MSc BLOG – Ketamine for DEPR

July 6, 2018

Ketamine for Depression

During my time working with patients we noticed that each patient receiving repeated ketamine infusions often has very different treatment experiences and dissociative side effects from one treatment to the next despite no changes to their treatment regimes.

It was wanting to examine this variation that lead me to the MSC in Evidence-Based Healthcare programme to learn the skills and knowledge necessary to investigate this and write it up as my dissertation.

Hayley Trueman,  Clinical practitioner within the ECT and ketamine clinic at the Warneford Hospital Oxford


In patients receiving repeated IV ketamine treatment for depression, does an individual’s severity of depression affect the dissociative side effects experienced during treatment?

In my clinical practice I treat individuals with depression that has not responded to many previous treatments. Within the clinic we use intravenous ketamine treatment, which is a novel and innovative antidepressant treatment.

During my time working with patients we noticed that each patient receiving repeated ketamine infusions often has very different treatment experiences and dissociative side effects from one treatment to the next despite no changes to their treatment regimes.

It was wanting to examine this variation that lead me to the MSC in Evidence-Based Healthcare programme to learn the skills and knowledge necessary to investigate this and write it up as my dissertation.

It is unclear when examining the literature whether this variation may be related to patient benefit and response to treatment. In the clinic it was observed that when patients were more depressed they appeared to have less dissociative side effects during their treatment and patients had reported they thought changes in their sleep, appetite or suicidality affected their experience of treatment.

What did we do?

To my knowledge this was the first investigation into the variability of experience during ketamine treatment for depression.

Initially we conducted a review of the current literature; however as ketamine for depression is a relatively new concept, most of the studies were clinical trials where the dissociative side effects were measured as adverse events and not considered in any detail.

Therefore we undertook a statistical analysis of routinely collected data from patients receiving repeated intravenous ketamine treatment. We used the Becks depression inventory (BDI) and measured side effects using a non-validated side effects visual analogue scale (SEVAS), which had been used in a previous study to monitor dissociation. The BDI has questions related to sleep, appetite and suicidality.

What did we find?

The analysis found that severity of depression was a significant predictor of dissociation during treatment for only 1 patient. Other significant predictors of dissociation, including sleep, appetite and suicidality, were found in a further 5 patients.

For the remaining 7 patients the reasons for the variability in their dissociation and treatment experience remain unexplained.

An interesting observation was that the significant findings were found almost exclusively in patients with Bipolar disorder as their primary diagnosis.

 What do these results mean?

The variation of side effects experienced by some patients during their infusions can be explained by looking at changes in their depression, suicidality, sleep and appetite.

For others the variability is currently unexplained however, through seeing variability across all patients we can reassure them that this is a ‘normal’ experience.

The study was comparable to a previous clinical trial which reported that side effects reduce over repeated infusions, however the results of our study (using a larger data set) did not support this.

Further research is needed to explore side effect variability and perhaps side effect – response relationships. We are using the results of the study in clinical practice and evaluating the measures we use within clinic to try and make them more sensitive to capturing patient experience. Qualitative research is being conducted to try to understand further the patient experience.

Hayley Trueman,  Clinical practitioner within the ECT and ketamine clinic at the Warneford Hospital Oxford

 

About CEBM

CEBM Centre Manager Responsible for maintaining the Centre's ability to respond to new initiatives. Facilitating the development and dissemination of research to improve clinical practice and patient care. Elevating the position of all EBM and EBHC learning related activities globally. Follow CEBM on twitter @CebmOxford and facebook cebm.oxford

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