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The following is a summary of “A randomized controlled pilot study of daily intravenous ketamine over three days for treatment-resistant depression,” published in the July 2024 issue of Psychiatry by Pattanaseri et al.
Despite ketamine’s proven rapid antidepressant effects, standardized guidelines for its use in treatment-resistant depression are lacking. However, a continuous 10-day infusion has shown efficacy in managing persistent pain without notable side effects.
Researchers conducted a retrospective study assessing the antidepressant effectiveness of consecutive ketamine infusions over 3 days, along with the duration of therapeutic response and the overall safety of the treatment.
They involved participants aged 18–64 with treatment-resistant depression to receive either IV ketamine or midazolam (as an active placebo) over 3 consecutive days for 40 days. Changes in the Montgomery–Åsberg Depression Rating Scale (MADRS) total score and Clinical Global Impression-Severity were analyzed using repeated measures ANOVA from the initial assessment to 10 and 31 days post-infusion. Additionally, Kaplan–Meier survival analysis was used to evaluate the duration of response and remission.
The result showed 33 participants, of which only 20 completed planned treatment. A mean reduction in MADRS score of 12.55 (95% CI = 6.70–18.09) on the 10th day was observed in the ketamine group, while a decrease in the midazolam group of 17.22 (95% CI = 11.09–23.36) was seen. The pattern continued through day 31, with ketamine resulting in a decreased mean score of 13.73 (95% CI = 7.54–19.91) and midazolam reduced to 12.44 (95% CI = 5.61–19.28). Both treatments were well tolerated, with ketamine-associated dissociative symptoms being brief and subsiding by the conclusion of each infusion.
Investigators concluded that administering intravenous ketamine over 3 days showed no significant antidepressant advantage over midazolam, suggesting a need for further research on effective treatment regimens for treatment-resistant depression.
Source: bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-024-05951-5
