Intravenous Ketamine for Adolescents with Treatment-Resistant Depression: An Open-Label Study

Kathryn R. Cullen, Palistha Amatya, Mark G. Roback, Christina Sophia Albott, Melinda Westlund Schreiner, Yanan Ren, Lynn E. Eberly, Patricia Carstedt, Ali Samikoglu, Meredith Gunlicks-Stoessel, Kristina Reigstad, Nathan Horek, Susannah J Tye, Kelvin O. Lim, Bonnie Klimes-Dougan

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Novel interventions for treatment-resistant depression (TRD) in adolescents are urgently needed. Ketamine has been studied in adults with TRD, but little information is available for adolescents. This study investigated efficacy and tolerability of intravenous ketamine in adolescents with TRD, and explored clinical response predictors. Methods: Adolescents, 12-18 years of age, with TRD (failure to respond to two previous antidepressant trials) were administered six ketamine (0.5 mg/kg) infusions over 2 weeks. Clinical response was defined as a 50% decrease in Children's Depression Rating Scale-Revised (CDRS-R); remission was CDRS-R score ≤28. Tolerability assessment included monitoring vital signs and dissociative symptoms using the Clinician-Administered Dissociative States Scale (CADSS). Results: Thirteen participants (mean age 16.9 years, range 14.5-18.8 years, eight biologically male) completed the protocol. Average decrease in CDRS-R was 42.5% (p = 0.0004). Five (38%) adolescents met criteria for clinical response. Three responders showed sustained remission at 6-week follow-up; relapse occurred within 2 weeks for the other two responders. Ketamine infusions were generally well tolerated; dissociative symptoms and hemodynamic symptoms were transient. Higher dose was a significant predictor of treatment response. Conclusions: These results demonstrate the potential role for ketamine in treating adolescents with TRD. Limitations include the open-label design and small sample; future research addressing these issues are needed to confirm these results. Additionally, evidence suggested a dose-response relationship; future studies are needed to optimize dose. Finally, questions remain regarding the long-term safety of ketamine as a depression treatment; more information is needed before broader clinical use.

Original languageEnglish (US)
Pages (from-to)437-444
Number of pages8
JournalJournal of Child and Adolescent Psychopharmacology
Volume28
Issue number7
DOIs
StatePublished - Sep 1 2018

Fingerprint

Treatment-Resistant Depressive Disorder
Ketamine
Depression
Vital Signs
Antidepressive Agents
Signs and Symptoms
Hemodynamics
Safety
Recurrence
Therapeutics

Keywords

  • adolescent
  • depression
  • ketamine
  • treatment-resistant

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Psychiatry and Mental health
  • Pharmacology (medical)

Cite this

Cullen, K. R., Amatya, P., Roback, M. G., Albott, C. S., Westlund Schreiner, M., Ren, Y., ... Klimes-Dougan, B. (2018). Intravenous Ketamine for Adolescents with Treatment-Resistant Depression: An Open-Label Study. Journal of Child and Adolescent Psychopharmacology, 28(7), 437-444. https://doi.org/10.1089/cap.2018.0030

Intravenous Ketamine for Adolescents with Treatment-Resistant Depression : An Open-Label Study. / Cullen, Kathryn R.; Amatya, Palistha; Roback, Mark G.; Albott, Christina Sophia; Westlund Schreiner, Melinda; Ren, Yanan; Eberly, Lynn E.; Carstedt, Patricia; Samikoglu, Ali; Gunlicks-Stoessel, Meredith; Reigstad, Kristina; Horek, Nathan; Tye, Susannah J; Lim, Kelvin O.; Klimes-Dougan, Bonnie.

In: Journal of Child and Adolescent Psychopharmacology, Vol. 28, No. 7, 01.09.2018, p. 437-444.

