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
AU - Lim, Kelvin O.
AU - Klimes-Dougan, Bonnie
N1 - Funding Information:
Funding: The study was funded by a K to R Transition Award given to Dr. Cullen through the University of Minnesota Clinical and Translational Science Institute (UL1 TR000114), as well as an Amplatz Scholarship awarded to Dr. Cullen by the University of Minnesota Foundation.
Publisher Copyright:
© Copyright 2018, Mary Ann Liebert, Inc., publishers 2018.
PY - 2018/9
Y1 - 2018/9
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
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U2 - 10.1089/cap.2018.0030
DO - 10.1089/cap.2018.0030
M3 - Article
C2 - 30004254
AN - SCOPUS:85053681677
SN - 1044-5463
VL - 28
SP - 437
EP - 444
JO - Journal of Child and Adolescent Psychopharmacology
JF - Journal of Child and Adolescent Psychopharmacology
IS - 7
ER -