Frequency analysis of symptomatic worsening following ketamine infusions for treatment resistant depression in a real-world sample: Results from the canadian rapid treatment center of excellence. (January 2022)

• Record Type: Journal Article
• Authors: Di Vincenzo, Joshua D.; Lipsitz, Orly; Rodrigues, Nelson B.; Jones, Brett D.M.; Gill, Hartej; Lee, Yena; Lui, Leanna M.W.; Teopiz, Kayla M.; Ho, Roger; Lin, Kangguang; Nasri, Flora; McIntyre, Roger S.; Rosenblat, Joshua D.
• Is Part Of: Psychiatry research. Volume 307(2022)
• Publication Date: 2022-01
• Subjects: CRTCE -- Ketamine -- Depression -- Worsening -- Bipolar; Psychiatry -- Periodicals; Psychiatry -- periodicals; Psychiatrie -- Périodiques; 616.89
• DOI: 10.1016/j.psychres.2021.114321
• Languages: English
• ISSNs: 0165-1781

Abstract

Abstract: Antidepressants are associated with symptomatic worsening in a subgroup of patients. Replicated evidence has demonstrated rapid and robust antidepressant effects with intravenous (IV) ketamine in treatment resistant depression (TRD); however, the risk of ketamine worsening depressive symptoms in a subgroup of patients remains unknown. Herein we report a retrospective analysis on the rates of symptomatic worsening during an acute course of IV ketamine in individuals with unipolar ( n = 142) and bipolar ( n = 22) TRD. Adults ( N = 164; mean age = 45.97) with TRD underwent four sub-anesthetic infusions (0.5–0.75 mg/kg over 40 min) of IV ketamine over two weeks, and were assessed with the Quick Inventory for Depression Symptomatology-Self Report-16 (QIDS-SR16 ) at baseline and after each infusion. The primary outcome was the proportion of patients experiencing clinically significant worsening of depressive symptoms (≥20% increase on the QIDS-SR16 ) at each time point relative to baseline. Secondary analyses explored trends in the results. The frequency of clinically significant worsening fluctuated between 1.83% to 5.49%, with no identifiable trend across time. Zero individuals with bipolar TRD reported symptomatic worsening. Limitations include the single-centered, uncontrolled, retrospective nature of this study. Rates of symptomatic worsening associated with IV ketamine therapy for TRD appear to be very low and similar to conventional antidepressants.