Research output: Contribution to journalArticle

Cullen, KR, Amatya, P, Roback, MG, Albott, CS, Westlund Schreiner, M, Ren, Y, Eberly, LE, Carstedt, P, Samikoglu, A, Gunlicks-Stoessel, M, Reigstad, K, Horek, N, Tye, SJ, Lim, KO & Klimes-Dougan, B 2018, 'Intravenous Ketamine for Adolescents with Treatment-Resistant Depression: An Open-Label Study', Journal of Child and Adolescent Psychopharmacology, vol. 28, no. 7, pp. 437-444. https://doi.org/10.1089/cap.2018.0030
Cullen, Kathryn R. ; Amatya, Palistha ; Roback, Mark G. ; Albott, Christina Sophia ; Westlund Schreiner, Melinda ; Ren, Yanan ; Eberly, Lynn E. ; Carstedt, Patricia ; Samikoglu, Ali ; Gunlicks-Stoessel, Meredith ; Reigstad, Kristina ; Horek, Nathan ; Tye, Susannah J ; Lim, Kelvin O. ; Klimes-Dougan, Bonnie. / Intravenous Ketamine for Adolescents with Treatment-Resistant Depression : An Open-Label Study. In: Journal of Child and Adolescent Psychopharmacology. 2018 ; Vol. 28, No. 7. pp. 437-444.
@article{fac7870968af45db975217c3252dbfbf,
title = "Intravenous Ketamine for Adolescents with Treatment-Resistant Depression: An Open-Label Study",
abstract = "Background: Novel interventions for treatment-resistant depression (TRD) in adolescents are urgently needed. Ketamine has been studied in adults with TRD, but little information is available for adolescents. This study investigated efficacy and tolerability of intravenous ketamine in adolescents with TRD, and explored clinical response predictors. Methods: Adolescents, 12-18 years of age, with TRD (failure to respond to two previous antidepressant trials) were administered six ketamine (0.5 mg/kg) infusions over 2 weeks. Clinical response was defined as a 50{\%} decrease in Children's Depression Rating Scale-Revised (CDRS-R); remission was CDRS-R score ≤28. Tolerability assessment included monitoring vital signs and dissociative symptoms using the Clinician-Administered Dissociative States Scale (CADSS). Results: Thirteen participants (mean age 16.9 years, range 14.5-18.8 years, eight biologically male) completed the protocol. Average decrease in CDRS-R was 42.5{\%} (p = 0.0004). Five (38{\%}) adolescents met criteria for clinical response. Three responders showed sustained remission at 6-week follow-up; relapse occurred within 2 weeks for the other two responders. Ketamine infusions were generally well tolerated; dissociative symptoms and hemodynamic symptoms were transient. Higher dose was a significant predictor of treatment response. Conclusions: These results demonstrate the potential role for ketamine in treating adolescents with TRD. Limitations include the open-label design and small sample; future research addressing these issues are needed to confirm these results. Additionally, evidence suggested a dose-response relationship; future studies are needed to optimize dose. Finally, questions remain regarding the long-term safety of ketamine as a depression treatment; more information is needed before broader clinical use.",
keywords = "adolescent, depression, ketamine, treatment-resistant",
author = "Cullen, {Kathryn R.} and Palistha Amatya and Roback, {Mark G.} and Albott, {Christina Sophia} and {Westlund Schreiner}, Melinda and Yanan Ren and Eberly, {Lynn E.} and Patricia Carstedt and Ali Samikoglu and Meredith Gunlicks-Stoessel and Kristina Reigstad and Nathan Horek and Tye, {Susannah J} and Lim, {Kelvin O.} and Bonnie Klimes-Dougan",
year = "2018",
month = "9",
day = "1",
doi = "10.1089/cap.2018.0030",
language = "English (US)",
volume = "28",
pages = "437--444",
journal = "Journal of Child and Adolescent Psychopharmacology",
issn = "1044-5463",
publisher = "Mary Ann Liebert Inc.",
number = "7",

}

TY - JOUR

T1 - Intravenous Ketamine for Adolescents with Treatment-Resistant Depression

T2 - An Open-Label Study

AU - Cullen, Kathryn R.

AU - Amatya, Palistha

AU - Roback, Mark G.

AU - Albott, Christina Sophia

AU - Westlund Schreiner, Melinda

AU - Ren, Yanan

AU - Eberly, Lynn E.

