From the Guidelines
Ketamine infusions are most effectively used in conjunction with ongoing antidepressant treatment, particularly in patients with treatment-resistant depression (TRD), with no specific medication proven to work best, but esketamine as an augmentation therapy has shown promise in improving depressive symptoms and remission rates. When considering the use of ketamine infusions for depression, it's crucial to understand that the current evidence supports its use as an adjunctive treatment, particularly for short-term reduction in suicidal ideation in patients with major depressive disorder (MDD) 1. The management of MDD involves a comprehensive approach, and ketamine infusions have been found to significantly improve depressive symptoms when used in conjunction with ongoing antidepressant treatment, with these improvements persisting for up to 7 days in patients with TRD 1.
Some key points to consider when using ketamine infusions include:
- The efficacy of ketamine in maintaining treatment gains when used as monotherapy or in conjunction with an antidepressant in patients with TRD, with significant improvements in depressive symptoms after 24 hours and at 3- and 4-day follow-up visits 1.
- The use of esketamine as an augmentation therapy, which has been found to improve depressive symptoms and remission rates in patients with MDD, particularly those with TRD and those with new or optimized antidepressant therapy 1.
- The importance of continuing ongoing antidepressant treatment while adding ketamine therapy, rather than starting a new medication specifically to complement ketamine.
- The potential for benzodiazepines to reduce ketamine's effectiveness, and the consideration of minimizing their use around infusion times.
Overall, the approach to using ketamine infusions in conjunction with other medications for depression should be individualized, taking into account the patient's specific needs and circumstances, and under the guidance of a qualified healthcare professional.
From the Research
Medication for Depression in Conjunction with Ketamine Infusions
- The most effective medication for depression to use in conjunction with ketamine infusions is not explicitly stated in the provided studies, but research suggests that esketamine can be combined with a selective serotonin reuptake inhibitor (SSRI) or a serotonin-norepinephrine reuptake inhibitor (SNRI) for treatment-resistant depression 2.
- A study found that patients treated with esketamine + SNRI had significantly lower all-cause mortality, hospitalization rates, and depression relapses compared to those treated with esketamine + SSRI 2.
- Another study suggested that repeated low-dose ketamine infusions improved the antidepressant effect, but not the antisuicidal effect, compared with a single infusion 3.
- Research also showed that repeated ketamine infusions have cumulative and sustained antidepressant effects, and reductions in depressive symptoms were maintained among responders through once-weekly infusions 4.
Ketamine Infusion Treatment
- Ketamine infusions administered intravenously 1 to 3 times per week are a quick and effective treatment for depression, particularly for treatment-resistant depression and depressive episodes of bipolar affective disorder 5.
- Low-dose ketamine infusions have been shown to be a safe and effective alternative to standard depression treatment, with many patients experiencing significant improvements in depressive symptoms 6.
Combination Therapy
- The combination of esketamine with an SSRI or SNRI has been shown to be effective in treating treatment-resistant depression, with the esketamine + SNRI group showing lower incidence of mortality, hospitalizations, and depressive relapses 2.
- The choice of medication to use in conjunction with ketamine infusions may depend on individual patient needs and responses to treatment, and further research is needed to determine the most effective combination therapies 2, 3, 4.