2 NEWS
2 NEWS
4 AUGUST 2023 ausdoc . com . au
Ketamine trial shows ‘ promise ’
One in five achieved remission in severe depression .
Rachel Carter A MONTH-long course of ketamine injections may be an effective treatment for severe depression , say Australian doctors who found “ promising ” remission rates in their largest-of-its-kind trial .
One in five adults in the Ketamine for Adult Depression Study achieved total remission after four weeks of twice-weekly subcutaneous ketamine , reported the UNSW Sydney – led team .
And nearly a third of the 179 participants with treatment-resistant depression had a 50 % reduction in symptom severity .
However , these benefits disappeared after treatment cessation , which the researchers said suggested a need for longer-term treatment to maintain the antidepressant effects .
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Participants in the multicentre trial were randomly assigned to receive subcutaneous racemic ketamine ( 0.5-0.9mg / kg ) or midazolam ( 0.025-0.045mg / kg ), an active control with psychoactive properties .
They were then monitored in the clinic for two hours while the dissociative and sedative effects wore off .
Overall , 20 % of those in the ketamine group achieved
remission — defined as a Montgomery – Åsberg Rating Scale for Depression score of ≤10 after treatment cessation — compared with 2 % in controls .
The subcutaneous injections were tolerated with no major side effects .
But the remission rate in the ketamine group dropped to 8 % versus 2 % among midazolam recipients at four-week follow-up : a
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“ This supports other evidence that ongoing treatment is required to maintain antidepressant effects for most participants ,” the authors wrote in The British Journal of Psychiatry .
Lead researcher Professor Colleen Loo told Australian Doctor that a key strength of the trial was the absence of an upper limit on depression severity among participants , which allowed those who had previously failed to respond to ECT to take part .
The clinicians also highlighted the low cost of the generic ketamine used in the trial , costing about $ 5 per dose compared with about $ 800 for the patented esketamine nasal spray currently in use .
Professor Loo said the Black Dog Institute had applied to the Medical Services Advisory Committee for an MBS item to fund the treatment , with a suggested cost of $ 350 for monitoring at each session .
“[ If ] you consider that many of these people might spend many months in hospital or be unable to work and are often quite suicidal , it is quite cost-effective when you see how incredibly quickly and powerfully it works ,” she said .
“ We have seen people go back to work , study or leave hospital because of this treatment in a matter of weeks .” She said future studies would investigate ketamine in combination with other therapies and how it compared with psilocybin-assisted therapy for treatment-resistant depression .
In terms of benefits disappearing after treatment cessation , she said : “ The data to date on ketamine suggest significant risk of relapse when treatment is stopped . “ We don ’ t want to tell people they need to continue with treatment beyond four weeks unnecessarily , … but we now have good data that demonstrate this .
“ Regardless of when the ketamine stops , follow-up is very important as that is when people are at risk of relapse .”
While researchers were yet to determine a set protocol for ongoing treatment , Professor Loo said the injections could be reduced to once weekly and then fortnightly before stopping completely , if possible .
“ For many , ongoing treatment for weeks to months will be needed to maintain response and allow them to reclaim their lives .”