“Sublingual ketamine for treatment-resistant depression.”

Since September 2014 I have been prescribing low-dose sublingual ketamine to help my patients suffering from treatment-resistant depression. To date I have started this therapy with an initial monitored dose being given in my rooms and subsequent doses being taken at home with dosage and dose intervals being varied according to progress. [1]

My peer review group, having been given regular updates on progress, initially referred patients for treatment and currently two of the members are now prescribing ketamine for their own patients. In addition our local private hospital’s Medical Advisory Committee has approved the use of ketamine for treatment-resistant psychiatric disorders after being supplied relevant information.

Results to April 2016:

3 have not responded.

9 have showed partial improvement.

9 have improved strongly either attaining remission [“best I’ve been for 15 years”] or near-remission.

During the initial test dose some have recorded small, temporary increases in blood pressure and pulse rate. The most common subjective experience has been that of feeling light-headed and dissociative symptoms e.g. ‘time slowing” and “wave-like sensations” have been described at higher doses. There have been neither reports of bladder symptoms nor evidence of diversion or addiction.

Although treatment resistant depression has been the primary target almost all patients have co-morbidities and there have been significant improvements described in GAD, PTSD, SAD, neuropathic pain and acute suicidality. The age range has been 30-70 and both unipolar and bipolar depressive episodes have responded. In all cases ketamine has been added to current therapy and, for many, the original treatments have been reduced or stopped over time.

Ketamine for my group of patients living with severe chronic illness has not been a “cure” in that the majority have required further doses at intervals varying between every few days to 3 months to maintain benefit and some, particularly bipolar patients, have needed further courses for new episodes.

Using low-dose sublingual ketamine, which can be safely taken at home, has meant that treatment has been affordable even for those receiving income support although one patient has given up their daily newspaper and another nicotine, in order to mitigate the cost.

For my patients ketamine has not been a ‘magic bullet,’ nor is it suitable for everyone, but it has proved to be an extremely useful addition to the range of treatments available for severe depression. Based on my experience and that of many other psychiatrists around the world, [I am a member of an online group which has collectively treated more than 2,000 patients with ketamine over the past 3 years], I think we should all heed our College’s position that ketamine is an innovative therapy suitable, with appropriate safeguards, for patients with treatment-resistant depression. [2]

Author: Dr. Stephen J Hyde

FRANZCP

References:

[1] Hyde SJ (2015) ”Ketamine for Depression.” Xlibris.

[2] RANZCP (Nov 2015 online) Clinical Memorandum CLM PPP “Use of ketamine for treating depression.”