Acute and Longer-Term Outcomes Using Ketamine as a Clinical Treatment at the Yale Psychiatric Hospital.

TitleAcute and Longer-Term Outcomes Using Ketamine as a Clinical Treatment at the Yale Psychiatric Hospital.
Publication TypeJournal Article
Year of Publication2018
AuthorsWilkinson ST, Katz RB, Toprak M, Webler R, Ostroff RB, Sanacora G
JournalJ Clin Psychiatry
Volume79
Issue4
Date Published2018 Jul 24
ISSN1555-2101
KeywordsAdolescent, Adult, Aged, Aged, 80 and over, Antidepressive Agents, Depressive Disorder, Treatment-Resistant, Drug Administration Schedule, Female, Hospitals, Psychiatric, Hospitals, University, Humans, Ketamine, Male, Middle Aged, Mood Disorders, Treatment Outcome, Young Adult
Abstract

OBJECTIVE: Ketamine has emerged as a rapid-acting antidepressant, though controversy remains whether sufficient data exist to justify its use outside of research protocols. In October 2014, the authors' institution began providing ketamine as an off-label therapy on a case-by-case basis for patients unable to participate in research protocols. Here, the participant experience during 29 months of providing ketamine as a clinical treatment for severe and treatment-resistant mood disorders through February 2017 is described.

METHODS: Patients were initially treated with a single- or double-infusion protocol (0.5 mg/kg for 40 minutes intravenously) and were later transitioned to a 4-infusion protocol over 2 weeks.

RESULTS: Fifty-four patients received ketamine, with 518 total infusions performed. A subset of 44 patients with mood disorders initiated the 4-infusion protocol, of whom 45.5% responded and 27.3% remitted by the fourth infusion. A subsample (n = 14) received ketamine on a long-term basis, ranging from 12 to 45 total treatments, over a course of 14 to 126 weeks. No evidence was found of cognitive decline, increased proclivity to delusions, or emergence of symptoms consistent with cystitis in this subsample.

CONCLUSIONS: In general, ketamine infusions were tolerated well. The response and remission rates in this clinical sample were lower than those observed in some research protocols. The small number of patients who were treated on a maintenance schedule limits the conclusions that can be drawn regarding the long-term safety of ketamine; however, no long-term adverse effects were observed in this sample.

DOI10.4088/JCP.17m11731
Alternate JournalJ Clin Psychiatry
PubMed ID30063304
PubMed Central IDPMC6296748
Grant ListL30 MH111000 / MH / NIMH NIH HHS / United States
T32 MH062994 / MH / NIMH NIH HHS / United States
Related Faculty: 
Mesut Toprak, M.D.

Pathology & Laboratory Medicine 1300 York Avenue New York, NY 10065 Phone: (212) 746-6464
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