Ketamine infusions for treatment resistant depression: a series of 28 patients treated weekly or twice weekly in an ECT clinic
Ketamine infusions for treatment resistant depression: a series of 28 patients treated weekly or twice weekly in an ECT clinic
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DOI：
10.1177/0269881114527361
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发表时间：
2014-06-01
影响因子：
4.1
通讯作者：
McShane, Rupert
中科院分区：
文献类型：
--
作者：
Diamond, Peter R.;Farmery, Andrew D.;McShane, Rupert
背景：氯胺酮对难治性抑郁症（TRD）有快速的抗抑郁作用。认知功能的多个氯胺酮输液和并发抗抑郁药的反应率和duration的影响是未知的。方法：28例单或双极TRD的治疗超过三个星期，无论是三个或六个氯胺酮输液（0.5毫克/公斤，超过40分钟）在恢复室的常规ECT诊所。在第21天（末次输注后4-7天）进行治疗后记忆评估。患者随访6个月，在可能的情况下，与抑郁症的严重程度和副作用monitoredthrough.Results：8（29%）患者响应其中4缓解。只有3例（11%）患者在单次输注后6小时内出现应答，但在所有应答者中，应答均在第三次输注前出现。末次输注后的缓解持续时间各不相同（中位数70，范围25-168天）。停药包括2例（7%）由于输注期间的急性不良反应，5例（18%）由于未能获益和焦虑增加。氯胺酮与记忆障碍无关。ECT诊所被评为合适的患者，并提供了适当的水平monitoring.Conclusion：这个小的，开放标签的自然主义研究表明，高达6低剂量氯胺酮输注可以安全地在现有的NHS临床结构中，患者谁继续他们的抗抑郁药。缓解率与在无抗抑郁药患者中单次给予氯胺酮的RCT中发现的缓解率相当，但开发时间稍长。
Background: Ketamine has a rapid antidepressant effect in treatment-resistant depression (TRD). The effects on cognitive function of multiple ketamine infusions and of concurrent antidepressant medication on response rate and duration are not known.Method: Twenty-eight patients with uni- or bipolar TRD were treated over three weeks with either three or six ketamine infusions (0.5 mg/kg over 40 minutes) in the recovery room of a routine ECT clinic. Post-treatment memory assessments were conducted on day 21 (4-7 days after the final infusion). Patients were followed up for six months where possible, with severity of depression and side effects monitored throughout.Results: Eight (29%) patients responded of whom four remitted. Only three (11%) patients had responded within six hours after a single infusion, but in all responders, the response had developed before the third infusion. The duration of response from the final infusion was variable (median 70, range 25-168 days). Discontinuations included two (7%) because of acute adverse reactions during the infusion and five (18%) because of failure to benefit and increasing anxiety. Ketamine was not associated with memory impairment. The ECT clinic was rated suitable by patients and offered appropriate levels of monitoring.Conclusion: This small, open label naturalistic study shows that up to six low dose ketamine infusions can safely be given within an existing NHS clinical structure to patients who continue their antidepressants. The response rate was comparable to that found in RCTs of single doses of ketamine in antidepressant-free patients but took slightly longer to develop.