Table 1.
Studies reporting oral ketamine use for treatment of depression
| Study | Number of patients | Dose and frequency | Side effects | Results | Conclusions |
|---|---|---|---|---|---|
| Paslakis et al29 Severe depression, chronic MDD, recurrent depressive disorder HAMD used for assessment |
4 | Starting dose: 10 mg TID, maximum dose: 1.25 mg/kg TID for 12–14 days | No psychotomimetic effects | Pt 1: Pretreatment HAMD 24, repeat HAMD 8, sustained Pt 2: Pretreatment HAMD 24, repeat HAMD 19 Pt 3: Pretreatment HAMD 19, repeat HAMD no change Pt 4: Pretreatment HAMD 21, repeat HAMD 8, sustained |
Potential ‘add-on’ therapy in patients on conventional antidepressant medication. |
| Irwin and Iglewicz12 Severe depression HADS used for assessment |
2 | 0.5 mg/kg, single dose | No side effects reported | Pt 1: Pretreatment HADS 18, repeat HADS 7 at 60 min, repeat HADS 9 at 15 days Pt 2: Pretreatment HADS 33, repeat HADS 21 at 60 min, repeat HADS 13 at 8 days |
Improved pain, anxiety and depression scales in hospice patients (home setting). |
| McNulty and Hahn16 Severe depression |
1 | 0.5 mg/kg daily for 2 months | No side effects reported | Pretreatment ‘depression score’ 8; post-treatment 0 | Improved pain, anxiety and depression in outpatient palliative and hospice patient. |
| Irwin et al13 Depression HADS≥15 used for assessment |
14 | 0.5 mg/kg daily for 28 days | Mild increase in diarrhoea, trouble sleeping and sitting still | 8 patients completed the study, 100% demonstrated a ≥30% decrease in HADS depression scale | Proof of concept in population of hospice patients (home and skilled nursing facility). |
| Lara et al15 Refractory unipolar depression Likert scale used for assessment: 0–10 mood scale (0=very sad/distressed; 10=cheerful/positive/peaceful) |
26 | Starting dose: 10 mg daily, titrated by 5 mg increments; variable dosing frequency, no maximum dose reported, longest treatment was 6 months | Transient agitation and light-headedness | 20 patients: remission or ‘clear response’ 3 patients: moderate or partial response 3 patients: no response |
Low doses of oral ketamine may achieve remission and be sustained after cessation. |
| De Gioannis and De Leo31 Bipolar depression, chronic suicidal ideation MADRS used for assessment |
2 | 0.5–3 mg/kg, every 2–4 weeks | No side effects reported | Pt 1: Pretreatment MADRS 36, repeat MADRS 17 at 24 hours, sustained ‘remission’ of suicidal ideation. Pt 2: Pretreatment MADRS 31, repeat MADRS 10 at 24 hours, no suicidal ideation |
Sustained remission of suicidal ideation. |
| Nguyen L et al32 MDD, TRD DSM-IV-TR used for diagnosis; assessment of response based on clinician opinion and drug refill history; standardised test not used |
17 | 0.5–1 mg/kg of ketamine held for as long as possible in mouth prior to swallowing | No notable side effects | 13/17 (76%) deemed responders 4/17 non-responders Patients classified as ‘responders’ or ‘non-responders’ on clinical basis/opinion and/or drug refill history |
Improved depression using transmucosal delivery of liquid oral ketamine in an outpatient psychiatric clinic setting. |
DSM-IV-TR, Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (Text Revision); HADS, Hospital Anxiety Depression Scale; HAMD, Hamilton Depression Rating Scale; MADRS, Montgomery-Asberg Depression Rating Scale; MDD, major depressive disorder; Pt, patient; TID, three times a day; TRD, treatment-resistant depression.