- •What is the primary question addressed by this study?Is repeat-dose intravenous (IV) ketamine treatment safe, effective, and well-tolerated in older adults with treatment-resistant depression receiving care at a specialized community-based clinic?
- •What is the main finding of this study?Twenty-seven percent of older adults responded to IV ketamine after four infusions (i.e., ≥50% symptomatic improvement compared to pre-treatment), and three individuals dropped out of treatment due to increased anxiety and/or inability to tolerate dissociative symptoms. Sixty-nine percent of participants experienced treatment-emergent hypertension during at least one infusion.
- •What is the meaning of the finding?Intravenous ketamine treatment was associated with transient treatment-emergent hypertension, and response rates in older adults were comparable to those previously reported in general adult populations.
To evaluate the safety, tolerability, and effectiveness of repeated doses of intravenous (IV) ketamine in older adults (i.e., ≥60 years of age) with treatment-resistant depression.
In this case series, fifty-three older adults (Mage = 67, SD = 6; 57% female [n = 30]) received 4 IV ketamine infusions, administered over 1–2 weeks. Effectiveness of IV ketamine was measured using the Quick Inventory for Depressive Symptomatology–Self Report 16 (QIDS-SR16) approximately 2 days after infusions 1–3, and 1–2 weeks after infusion 4. Safety was measured as hemodynamic changes before, during, immediately after, and 20 minutes after each infusion. Tolerability was assessed via systematic reporting of treatment-emergent adverse events during and after each infusion, in addition to symptoms of dissociation measured using the Clinician Administered Dissociative States Scale. Partial response (25%–50% symptomatic improvement from baseline), response (≥50% symptomatic improvement from baseline), clinically significant improvements (≥25% symptomatic improvement from baseline), and remission rates (QIDS-SR16 ≤5) were also calculated.
Participants reported significant decreases in depressive symptoms (i.e., as measured by the QIDS-SR16) with repeated ketamine infusions (F(4, 92) = 7.412, p <0.001). The mean QIDS-SR16 score was 17.12 (SD = 5.33) at baseline and decreased to 12.52 (SD = 5.79) following 4 infusions. After 4 infusions, 31% (n = 8) of participants partially responded to IV ketamine, 27% (n = 7) responded, 58% (n = 15) experienced clinically significant improvements, and 10% (n = 3) met remission criteria. Thirty-six participants (69%) experienced treatment-emergent hypertension during at least 1 infusion, and 10 (19%) required intervention with an antihypertensive. Drowsiness was the most commonly reported adverse event (50% of infusions; n = 73).
Ketamine was associated with transient treatment-emergent hypertension. Response and remission rates were comparable to those reported in general adult samples. Findings are limited by the open-label, chart review nature of this study.
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Published online: January 09, 2021
Accepted: December 29, 2020
Received in revised form: December 29, 2020
Received: November 19, 2020
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