Rapid antidepressant effect of S-ketamine in schizophrenia

This open-label case study (n=1) describes a patient with schizophrenia whose treatment regimen was augmented with a ketamine (25mg) infusion to alleviate her symptoms of depression and suicidal ideation (SI). Her symptoms underwent a robust and sustained remission after the infusion, without any accompanying psychotic or dissociative phenomena.

Abstract

Introduction: Rapid anti-suicidal and antidepressant effects of ketamine have repeatedly been confirmed in unipolar and bipolar depression. Although meaningful antidepressant efficacy of ketamine has also been shown in depressed patients with a history of psychotic symptoms, its administration in psychotic disorders has largely been neglected due to its potential to exacerbate dissociative or psychotic symptoms.

Methods: Presenting a case of a young female inpatient suffering from schizophrenia with severe post-psychotic depression, we demonstrate a robust anti-suicidal and antidepressant effect of S-ketamine infusions administered thrice weekly for 3 weeks in total.

Results: Importantly, no relevant psychotic or dissociative symptoms occurred during the whole augmentation treatment period leading to sustained remission of depressive symptoms and suicidality.

Discussion: Our safe and effective experience with intravenous S-ketamine might encourage researchers and clinicians to widen its administration range beyond the diagnosis of depression to enrich the current knowledge of ketamine effects in psychotic disorders.”

Authors: Lucie Bartova, Konstantinos Papageorgiou, Ivan Milenkovic, Markus Dold, Ana Weidenauer, Matthaeus Willeit, Dietmar Winkler & Siegfried Kasper

Summary

Ketamine has been shown to have anti-suicidal and antidepressant effects in depression, but has been neglected in psychotic disorders due to its potential to exacerbate dissociative or psychotic symptoms. We demonstrate a case of a young female inpatient suffering from schizophrenia with a severe post-psychotic depression.

  1. Introduction

Post-psychotic depression is a challenging clinical phenomenon affecting up to 36% of patients with schizophrenia. Ketamine is an effective antidepressant but its clinical effects in schizophrenia remain largely unknown.

  1. Case description

A 30-year-old female inpatient suffering from severe and chronic schizophrenia developed severe post-psychotic depression with concrete suicidal ideation. After receiving intravenous S-ketamine 25 mg per application, a robust anti-suicidal and antidepressant response lasting several days was observed. Intravenous S-ketamine was well tolerated and achieved a sustained remission of depressive symptoms and suicidality in 3 weeks.

  1. Discussion

This report presents the first report on the use of S-ketamine as an antidepressant augmentation treatment in schizophrenia. The patient experienced rapid anti-suicidal and antidepressant effects without any accompanying meaningful psychotic or dissociative phenomena.

The present manuscript was compiled without any involvement of funding sources. Lucie Bartova wrote the first draft and all listed authors reviewed and approved the final manuscript.

Contributors

The present manuscript was compiled without any involvement of funding sources. All listed authors have meaningfully involved in the performance of the reported therapy.

Conflict of interest

Lucie Bartova, Ivan Milenkovic, Ana Weidenauer and Konstantinos Papageorgiou declare no conflicts of interest. Markus Dold has received a travel grant from Janssen-Cilag.

Acknowledgment

The present manuscript was compiled without involvement of funding sources. Lucie Bartova wrote the first draft and all authors reviewed and approved the final manuscript.

Study details

Compounds studied
Ketamine

Topics studied
Schizophrenia Depression Suicidality

Study characteristics
Open-Label Case Study

Participants
1