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Ketamine shows potential in teens with treatment-resistant depression

Average scores on the Children's Depression Rating Scale dropped by 42.5% following low-dose IV ketamine infusions among 13 teenagers with treatment-resistant depression, findings published in Journal of Child and Adolescent Psychopharmacology showed.

“Adult [treatment-resistant depression] research has begun to explore repeated administrations of ketamine, which may have promise for greater effectiveness and longer remission periods than single doses,” Kathryn R. Cullen, MD, division of child and adolescent psychiatry, University of Minnesota Medical School, and colleagues wrote. “Although adolescence is a key time period for emergence of depression and represents an opportune and critical developmental window for intervention to prevent negative outcomes, no information is yet available on the efficacy or tolerability of ketamine as a treatment for [treatment-resistant depression] in adolescents.”

Researchers examined the efficacy and tolerability of IV ketamine among teenagers aged 12 to 18 years with treatment-resistant depression who received six open-label IV ketamine infusions (0.5 mg/kg) over the course of 2 weeks.

Ketamine was infused over 40 minutes, followed by a 2-hour monitoring period to assess depressive symptoms. To determine the extent and duration of clinical response, the investigators examined response and remission one day following the six infusions and measured duration of response in a 6-week follow-up period. In tolerability assessment, they also monitored vital signs and dissociative symptoms.

Thirteen teenagers completed the clinical trial. Average Children’s Depression Rating Scale-Revised percent change was 42.5% (P = .0004). The results showed that five participants met criteria for clinical response and three responders showed sustained remission at 6-week follow-up, with relapse occurring within 2 weeks for the other two responders.

Ketamine infusions were generally well-tolerated, with transient dissociative symptoms and hemodynamic symptoms. However, one participant who had a high level of suicidal thinking at baseline reported a high level of suicidality throughout the study. Importantly, the researchers found that participants who received higher doses due to their higher BMI had the best responses.

“The preliminary results reported here are promising; but large-scale, double-blind, randomized control designs are needed to determine if ketamine is a safe and effective treatment for adolescent [treatment-resistant depression],” Cullen and colleagues wrote.

“Important questions remain regarding optimal dose, response prediction (patient selection), and long-term safety following acute treatment,” they continued. “Before ketamine can be considered for broader clinical use, efficacy and safety data are needed on strategies to sustain ketamine-induced remission. Ultimately, safe and effective strategies to achieve sustained remission during adolescence could restore healthy neurodevelopment and improve outcomes over the lifespan.” – by Savannah Demko

Disclosure: The authors report no relevant financial disclosures.