One-third of depressed patients do not achieve an adequate clinical response to available treatment and are considered to have treatment-resistant depression (TRD). As such, there is an urgent need for more rapidly effective pharmacotherapies for major depressive disorder and bipolar disorder (BP) that responds poorly to conventional treatments. Multiple controlled trials have now demonstrated a rapid, non-sustained anti-depressive response to a single intravenous infusion and, more recently, to repeated short-term infusions of ketamine in patients with TRD. The therapeutic potential of ketamine has stimulated considerable excitement among clinicians, patients, advocacy groups, and industry and has led to the increasing use of ketamine as an off-label substitute for ECT and other anti-depressive treatments. The early adoption of intravenous, intranasal and other forms of ketamine into routine clinical practice has included the use of repeated long-term ketamine administration for TRD. A thorough review of the available evidence of clinical effectiveness and safety is timely given the increasing use of ketamine in routine practice, with an eye toward important unanswered questions about ketamine effectiveness and safety for longer-term use. This presentation reviews, in detail, the results of randomized trials of intravenous or intranasal ketamine for treatment-resistant unipolar and bipolar major depression, highlighting methodological limitations of the most important studies and limitations of study findings for long-term ketamine administration. The presenter is a clinician familiar with the use of intravenous ketamine in acute settings at a major academic medical center.
**This content was captured at the 2017 APA Annual Meeting and may reference information from various sources and terminology from previous editions of the DSM.
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Funding for this initiative was made possible (in part) by Grant No. 1H79SM080818-01 from SAMHSA. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government. (Effective January 1, 2019)
- Describe the key findings from the most important studies of the effectiveness and safety of low-dose ketamine for the acute management of treatment-resistant unipolar or bipolar major depression
- Define the principal short- and long-term safety and tolerability concerns regarding the use of low-dose ketamine for the management of treatment-resistant unipolar or bipolar major depression
- Discuss the methods applied at Mayo Clinic and clinical programming steps that have been undertaken in order to develop a ketamine infusion therapy service
Estimated Time to Complete
Estimated Duration: 30 minutes
Begin Date: January 1, 2018
End Date: December 31, 2020
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The APA designates this enduring CME activity for a maximum of 0.5 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Faculty and Planner Disclosures
- Kathryn M. Schak, M.D., Mayo Clinic. Reports no financial relationships with commercial interests.
- Tristan Gorrindo, M.D., Director of Education, American Psychiatric Association. Reports no financial relationships with commercial interests.
- Ricardo A. Juarez, M.S., Director, District Branch and International Relations, American Psychiatric Association. Reports no financial relationships with commercial interests.
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