Is Ketamine the Future Clozapine for Depression? A Case Series and Literature Review on Maintenance Ketamine in Treatment-resistant Depression with Suicidal Behavior

Lai Fong Chan, Choon Leng Eu, Shean Yih Soh, Thambu Maniam, Zuri Shahidii Kadir, Benedict Tak Wai Chong, Jiann Lin Loo, Shalisah Sharip, Vincent Choong Wai Wong, Tsui Huei Loo, Yin Ping Ng, David A. Kahn

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Ketamine has shown effectiveness as a rapid-acting antidepressant with antisuicidal effects in terms of reduction of suicidal ideation in the short term. However, the evidence for long-term maintenance ketamine therapy for treatment-resistant depression (TRD) and suicidal behavior is limited. This case series (N=13) highlights the role of adjunctive serial maintenance ketamine infusions in restoring functionality in treatment-resistant unipolar and bipolar (mixed) depression with significant suicide risk and multiple comorbidities, including alcohol dependence. Two cases of TRD achieved functional remission with long-term maintenance ketamine treatment. The first case illustrates the potential synergistic interaction between ketamine and lamotrigine to achieve a sustained antidepressant response in the patient for 7 months. The second case may possibly be the longest reported case of maintenance ketamine therapy, with treatment continuing for 5 years to date. Ketamine treatment showed acute effectiveness in another 7 cases, especially in terms of reduction of suicidal ideation, albeit without significant long-term antidepressant effect. Factors that may contribute to lack of effectiveness of serial ketamine include inadequate mood stabilization in TRD in bipolar spectrum diagnoses, concomitant benzodiazepine use, complex comorbidities, and adverse effects such as significant hypertension and severe dissociation. Future systematic controlled studies are warranted to establish the efficacy and safety profile of long-term ketamine as maintenance therapy for TRD with suicidal behavior.

Original languageEnglish
Pages (from-to)279-291
Number of pages13
JournalJournal of Psychiatric Practice
Volume24
Issue number4
DOIs
Publication statusPublished - 1 Jul 2018

Fingerprint

Treatment-Resistant Depressive Disorder
Clozapine
Ketamine
Maintenance
Depression
Antidepressive Agents
Suicidal Ideation
Comorbidity
Dissociative Disorders
Therapeutics
Benzodiazepines
Bipolar Disorder
Suicide
Alcoholism
Hypertension
Safety

Keywords

  • maintenance ketamine
  • suicidal behavior
  • treatment-resistant unipolar/bipolar depression

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Is Ketamine the Future Clozapine for Depression? A Case Series and Literature Review on Maintenance Ketamine in Treatment-resistant Depression with Suicidal Behavior. / Chan, Lai Fong; Eu, Choon Leng; Soh, Shean Yih; Maniam, Thambu; Kadir, Zuri Shahidii; Chong, Benedict Tak Wai; Loo, Jiann Lin; Sharip, Shalisah; Wong, Vincent Choong Wai; Loo, Tsui Huei; Ng, Yin Ping; Kahn, David A.

In: Journal of Psychiatric Practice, Vol. 24, No. 4, 01.07.2018, p. 279-291.

Research output: Contribution to journalArticle

Chan, Lai Fong ; Eu, Choon Leng ; Soh, Shean Yih ; Maniam, Thambu ; Kadir, Zuri Shahidii ; Chong, Benedict Tak Wai ; Loo, Jiann Lin ; Sharip, Shalisah ; Wong, Vincent Choong Wai ; Loo, Tsui Huei ; Ng, Yin Ping ; Kahn, David A. / Is Ketamine the Future Clozapine for Depression? A Case Series and Literature Review on Maintenance Ketamine in Treatment-resistant Depression with Suicidal Behavior. In: Journal of Psychiatric Practice. 2018 ; Vol. 24, No. 4. pp. 279-291.
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