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Potential advantages of ketamine over electroconvulsive therapy in the treatment of nonrefractory severe depression in older patients with multiple medical comorbidities

Published online by Cambridge University Press:  02 May 2022

Fábio Lopes Rocha Open the ORCID record for Fábio Lopes Rocha [Opens in a new window] ,
Ulisses Gabriel V. Cunha ,
Débora B. Duarte  and
Cláudia Hara
Fábio Lopes Rocha*
Affiliation:
Psychiatric Unit, Social Security Institute for Public Servants of the State of Minas Gerais (Instituto de Previdência dos Servidores do Estado de Minas Gerais – IPSEMG), Belo Horizonte, Minas Gerais, Brazil
Ulisses Gabriel V. Cunha
Affiliation:
Geriatric Unit, Social Security Institute for Public Servants of the State of Minas Gerais (Instituto de Previdência dos Servidores do Estado de Minas Gerais - IPSEMG), Belo Horizonte, Minas Gerais, Brazil
Débora B. Duarte
Affiliation:
Geriatric Unit, Social Security Institute for Public Servants of the State of Minas Gerais (Instituto de Previdência dos Servidores do Estado de Minas Gerais - IPSEMG), Belo Horizonte, Minas Gerais, Brazil
Cláudia Hara
Affiliation:
Psychiatric Department, Faculty of Medical Sciences of Minas Gerais (Faculdade de Ciências Médicas de Minas Gerais), Belo Horizonte, Minas Gerais, Brazil
*
*Author for correspondence: Fábio Lopes Rocha, M.D., Ph.D. Email: rochafl@uol.com.br
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Abstract

Depression in older adults with multiple medical comorbidities can contribute to clinical deterioration, and increased mortality. Electroconvulsive therapy (ECT) is the first-line treatment for these patients. This study aimed to evaluate the effectiveness and safety of subcutaneous (SC) ketamine as an alternative to ECT. We reviewed the medical records of all consecutive older inpatients with severe depression and multiple medical comorbidities who were referred for ECT but treated with SC ketamine over 1 year in our institution. Demographic data, DSM-5 diagnosis, MÅDRS score, and CGI score were analyzed. Twelve patients aged 67–94 years were included. All patients were rated as severely ill, 83% were women, with a mean of 12.6 (SD, 1.4) medical comorbidities. Remission was achieved in 75% of the intention-to-treat population and 100% of treatment completers. The number of sessions ranged from 1 to 6, and days until remission from 1 to 16. Patients remained without relapse for 8–28 months. SC ketamine was safe and well tolerated, and most adverse events were mild and transient. Although limited by the retrospective open-label design of the study and small sample size, our findings provide a potential new indication for ketamine: treatment of severe depression, not necessarily resistant to antidepressants, in older patients with multiple medical comorbidities, at risk of clinical deterioration, and referral for ECT. SC ketamine was highly effective in this population, with no relapse and good tolerance. Randomized controlled trials are needed to adequately test the use of ketamine in this specific group.

Keywords

Depressionketaminecomorbiditieselderlyelectroconvulsive therapy
Type
Case based Review
Information
CNS Spectrums , Volume 28 , Issue 3 , June 2023 , pp. 313 - 318
Copyright
© The Author(s), 2022. Published by Cambridge University Press

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References

Gold, SM, Kohler-Forsberg, O, Moss-Morris, R, et al. Comorbid depression in medical diseases. Nat Rev Dis Primers. 2020;6(1):69.CrossRefGoogle ScholarPubMed
Kerner, N, Prudic, J. Current electroconvulsive therapy practice and research in the geriatric population. Neuropsychiatry. 2014;4(1):33–54.CrossRefGoogle ScholarPubMed
Cavenaghi, VB, da Costa, LP, Lacerda, ALT, Hirata, ES, Miguel, EC, Fraguas, R. Subcutaneous ketamine in depression: a systematic review. Front Psychiatry. 2021;12:513068.CrossRefGoogle ScholarPubMed
Sforzini, L, Worrell, C, Kose, M, et al. A Delphi-method-based consensus guideline for definition of treatment-resistant depression for clinical trials. Mol Psychiatry. 2021; doi: 10.1038/s41380-021-01381-x. Epub ahead of print. PMID: 34907394.Google ScholarPubMed
Rocha, FL, de Vasconcelos Cunha, UG, Paschoalin, RC, Hara, C, Thomaz, DP. Use of subcutaneous ketamine to rapidly improve severe treatment-resistant depression in a patient with Alzheimer’s disease. Int Clin Psychopharmacol. 2021;36(2):104–105.CrossRefGoogle Scholar
Cunha, UGV, Rocha, FL, Carvalho, FBCL, Duarte, DB. Ketamine for severe major depression in a 94 year-old man: a case report. J Clin Pharmacol Ther. 2021;2:16–17.Google Scholar
Ochs-Ross, R, Daly, EJ, Zhang, Y, et al. Efficacy and safety of esketamine nasal spray plus an oral antidepressant in elderly patients with treatment-resistant depression-TRANSFORM-3. Am J Geriatr Psychiatry. 2020;28(2):121–141.CrossRefGoogle ScholarPubMed
George, D, Gálvez, V, Martin, D, et al. Pilot randomized controlled trial of titrated subcutaneous ketamine in older patients with treatment-resistant depression. Am J Geriatr Psychiatry. 2017;25(11):1199–1209.CrossRefGoogle ScholarPubMed
Lipsitz, O, Di Vincenzo, JD, Rodrigues, NB, et al. Safety, tolerability, and real-world effectiveness of intravenous ketamine in older adults with treatment-resistant depression: a case series. Am J Geriatr Psychiatry. 2021;29(9):899–913.CrossRefGoogle ScholarPubMed
Subramanian, S, Lenze, EJ. Ketamine for depression in older adults. Am J Geriatr Psychiatry. 2021;29(9):914–916.CrossRefGoogle ScholarPubMed
Ghasemi, M, Kazemi, MH, Yoosefi, A, et al. Rapid antidepressant effects of repeated doses of ketamine compared with electroconvulsive therapy in hospitalized patients with major depressive disorder. Psychiatry Res. 2014;215(2):355–361.CrossRefGoogle ScholarPubMed
Kheirabadi, D, Kheirabadi, GR, Mirlohi, Z, Tarrahi, MJ, Norbaksh, A. Comparison of rapid antidepressant and antisuicidal effects of intramuscular ketamine, oral ketamine, and electroconvulsive therapy in patients with major depressive disorder: a pilot study. J Clin Psychopharmacol. 2020;40(6):588–593.CrossRefGoogle ScholarPubMed
Shiroma, PR, Johns, B, Kuskowski, M, et al. Augmentation of response and remission to serial intravenous subanesthetic ketamine in treatment resistant depression. J Affect Disord. 2014;155:123–129.CrossRefGoogle ScholarPubMed
Mathew, SJ, Murrough, JW, aan het Rot, M, Collins, KA, Reich, DL, Charney, DS. Riluzole for relapse prevention following intravenous ketamine in treatment-resistant depression: a pilot randomized, placebo-controlled continuation trial. Int J Neuropsychopharmacol.2010;13(1):71–82.CrossRefGoogle ScholarPubMed
McMullen, EP, Lee, Y, Lipsitz, O, et al. Strategies to prolong ketamine’s efficacy in adults with treatment-resistant depression. Adv Ther. 2021;38(6):2795–2820.CrossRefGoogle ScholarPubMed