Abstract：
For individuals with treatment-resistant depression (TRD), transcranial magnetic stimulation (TMS) has become a well-established approach. In the past decade, intravenous (IV) racemic ketamine has also emerged as a potential treatment for TRD. Currently, little data is available on the clinical effects of IV racemic ketamine in TRD patients who experienced TMS-failure.
Twenty-one (21) TRD patients who had failed to respond to a standard course of high-frequency left-dorsolateral prefrontal cortex TMS were subsequently scheduled to received IV racemic ketamine infusions. The IV racemic ketamine protocol consisted of 0,5 mg/kg infusions over 60 min, 3 times a week over 2 weeks.
Treatment was safe with minimal side-effects. Mean baseline MADRS score was 27.6 ± 6.4 (moderate depression), decreasing down to 18.6 ± 8.9 (mild depression) post-treatment. Mean percent improvement was 34.5 % ± 21.1 from baseline to post-treatment. Paired sample t-test showed significant MADRS score decrease pre- to post-treatment [t(20) = 7.212, p < .001]. Overall, four (4) patients (19.0 %) responded and two (2) of those achieved remission (9.5 %).
Limitations of this case series include its retrospective and uncontrolled open-label nature, the lack of self-rating and standardized adverse events questionnaires, as well as follow-ups beyond the immediate treatment period.
Novel ways to increase the clinical effects of ketamine are being explored. We discuss potential combination approaches of ketamine with other modalities to augment its effects. Given the global burden of TRD, novel approaches are needed to curb the current mental health epidemic around the world.
Twenty-one (21) TRD patients who had failed to respond to a standard course of high-frequency left-dorsolateral prefrontal cortex TMS were subsequently scheduled to received IV racemic ketamine infusions. The IV racemic ketamine protocol consisted of 0,5 mg/kg infusions over 60 min, 3 times a week over 2 weeks.
Treatment was safe with minimal side-effects. Mean baseline MADRS score was 27.6 ± 6.4 (moderate depression), decreasing down to 18.6 ± 8.9 (mild depression) post-treatment. Mean percent improvement was 34.5 % ± 21.1 from baseline to post-treatment. Paired sample t-test showed significant MADRS score decrease pre- to post-treatment [t(20) = 7.212, p < .001]. Overall, four (4) patients (19.0 %) responded and two (2) of those achieved remission (9.5 %).
Limitations of this case series include its retrospective and uncontrolled open-label nature, the lack of self-rating and standardized adverse events questionnaires, as well as follow-ups beyond the immediate treatment period.
Novel ways to increase the clinical effects of ketamine are being explored. We discuss potential combination approaches of ketamine with other modalities to augment its effects. Given the global burden of TRD, novel approaches are needed to curb the current mental health epidemic around the world.
摘要：
背景：对于患有难治性抑郁症（TRD）的个体，经颅磁刺激（TMS）已成为一种行之有效的方法。在过去的十年里,静脉注射(IV)外消旋氯胺酮也成为TRD的潜在治疗方法.目前,关于静脉外消旋氯胺酮在TMS失败的TRD患者中的临床效果的数据很少.
方法：21例TRD患者对高频左背外侧前额叶皮质TMS标准疗程无反应，随后计划接受静脉外消旋氯胺酮输注。IV外消旋氯胺酮方案包括在60分钟内输注0.5mg/kg，每周3次超过2周。
结果：治疗是安全的，副作用最小。平均基线MADRS评分为27.6±6.4（中度抑郁），治疗后下降至18.6±8.9（轻度抑郁）。从基线到治疗后的平均改善百分比为34.5%±21.1。配对样本t检验显示治疗前后MADRS评分显著降低[t(20)=7.212,p<.001]。总的来说,四(4)名患者(19.0%)缓解,两(2)名患者缓解(9.5%).
结论：本病例系列的局限性包括其回顾性和不受控制的开放标签性质，缺乏自我评估和标准化的不良事件问卷，以及立即治疗期之后的随访。
结论：正在探索增加氯胺酮临床效果的新方法。我们讨论了氯胺酮与其他方式的潜在组合方法，以增强其效果。鉴于TRD的全球负担，需要新的方法来遏制当前世界各地的精神健康流行病。
方法：21例TRD患者对高频左背外侧前额叶皮质TMS标准疗程无反应，随后计划接受静脉外消旋氯胺酮输注。IV外消旋氯胺酮方案包括在60分钟内输注0.5mg/kg，每周3次超过2周。
结果：治疗是安全的，副作用最小。平均基线MADRS评分为27.6±6.4（中度抑郁），治疗后下降至18.6±8.9（轻度抑郁）。从基线到治疗后的平均改善百分比为34.5%±21.1。配对样本t检验显示治疗前后MADRS评分显著降低[t(20)=7.212,p<.001]。总的来说,四(4)名患者(19.0%)缓解,两(2)名患者缓解(9.5%).
结论：本病例系列的局限性包括其回顾性和不受控制的开放标签性质，缺乏自我评估和标准化的不良事件问卷，以及立即治疗期之后的随访。
结论：正在探索增加氯胺酮临床效果的新方法。我们讨论了氯胺酮与其他方式的潜在组合方法，以增强其效果。鉴于TRD的全球负担，需要新的方法来遏制当前世界各地的精神健康流行病。
