ketamine Advocacy Network suggests, I think it would be best to see if you qualify for a ketamine clinical trial:
In doing a google search for a blog post for ketamine for rapid sequence intubation, I came across this search ad: Ketamine Infusion Therapy. On clicking on it I was taken to the website Ketamine Clinics of Los Angeles.
