期刊
ACTA PSYCHIATRICA SCANDINAVICA
卷 134, 期 1, 页码 48-56出版社
WILEY-BLACKWELL
DOI: 10.1111/acps.12572
关键词
ketamine; dose titration; intravenous; intramuscular; intranasal
类别
资金
- NSW Institute of Psychiatry Research Fellowship Grant
- Pfizer Neuroscience Research grant
- Fundacio Pedro i Pons (University of Barcelona)
- Schizophrenia Research Institute (NSW Ministry of Health and the Macquarie Group Foundation)
- University of New South Wales
- Neuroscience Research Australia
- National Health and Medical Research Council (Australia) [1021970]
ObjectiveThis pilot study assessed the feasibility, efficacy and safety of an individual dose-titration approach, and of the intravenous (IV), intramuscular (IM) and subcutaneous (SC) routes for treating depression with ketamine. MethodFifteen treatment-refractory depressed participants received ketamine or midazolam (control treatment) in a multiple crossover, double-blind study. Ketamine was administered by IV (n = 4), IM (n = 5) or SC (n = 6) injection. Dose titration commenced at 0.1 mg/kg, increasing by 0.1 mg/kg up to 0.5 mg/kg, given in separate treatment sessions separated by 1 week, with one placebo control treatment randomly inserted. Mood, psychotomimetic and hemodynamic effects were assessed and plasma ketamine concentrations assayed. ResultsTwelve participants achieved response and remission criteria, achieved at doses as low as 0.1 mg/kg. All three routes of administration resulted in comparable antidepressant effects. Fewest adverse effects were noted with the SC route. Antidepressant response, adverse effects and ketamine concentrations were dose-related. ConclusionAntidepressant response occurred at a range of doses and at <0.5 mg/kg. The dose-titration approach is a practical method for optimizing the efficacy - side-effects trade-off on an individual patient basis. This pilot study provides preliminary evidence for SC injection as a practical, feasible and efficacious treatment approach.
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