Journal
PALLIATIVE & SUPPORTIVE CARE
Volume 18, Issue 1, Pages 110-112Publisher
CAMBRIDGE UNIV PRESS
DOI: 10.1017/S1478951519000580
Keywords
Palliative care; advanced cancer; depression; ketamine; suicidal risk
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Funding
- National Council of Science and Technology's (CONACyT) National System of Researchers
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Objective Major depressive disorder (MDD) is common in patients diagnosed with advanced cancer (AC), with a prevalence of 16.5%. It is associated with great disability and worsened quality of life, increased number and intensity of physical symptoms, and lower survival. It is the main factor for the presence of suicidal ideation. Antidepressants show modest efficacy, and response requires several weeks. Ketamine has demonstrated a fast and robust antidepressant effect in subanesthetic doses. This effect may prove useful in patients with AC, MDD, and suicidal risk. Method We report a case of a patient with advanced cervical cancer who presented with uncontrollable pain, MDD, and a suicide attempt. Result A 39-year-old woman diagnosed with cervical cancer stage IVB presented to the Emergency Department after a suicide attempt by hanging. Upon evaluation by the palliative care psychiatrist, she reported intense pain, unresponsive to analgesics, and had a history of persistent suicidal ideation. Antidepressant treatment was started (sertraline 50mg/d) after a single dose of ketamine hydrochloride IV (0.5 mg/kg) was administered. Treatment response was measured using the Brief Edinburgh Depression Scale before and after the intervention. The depressive symptoms decreased by 17% on day 1, 39% on day 3, and 72% on day 17.
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