Evaluation of IV Ketamine for Treatment Resistant Depression
One in 10 Canadians experience major depression at some point in their lives. Treatment for depression includes a combination of medications such as antidepressants and psychotherapy. However, 1 in 3 individuals living with depression does not respond to the current treatment approaches. These individuals are said to have TRD. Ketamine is an anesthetic drug that has been used off label for treatment-resistant depression for many years but the intranasal formulation (Spravato) was approved by FDA in 2019 and Health Canada in 2020.
With a growing number of reports about the benefits of single and repeated doses of ketamine among individuals experiencing treatment-resistant depression (TRD), ketamine clinics have been increasing over the years particularly in the United States. One such clinic was established at the Victoria Hospital in Prince Albert in 2016, where more than 100 patients have received ketamine infusions for treatment resistant depression.
Given the limited published data on the longer-term effectiveness and safety of ketamine and the need to inform local funding decisions about treatment for TRD, an evaluation was requested to examine clinical outcomes among patients who attended the ketamine clinic in Prince Albert. The SHA Research Department has been working with an Advisory Group comprised of decision makers, clinicians and patient partners to guide planning and implementation of the evaluation of the ketamine infusion clinic.
To date, the evaluation has found that the ketamine infusions were well tolerated by patients, a large proportion of whom have continued to pursue long-term IV ketamine treatment for their depression.
June Lundgren, Ketamine Clinic Coordinator at the Mental Health Unit in Prince Albert’s Victoria Hospital, says patients have seen significant improvements in their day-to-day activities.
“Their depression is not necessarily ‘cured,’” she explains, “but they obtain relief from debilitating symptoms and are able to resume/continue working, attend school and participate more fully in everyday life.”
Many clients have had no further “in patient” hospital admissions to the mental health unit since beginning treatment, adds Lundgren. She says initially patients may have felt somewhat uncertain about receiving the treatment; however, most reported, within a very short time after, a positive improvement in mood and motivation.
“They will also report intermittently a decrease in mood and feeling of wellbeing around the seven to 10 days prior to their next scheduled treatment,” which Lundgren notes is an indication of how much the treatments help patients.
“The first thing that I loved about ketamine was that I felt light when I came home. I felt that someone had lifted the fog,” says one patient. “I was able to move and focus on the stuff that I need to do rather than just lay on the couch and not move. This is what I had done for a year and a half.”
A retrospective chart review was conducted to describe demographic and clinical characteristics of patients as well as to assess the frequency and types of adverse effects and markers of clinical improvement. In addition, interviews are being conducted with current and former patients who received ketamine to understand their care and treatment experiences. The hope is the evaluation will add to scholarly knowledge about the use of ketamine and identify opportunities to improve care delivery.
Given that the gold standard treatment for depression is medication combined with evidence-based psychotherapy, this evaluation highlights a huge need for better access to psychological services among this patient population.