Hitoshi Sakurai1, Felipe Jain2, Simmie Foster2, Paola Pedrelli2, David Mischoulon2, Maurizio Fava2, Cristina Cusin3. 1. Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square, 6th Floor, Boston, MA 02114, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan. 2. Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square, 6th Floor, Boston, MA 02114, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA. 3. Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square, 6th Floor, Boston, MA 02114, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA. Electronic address: CCUSIN@mgh.harvard.edu.
Abstract
BACKGROUND: Little is known about the long-term outcomes of repeated ketamine infusions for depression. We conducted a retrospective chart review to investigate outcomes of maintenance intravenous ketamine treatment at Massachusetts General Hospital. METHODS: Eighty-five patients with treatment-resistant depression (TRD) who started intravenous ketamine from October 2018 to November 2019 were examined. Symptom severity was evaluated with the 16-item Quick Inventory of Depressive Symptomatology-Self Report scale (QIDS-SR16) at every visit prior to administration. The initial ketamine dose was usually 0.5 mg/kg infused over 40 min. Intravenous ketamine was administered twice-weekly for three weeks in an induction phase, followed by maintenance with a variable administration schedule and dose. Response was defined as a ≥50% reduction in total QIDS-SR16 score from baseline. RESULTS: Forty (47.1%) of the 85 patients who started treatment discontinued during or right after the induction phase; 3 (3.5%) were still on induction at the time of this report, and 42 (49.4%) transitioned to maintenance after completing induction. Among these patients, 14 (16.5%) discontinued during maintenance and 28 (32.9%) continued on maintenance. The mean ketamine dosage during maintenance was 0.91±0.28 mg/kg. Fifteen out of 82 patients (18.3%) responded to induction treatment and 6 (7.3%) remained in responder status at the time of data analysis during maintenance. Three patients discontinued ketamine due to side-effects. CONCLUSIONS: Despite the apparently low response rate in QIDS-SR16 scores and considerable out-of-pocket costs, almost half of real-world outpatients with TRD decided to continue with maintenance ketamine treatment due to perceived significant improvement.
BACKGROUND: Little is known about the long-term outcomes of repeated ketamine infusions for depression. We conducted a retrospective chart review to investigate outcomes of maintenance intravenous ketamine treatment at Massachusetts General Hospital. METHODS: Eighty-five patients with treatment-resistant depression (TRD) who started intravenous ketamine from October 2018 to November 2019 were examined. Symptom severity was evaluated with the 16-item Quick Inventory of Depressive Symptomatology-Self Report scale (QIDS-SR16) at every visit prior to administration. The initial ketamine dose was usually 0.5 mg/kg infused over 40 min. Intravenous ketamine was administered twice-weekly for three weeks in an induction phase, followed by maintenance with a variable administration schedule and dose. Response was defined as a ≥50% reduction in total QIDS-SR16 score from baseline. RESULTS: Forty (47.1%) of the 85 patients who started treatment discontinued during or right after the induction phase; 3 (3.5%) were still on induction at the time of this report, and 42 (49.4%) transitioned to maintenance after completing induction. Among these patients, 14 (16.5%) discontinued during maintenance and 28 (32.9%) continued on maintenance. The mean ketamine dosage during maintenance was 0.91±0.28 mg/kg. Fifteen out of 82 patients (18.3%) responded to induction treatment and 6 (7.3%) remained in responder status at the time of data analysis during maintenance. Three patients discontinued ketamine due to side-effects. CONCLUSIONS: Despite the apparently low response rate in QIDS-SR16 scores and considerable out-of-pocket costs, almost half of real-world outpatients with TRD decided to continue with maintenance ketamine treatment due to perceived significant improvement.
Authors: Sina Nikayin; Taeho Greg Rhee; Maria Elena Cunningham; Christina A de Fontnouvelle; Robert B Ostroff; Gerard Sanacora; Samuel T Wilkinson Journal: JAMA Psychiatry Date: 2022-07-01 Impact factor: 25.911
Authors: Adam Bayes; Brooke Short; Carlos A Zarate; Lawrence Park; James W Murrough; Declan M McLoughlin; Patricio Riva-Posse; Robert Schoevers; Jolien Veraart; Sagar Parikh; Paul Glue; Johnson Fam; Rupert McShane; Veronica Galvez; Donel Martin; Phern-Chern Tor; Andre R Brunoni; Colleen K Loo Journal: J Affect Disord Date: 2022-04-09 Impact factor: 6.533