AU - Carstedt, Patricia

AU - Samikoglu, Ali

AU - Gunlicks-Stoessel, Meredith

AU - Reigstad, Kristina

AU - Horek, Nathan

AU - Tye, Susannah J

AU - Lim, Kelvin O.

AU - Klimes-Dougan, Bonnie

PY - 2018/9/1

Y1 - 2018/9/1

N2 - Background: Novel interventions for treatment-resistant depression (TRD) in adolescents are urgently needed. Ketamine has been studied in adults with TRD, but little information is available for adolescents. This study investigated efficacy and tolerability of intravenous ketamine in adolescents with TRD, and explored clinical response predictors. Methods: Adolescents, 12-18 years of age, with TRD (failure to respond to two previous antidepressant trials) were administered six ketamine (0.5 mg/kg) infusions over 2 weeks. Clinical response was defined as a 50% decrease in Children's Depression Rating Scale-Revised (CDRS-R); remission was CDRS-R score ≤28. Tolerability assessment included monitoring vital signs and dissociative symptoms using the Clinician-Administered Dissociative States Scale (CADSS). Results: Thirteen participants (mean age 16.9 years, range 14.5-18.8 years, eight biologically male) completed the protocol. Average decrease in CDRS-R was 42.5% (p = 0.0004). Five (38%) adolescents met criteria for clinical response. Three responders showed sustained remission at 6-week follow-up; relapse occurred within 2 weeks for the other two responders. Ketamine infusions were generally well tolerated; dissociative symptoms and hemodynamic symptoms were transient. Higher dose was a significant predictor of treatment response. Conclusions: These results demonstrate the potential role for ketamine in treating adolescents with TRD. Limitations include the open-label design and small sample; future research addressing these issues are needed to confirm these results. Additionally, evidence suggested a dose-response relationship; future studies are needed to optimize dose. Finally, questions remain regarding the long-term safety of ketamine as a depression treatment; more information is needed before broader clinical use.

AB - Background: Novel interventions for treatment-resistant depression (TRD) in adolescents are urgently needed. Ketamine has been studied in adults with TRD, but little information is available for adolescents. This study investigated efficacy and tolerability of intravenous ketamine in adolescents with TRD, and explored clinical response predictors. Methods: Adolescents, 12-18 years of age, with TRD (failure to respond to two previous antidepressant trials) were administered six ketamine (0.5 mg/kg) infusions over 2 weeks. Clinical response was defined as a 50% decrease in Children's Depression Rating Scale-Revised (CDRS-R); remission was CDRS-R score ≤28. Tolerability assessment included monitoring vital signs and dissociative symptoms using the Clinician-Administered Dissociative States Scale (CADSS). Results: Thirteen participants (mean age 16.9 years, range 14.5-18.8 years, eight biologically male) completed the protocol. Average decrease in CDRS-R was 42.5% (p = 0.0004). Five (38%) adolescents met criteria for clinical response. Three responders showed sustained remission at 6-week follow-up; relapse occurred within 2 weeks for the other two responders. Ketamine infusions were generally well tolerated; dissociative symptoms and hemodynamic symptoms were transient. Higher dose was a significant predictor of treatment response. Conclusions: These results demonstrate the potential role for ketamine in treating adolescents with TRD. Limitations include the open-label design and small sample; future research addressing these issues are needed to confirm these results. Additionally, evidence suggested a dose-response relationship; future studies are needed to optimize dose. Finally, questions remain regarding the long-term safety of ketamine as a depression treatment; more information is needed before broader clinical use.

KW - adolescent

KW - depression

KW - ketamine

KW - treatment-resistant

UR - http://www.scopus.com/inward/record.url?scp=85053681677&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85053681677&partnerID=8YFLogxK

U2 - 10.1089/cap.2018.0030

DO - 10.1089/cap.2018.0030

M3 - Article

C2 - 30004254

AN - SCOPUS:85053681677

VL - 28

SP - 437

EP - 444

JO - Journal of Child and Adolescent Psychopharmacology

JF - Journal of Child and Adolescent Psychopharmacology

SN - 1044-5463

IS - 7

ER -