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Ketamine for acute depression with SI/SA

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We used a ketamine analog and a glutamate receptor modulator in two clinical trials for treatment resistant MDD. Most patients had either failed multiple SSRIs or SNRIs or were on treatment and currently subtherapeutic (most had SI). Both trials were eventually unblinded after completion to allow the sites to treat the patients in follow-up.


We had anecdotal positive results with the ketamine analog. Some patients fared pretty well after the 12 weeks of treatment, but there was a high placebo response. Infusions were given 3x/week for 3 weeks, 1x/week for 3 weeks, and 1x/2weeks for 6 weeks. We kind of expected a high placebo response given that we were advertising a trial that had the word ketamine in it. There were a handful of patients that achieved extended remittance on solely an SSRI/SNRI after completion. 


The glutmatate receptor modulator had way more mixed results. Really nothing worth mentioning in detail.


There is a lot more research going into this line of therapy, but I do think that it needs to be reserved for significantly ill individuals. The method of administration can be taxing on the patient and the low half-life means that the subject may not experience extended relief. Insurance almost always is not going to pay for this off-label use, so the sheer cost may make this not possible. There is always fear of abuse, and because of the lack of large-scale research all psychiatrists and inpatient behavioral centers in our area will not use this treatment outside of clinical trials.


Hope this helps a bit. I do know of some centers/practitioners down in the Miami area that are doing off-label infusions for MDD patients, but I cannot recall them offhand.

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