L Alison McInnes1, Jimmy J Qian2, Rishab S Gargeya3, Charles DeBattista4, Boris D Heifets5. 1. Osmind, San Francisco, CA, United States. Electronic address: alison@osmind.org. 2. Osmind, San Francisco, CA, United States; Stanford University School of Medicine, Stanford, CA, United States. 3. Osmind, San Francisco, CA, United States. 4. Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States. 5. Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States; Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States.
Abstract
BACKGROUND: Outcomes of ketamine intravenous therapy (KIT) for depression in real-world care settings have been minimally evaluated. We set out to quantify treatment response to KIT in a large sample of patients from community-based practices. METHODS: We retrospectively analyzed 9016 depression patients who received KIT between 2016 and 2020 at one of 178 community practices across the United States. Depression symptoms were evaluated using the Patient Health Questionnaire-9 (PHQ-9). The induction phase of KIT was defined to be a series of 4-8 infusions administered over 7 to 28 days. RESULTS: Among the 537 patients who underwent induction and had sufficient data, 53.6% of patients showed a response (≥ 50% reduction in PHQ-9 score) at 14-31 days post-induction and 28.9% remitted (PHQ-9 score drop to < 5). The effect size was d = 1.5. Among patients with baseline suicidal ideation (SI), 73.0% exhibited a reduction in SI. A subset (8.4%) of patients experienced an increase in depressive symptoms after induction while 6.0% of patients reported increased SI. The response rate was uniform across 4 levels of baseline depression severity. However, more severe illness was weakly correlated with a greater drop in scores while remission status was weakly inversely correlated with depression severity. Kaplan-Meier analyses showed that a patient who responds to KIT induction has approximately 80% probability of sustaining response at 4 weeks and approximately 60% probability at 8 weeks, even without maintenance infusions. CONCLUSION: KIT can elicit a robust antidepressant response in community clinics; however, a small percentage of patients worsened.
BACKGROUND: Outcomes of ketamine intravenous therapy (KIT) for depression in real-world care settings have been minimally evaluated. We set out to quantify treatment response to KIT in a large sample of patients from community-based practices. METHODS: We retrospectively analyzed 9016 depression patients who received KIT between 2016 and 2020 at one of 178 community practices across the United States. Depression symptoms were evaluated using the Patient Health Questionnaire-9 (PHQ-9). The induction phase of KIT was defined to be a series of 4-8 infusions administered over 7 to 28 days. RESULTS: Among the 537 patients who underwent induction and had sufficient data, 53.6% of patients showed a response (≥ 50% reduction in PHQ-9 score) at 14-31 days post-induction and 28.9% remitted (PHQ-9 score drop to < 5). The effect size was d = 1.5. Among patients with baseline suicidal ideation (SI), 73.0% exhibited a reduction in SI. A subset (8.4%) of patients experienced an increase in depressive symptoms after induction while 6.0% of patients reported increased SI. The response rate was uniform across 4 levels of baseline depression severity. However, more severe illness was weakly correlated with a greater drop in scores while remission status was weakly inversely correlated with depression severity. Kaplan-Meier analyses showed that a patient who responds to KIT induction has approximately 80% probability of sustaining response at 4 weeks and approximately 60% probability at 8 weeks, even without maintenance infusions. CONCLUSION: KIT can elicit a robust antidepressant response in community clinics; however, a small percentage of patients worsened.
Authors: Rebecca B Price; Nicholas Kissel; Andrew Baumeister; Rebecca Rohac; Mary L Woody; Elizabeth D Ballard; Carlos A Zarate; William Deakin; Chadi G Abdallah; Adriana Feder; Dennis S Charney; Michael F Grunebaum; J John Mann; Sanjay J Mathew; Bronagh Gallagher; Declan M McLoughlin; James W Murrough; Suresh Muthukumaraswamy; Rebecca McMillan; Rachael Sumner; George Papakostas; Maurizio Fava; Rebecca Hock; Jennifer L Phillips; Pierre Blier; Paulo Shiroma; Peter Šóš; Tung-Ping Su; Mu-Hong Chen; Mikael Tiger; Johan Lundberg; Samuel T Wilkinson; Meredith L Wallace Journal: Mol Psychiatry Date: 2022-09-07 Impact factor: 13.437
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