Impact of oral ketamine augmentation on hospital admissions in treatment-resistant depression and PTSD: a retrospective study
Impact of oral ketamine augmentation on hospital admissions in treatment-resistant depression and PTSD: a retrospective study
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DOI：
10.1007/s00213-017-4786-3
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发表时间：
2018-02-01
影响因子：
3.4
通讯作者：
De Gioannis, Angelo
中科院分区：
文献类型：
--
作者：
Hartberg, John;Garrett-Walcott, Simone;De Gioannis, Angelo
在澳大利亚，抑郁症发作是精神健康相关住院的主要原因，44%的住院患者既往有抑郁症住院史（Admitted patient mental health related care：（Australian Institute of Health and Welfare Aust Hospital Stat 2011-12，2013））。尽管有许多可用的抗抑郁治疗，但许多患者对常规治疗没有反应，具有所谓的“治疗抗性”（Fava Biol Psychiatry 53：649-659，2003）。近年来，氯胺酮作为一种有效的、快速起效的抗抑郁药已经崭露头角（氯胺酮：黑暗中的一盏灯：Paleos和Ross 28-33，2013）。然而，习惯的静脉（IV）和肌肉（IM）的管理和复发率后，停止仍然是障碍，更广泛采用usage.This研究的患者接受长期口服氯胺酮治疗难治性抑郁症和创伤后应激障碍（PTSD）的最大的回顾性审查。我们的目的是检查口服氯胺酮治疗的安全性和有效性，在门诊设置为衡量的变化住院精神病epissions.Hospital记录的37例接受口服氯胺酮治疗的患者进行了审查，比较治疗前后精神病住院的数量和持续时间。记录还筛选了不良医疗事件和氯胺酮剂量随时间的变化。治疗后，住院天数减少了70%，住院人数减少了65%。患者所需氯胺酮剂量随时间推移保持稳定，无耐受性形成的证据。没有严重的不良事件，也没有长期的不良反应与氯胺酮。口服氯胺酮提供了一个有前途的药理学辅助治疗抑郁症。它可能是IV或IM氯胺酮的更易接近的替代品。这些结果值得进一步研究口服氯胺酮用于精神病治疗的安全性和有效性。
Depressive episodes are the leading cause of mental health-related hospital admissions in Australia, and 44% of those admitted have a previous history of hospitalisations for depression (Admitted patient mental health-related care: (Australian Institute of Health and Welfare Aust Hospital Stat 2011-12, 2013). Despite numerous available antidepressant treatments, many patients do not respond to conventional therapy, having what is called 'treatment resistance' (Fava Biol Psychiatry 53:649-659, 2003). In recent years, ketamine has risen to prominence as an effective, rapidly acting antidepressant (Ketamine: a light in the darkness: Paleos and Ross 28-33, 2013). However, customary intravenous (IV) and intramuscular (IM) routes of administration and relapse rates after cessation remain barriers to more widely adopted usage.This study represents the largest retrospective review of patients receiving long-term oral ketamine for treatment-resistant depression and post-traumatic stress disorder (PTSD). Our purpose was to examine the safety and efficacy of oral ketamine therapy in an outpatient setting as measured by changes in hospitalisation for psychiatric episodes.Hospital records of 37 patients who received oral ketamine treatment were reviewed to compare the number and duration of psychiatric hospital admissions before and after treatment. Records were also screened for adverse medical events and changes in ketamine dosage over time.Following treatment, inpatient hospital days were reduced by 70%, and hospital admissions were reduced by 65%. The dose of ketamine patients required was stable over time with no evidence of tolerance building. There were no serious adverse events and no long-term negative effects associated with ketamine.Oral ketamine offers a promising pharmacologic adjunct to depression treatment. It may offer a more approachable alternative to IV or IM ketamine. The results warrant further investigation into the safety and efficacy of oral ketamine for psychiatric treatment.