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Payette O, Lespérance P, Jodoin VD, Longpré-Poirier C, Elkrief L, Richard M, Garel N, Miron JP. Intravenous ketamine for treatment-resistant depression patients who have failed to respond to transcranial magnetic stimulation: A case series. J Affect Disord 2023; 333:18-20. [PMID: 37075822 DOI: 10.1016/j.jad.2023.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 03/18/2023] [Accepted: 04/14/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND For individuals with treatment-resistant depression (TRD), transcranial magnetic stimulation (TMS) has become a well-established approach. In the past decade, intravenous (IV) racemic ketamine has also emerged as a potential treatment for TRD. Currently, little data is available on the clinical effects of IV racemic ketamine in TRD patients who experienced TMS-failure. METHODS Twenty-one (21) TRD patients who had failed to respond to a standard course of high-frequency left-dorsolateral prefrontal cortex TMS were subsequently scheduled to received IV racemic ketamine infusions. The IV racemic ketamine protocol consisted of 0,5 mg/kg infusions over 60 min, 3 times a week over 2 weeks. RESULTS Treatment was safe with minimal side-effects. Mean baseline MADRS score was 27.6 ± 6.4 (moderate depression), decreasing down to 18.6 ± 8.9 (mild depression) post-treatment. Mean percent improvement was 34.5 % ± 21.1 from baseline to post-treatment. Paired sample t-test showed significant MADRS score decrease pre- to post-treatment [t(20) = 7.212, p < .001]. Overall, four (4) patients (19.0 %) responded and two (2) of those achieved remission (9.5 %). LIMITATIONS Limitations of this case series include its retrospective and uncontrolled open-label nature, the lack of self-rating and standardized adverse events questionnaires, as well as follow-ups beyond the immediate treatment period. CONCLUSIONS Novel ways to increase the clinical effects of ketamine are being explored. We discuss potential combination approaches of ketamine with other modalities to augment its effects. Given the global burden of TRD, novel approaches are needed to curb the current mental health epidemic around the world.
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Affiliation(s)
- Olivier Payette
- Centre Hospitalier de l'Université de Montréal (CHUM) et Centre de Recherche du CHUM (CRCHUM), Université de Montréal, QC, Canada
| | - Paul Lespérance
- Centre Hospitalier de l'Université de Montréal (CHUM) et Centre de Recherche du CHUM (CRCHUM), Université de Montréal, QC, Canada; Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, QC, Canada
| | - Véronique Desbeaumes Jodoin
- Centre Hospitalier de l'Université de Montréal (CHUM) et Centre de Recherche du CHUM (CRCHUM), Université de Montréal, QC, Canada
| | | | - Laurent Elkrief
- Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, QC, Canada
| | - Maxime Richard
- Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, QC, Canada
| | - Nicolas Garel
- Department of Psychiatry, Faculty of Medecine, McGill University, Ludmer Research & Training Building, 1033 Av. des Pins, Montréal, Quebec H3A 1A1, Canada
| | - Jean-Philippe Miron
- Centre Hospitalier de l'Université de Montréal (CHUM) et Centre de Recherche du CHUM (CRCHUM), Université de Montréal, QC, Canada; Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, QC, Canada.
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Payette O, Jodoin VD, Medjahed N, Massé-Leblanc C, Elkrief L, Longpré-Poirier C, Lespérance P, Miron JP. Intravenous ketamine for treatment-resistant depression in patients who have failed to respond to transcranial magnetic stimulation: a case series. Brain Stimul 2023. [DOI: 10.1016/j.brs.2023.01.491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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Elkrief L, Payette O, Foucault JN, Longpré-Poirier C, Richard M, Desbeaumes Jodoin V, Lespérance P, Miron JP. Transcranial magnetic stimulation and intravenous ketamine combination therapy for treatment-resistant bipolar depression: A case report. Front Psychiatry 2022; 13:986378. [PMID: 36213934 PMCID: PMC9532540 DOI: 10.3389/fpsyt.2022.986378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/23/2022] [Indexed: 11/20/2022] Open
Abstract
About a third of patients suffering from major depression develop treatment-resistant depression (TRD). Although repetitive transcranial magnetic stimulation (rTMS) and intravenous ketamine have proven effective for the management of TRD, many patients remain refractory to treatment. We present the case of a patient suffering from bipolar TRD. The patient was referred to us after failure to respond to first-and second-line pharmacotherapy and psychotherapy. After minimal response to both rTMS and ketamine alone, we attempted a combination rTMS and ketamine protocol, which led to complete and sustained remission. Various comparable and complimentary mechanisms of antidepressant action of ketamine and rTMS are discussed, which support further study of this combination therapy. Future research should focus on the feasibility, tolerability, and efficacy of this novel approach.
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Affiliation(s)
- Laurent Elkrief
- Centre Hospitalier de l'Université de Montréal et Centre de Recherche du CHUM, Université de Montréal, Montreal, QC, Canada.,Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
| | - Olivier Payette
- Centre Hospitalier de l'Université de Montréal et Centre de Recherche du CHUM, Université de Montréal, Montreal, QC, Canada
| | - Jean-Nicolas Foucault
- Centre Hospitalier de l'Université de Montréal et Centre de Recherche du CHUM, Université de Montréal, Montreal, QC, Canada
| | - Christophe Longpré-Poirier
- Centre Hospitalier de l'Université de Montréal et Centre de Recherche du CHUM, Université de Montréal, Montreal, QC, Canada.,Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
| | - Maxime Richard
- Centre Hospitalier de l'Université de Montréal et Centre de Recherche du CHUM, Université de Montréal, Montreal, QC, Canada.,Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
| | - Véronique Desbeaumes Jodoin
- Centre Hospitalier de l'Université de Montréal et Centre de Recherche du CHUM, Université de Montréal, Montreal, QC, Canada
| | - Paul Lespérance
- Centre Hospitalier de l'Université de Montréal et Centre de Recherche du CHUM, Université de Montréal, Montreal, QC, Canada.,Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
| | - Jean-Philippe Miron
- Centre Hospitalier de l'Université de Montréal et Centre de Recherche du CHUM, Université de Montréal, Montreal, QC, Canada.,Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
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