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Type: Journal article
Title: Placebo-controlled pilot trial testing dose titration and intravenous, intramuscular and subcutaneous routes for ketamine in depression
Author: Loo, C.
Gálvez, V.
O'Keefe, E.
Mitchell, P.
Hadzi-Pavlovic, D.
Leyden, J.
Harper, S.
Somogyi, A.
Lai, R.
Weickert, C.
Glue, P.
Citation: Acta Psychiatrica Scandinavica, 2016; 134(1):48-56
Publisher: Wiley
Issue Date: 2016
ISSN: 0001-690X
Statement of
C.K. Loo, V. Gálvez, E. O’Keefe, P.B. Mitchell, D. Hadzi-Pavlovic, J. Leyden, S. Harper, A.A. Somogyi, R. Lai, C.S. Weickert, P. Glue
Abstract: Objective: This pilot study assessed the feasibility, efficacy and safety of an individual dose-titration approach, and of the intravenous (IV), intramuscular (IM) and subcutaneous (SC) routes for treating depression with ketamine. Method: Fifteen treatment-refractory depressed participants received ketamine or midazolam (control treatment) in a multiple crossover, double-blind study. Ketamine was administered by IV (n = 4), IM (n = 5) or SC (n = 6) injection. Dose titration commenced at 0.1 mg/kg, increasing by 0.1 mg/kg up to 0.5 mg/kg, given in separate treatment sessions separated by ≥1 week, with one placebo control treatment randomly inserted. Mood, psychotomimetic and hemodynamic effects were assessed and plasma ketamine concentrations assayed. Results: Twelve participants achieved response and remission criteria, achieved at doses as low as 0.1 mg/kg. All three routes of administration resulted in comparable antidepressant effects. Fewest adverse effects were noted with the SC route. Antidepressant response, adverse effects and ketamine concentrations were dose-related. Conclusion: Antidepressant response occurred at a range of doses and at <0.5 mg/kg. The dose-titration approach is a practical method for optimizing the efficacy - side-effects trade-off on an individual patient basis. This pilot study provides preliminary evidence for SC injection as a practical, feasible and efficacious treatment approach.
Keywords: Ketamine; dose titration; intraveneous; intramuscular; intranasal
Rights: © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
DOI: 10.1111/acps.12572
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