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Ketamine safe, effective for geriatric treatment-resistant depression

Steven Levine

Subcutaneous ketamine was safe and effective for older adults with treatment-resistant depression, according to preliminary findings.

“As in younger populations, ketamine has the potential in low doses to rapidly improve the symptoms of depression. Older sufferers of depression are often taking multiple medications that may interact with antidepressants, and common side effects of these medicines may increase risk [for] falls,” Steven Levine, MD, of Ketamine Treatment Centers, told Healio/Psychiatry. “Because ketamine is very safe, even in more fragile medical conditions, and is given intermittently (with no constant level of medicine in the system), it is a particularly safe option for the elderly.”

To assess efficacy and safety of subcutaneous ketamine for geriatric treatment-resistant depression, researchers conducted a randomized, double-blind, controlled trial among 16 individuals aged 60 years and older with treatment-resistant depression. Study participants who did not remit in the randomized trial were administered an open-label phase. Participants were randomly assigned to receive up to 5 subcutaneous doses of ketamine at 0.1 mg, 0.2 mg, 0.3 mg, 0.4 mg, and 0.5 mg/kg in separate sessions approximately one week apart. There was one active control, midazolam, which was randomly inserted. In the open-label phase, 12 ketamine treatments were administered.

Of the 14 participants who completed the randomized phase, seven remitted. Five participants remitted at doses below 0.5 mg/kg.

Doses of 0.2 mg/kg or greater were significantly more effective than midazolam.

Participants who received repeated treatments were more likely to achieve remission and had a longer time to relapse.

Ketamine was well-tolerated, according to researchers.

“Elderly patients with severe depression face additional barriers when seeking treatment for the condition. Many medications may cause more side effects or have lower efficacy as the brain ages,” Duncan George, MBBS, of University of New South Wales, Sydney, said in a press release. “Older people are also more likely to have co-morbidities like neurodegenerative disorders and chronic pain, which can cause further complications due to ketamine’s reported side effects. “Our results indicate a dose-titration method may be particularly useful for older patients, as the best dose was selected for each individual person to maximize ketamine’s benefits while minimizing its adverse side effects.” – by Amanda Oldt

Disclosures : George reports no relevant financial disclosures. Levine is the founder and CEO of Ketamine Treatment Centers. Please see the full study for a list of all other researchers’ relevant financial disclosures.