The use of ketamine in treatment-resistant major depression: a case study

Introduction: According to recent research ketamine appears to be a sufficient treatment in suicidal states and treatment-resistant major depression. In current studies treatment with six infusions over a period of two weeks has been proven to be safe (De Wilde, K E et al., Ann NY Acad Sci 2015, 1345(1): 47–58). However, there is little data regarding the long-term use of ketamine. In this case study we examine whether the long-term use of ketamine is safe and sufficient in the treatment of therapy-resistant major depression. Methods: Four patients with therapy-resistant major depression were included in this case study. All of them were treated with regular infusions of esketamine in a subanesthetic dose (< 1 mg/kg body weight) over at least two weeks. Depressive symptoms were periodically controlled with the becks depression inventory (BDI). Common side effects such as high blood pressure or dissociative symptoms were treated with antihypertensive drugs and benzodiazepines. Esketamine was initially applied three times a week. Depending on the clinical symptoms, the treatment frequency was extended. Results: In this case study we show that the long-term treatment with ketamine is safe and sufficient for the treatment of therapy-resistant major depression. The antidepressant effect was partially restricted by the side effects mentioned above. An alternative way of application could overcome the abovementioned restricting factors and enable a higher treatment frequency.