Rapid effectiveness of intravenous ketamine for ultraresistant depression in a clinical setting and evidence for baseline anhedonia and bipolarity as clinical predictors of effectiveness

• Author / Creator

  Thomas, Rejish

• Background
  Intravenous ketamine has been established as an efficacious and safe treatment, with transient effect, for treatment-resistant depression. However, the effectiveness of intravenous ketamine in non-research settings and with ultraresistant depression patients remains understudied.
  Aims:
  This study aimed to measure the response and remission rates in ultraresistant depression patients in a clinical setting by means of a retrospective, open label, database study. Secondarily, the study investigated previous findings of clinical predictors of effectiveness with intravenous ketamine treatment in an ultraresistant depression population.
  Methods:
  Fifty patients with ultraresistant depression were treated between May 2015 and December 2016, inclusive, in two community hospitals in Edmonton using six ketamine infusions of 0.5mg/kg over forty minutes over two to three weeks. Data were collected retrospectively from inpatient and outpatient charts. Statistical analysis to investigate clinical predictors of effectiveness included logistic regression analysis using a dependent variable of a 50% reduction in rating scale score at any point during treatment.
  Results:
  The average treatment resistance was severe at baseline, with a Maudsley Staging Method for treatment-resistant depression score of 12.1/15, and an average Beck Depression Inventory score of 34.2. Ninety percent of patients were resistant to electroconvulsive therapy. The response rate to intravenous ketamine was 44% and remission rate was 16%. As a single predictor, moderate or severe anhedonia at baseline predicted a 55% increased likelihood of response. As a combined predictor, moderate or severe anhedonia at baseline with a diagnosis of bipolar depression predicted a 73% increased likelihood of response.
  Conclusion:
  In a clinical setting, intravenous ketamine showed effectiveness in a complex, severely treatment-resistant, depressed population on multiple medication profiles concurrently. This study gave support to anhedonia and bipolar depression as clinical predictors of effectiveness.

• Subjects / Keywords

  • Ketamine
  • treatment resistant depression
  • ultraresistant depression
  • suicide
  • intravenous
  • predictors.

• Graduation date

  Fall 2018

• Type of Item

  Thesis

• Degree

  Master of Science

• DOI

  https://doi.org/10.7939/R3ZS2KV9T

• License

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