Nelson B Rodrigues1,2, Roger S McIntyre1,2,3,4, Orly Lipsitz1,2, Yena Lee1,2, Danielle S Cha1, Flora Nasri1, Hartej Gill1,2, Leanna M W Lui1, Mehala Subramaniapillai1,2, Kevin Kratiuk2, Kangguang Lin5,6, Roger Ho7, Rodrigo B Mansur1,4, Joshua D Rosenblat1,2,3,4. 1. Mood Disorders Psychopharmacology Unit, University Health Network; University of Toronto , Toronto, ON, Canada. 2. Canadian Rapid Treatment Center of Excellence , Mississauga, ON, Canada. 3. Brain and Cognition Discovery Foundation, Canada; University of Toronto , Toronto, ON, Canada. 4. Department of Psychiatry, University of Toronto , Toronto, ON, Canada. 5. Department of Affective Disorder, The Affiliated Brain Hospital of Guangzhou Medical University, (Guangzhou Huiai Hospital), Guangzhou Medical University , Guangzhou, China. 6. Laboratory of Emotion and Cognition, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou Medical University , Guangzhou, China. 7. Department of Psychological Medicine, National University of Singapore , Singapore.
Abstract
OBJECTIVES: Rigorous clinical trials suggest ketamine is safe and well-tolerated in patients with treatment-resistant depression (TRD). There is a paucity of data on the safety and tolerability of ketamine in community-based clinics treating patients with TRD. METHODS: Retrospective data was analyzed from 203 patients with TRD who received repeat-dose IV ketamine. Safety was operationalized as hemodynamic changes. Tolerability was evaluated through the reporting of adverse events and dissociation symptom severity, as measured by the Clinician-Administered Dissociative States Scale. RESULTS: Ketamine was well-tolerated, with less than 5% of patients withdrawing due to tolerability concerns. Blood pressure significantly increased during infusion, with 44.3% meeting criteria for treatment-emergent hypertension (i.e., blood pressure ≥ 165/100 mmHg). 12% of patients exhibiting hypertension required pharmacological intervention. The most frequently reported adverse events included drowsiness (56.4%), dizziness (45.2%), dissociation (35.6%), and nausea (13.3%). Dissociation severity significantly attenuated after the first infusion, but plateaued for subsequent infusions. CONCLUSION: Intravenous ketamine was safe and well-tolerated. Hypertension was commonly observed and was often transient. Dissociation was most frequently reported after the first infusion but remained a consistent but not treatment-limiting adverse event thereafter. No patients exhibited psychosis, mania, or new onset suicidality with IV ketamine.
OBJECTIVES: Rigorous clinical trials suggest ketamine is safe and well-tolerated in patients with treatment-resistant depression (TRD). There is a paucity of data on the safety and tolerability of ketamine in community-based clinics treating patients with TRD. METHODS: Retrospective data was analyzed from 203 patients with TRD who received repeat-dose IV ketamine. Safety was operationalized as hemodynamic changes. Tolerability was evaluated through the reporting of adverse events and dissociation symptom severity, as measured by the Clinician-Administered Dissociative States Scale. RESULTS:Ketamine was well-tolerated, with less than 5% of patients withdrawing due to tolerability concerns. Blood pressure significantly increased during infusion, with 44.3% meeting criteria for treatment-emergent hypertension (i.e., blood pressure ≥ 165/100 mmHg). 12% of patients exhibiting hypertension required pharmacological intervention. The most frequently reported adverse events included drowsiness (56.4%), dizziness (45.2%), dissociation (35.6%), and nausea (13.3%). Dissociation severity significantly attenuated after the first infusion, but plateaued for subsequent infusions. CONCLUSION: Intravenous ketamine was safe and well-tolerated. Hypertension was commonly observed and was often transient. Dissociation was most frequently reported after the first infusion but remained a consistent but not treatment-limiting adverse event thereafter. No patients exhibited psychosis, mania, or new onset suicidality with IV ketamine.
Authors: Jason Ng; Leanna M W Lui; Joshua D Rosenblat; Kayla M Teopiz; Orly Lipsitz; Danielle S Cha; Jiaqi Xiong; Flora Nasri; Yena Lee; Kevin Kratiuk; Nelson B Rodrigues; Hartej Gill; Mehala Subramaniapillai; Rodrigo B Mansur; Roger Ho; Bing Cao; Roger S McIntyre Journal: Psychopharmacology (Berl) Date: 2021-01-23 Impact factor: 4.530
Authors: Michael D Kritzer; Nicholas A Mischel; Jonathan R Young; Christopher S Lai; Prakash S Masand; Steven T Szabo; Sanjay J Mathew Journal: Ann Clin Psychiatry Date: 2022-02 Impact factor: 2.691
Authors: Eric P McMullen; Yena Lee; Orly Lipsitz; Leanna M W Lui; Maj Vinberg; Roger Ho; Nelson B Rodrigues; Joshua D Rosenblat; Bing Cao; Hartej Gill; Kayla M Teopiz; Danielle S Cha; Roger S McIntyre Journal: Adv Ther Date: 2021-04-30 Impact factor: 3.845
Authors: Felicia Ceban; Joshua D Rosenblat; Kevin Kratiuk; Yena Lee; Nelson B Rodrigues; Hartej Gill; Mehala Subramaniapillai; Flora Nasri; Leanna M W Lui; Orly Lipsitz; Anil Kumar; Jung Goo Lee; Edmond H Chau; Bing Cao; Kangguang Lin; Roger C Ho; Rodrigo B Mansur; Jennifer Swainson; Roger S McIntyre Journal: CNS Drugs Date: 2021-08-07 Impact factor: 5.749