Real-world effectiveness of repeated ketamine infusions for treatment resistant depression during the COVID-19 pandemic

This open-label study (n=267) investigated if Covid had any impact on the effectiveness of ketamine treatments (iv, 4x 35-53mg/70kg) for depression (TRD). Patients in both groups experience significant and comparable improvements in depressive symptoms, suicidal ideation (SI), and anxiety.

Abstract

“Herein we evaluate the impact of COVID-19 restrictions on antidepressant effectiveness of intravenous (IV) ketamine in adults with treatment-resistant depression (TRD). We conducted a case series analysis of adults with TRD (n = 267) who received four ketamine infusions at an outpatient clinic in Ontario, Canada, during COVID-19 restrictions (from March 2020 – February 2021; n = 107), compared to patients who received treatment in the previous year (March 2019 – February 2020; n = 160). Both groups experienced significant and comparable improvements in depressive symptoms, suicidal ideation, and anxiety with repeated ketamine infusions. Effectiveness of IV ketamine was not attenuated during the COVID-19 period.“

Authors: Joshua D. Rosenblat, Orly Lipsitz, Joshua D. Di Vincenzo, Nelson B. Rodrigues, Kevin Kratiuk, Mehala Subramaniapillai, Yena Lee, Anil K. Arekapudi, Amir Abrishami, Edmond H. Chau, Witold Szpejda, Leslie Wong, Rodrigo B. Mansur & Roger S. McIntyre

Summary

Short communication

Herein we evaluated the impact of COVID-19 restrictions on antidepressant effectiveness of intravenous ketamine in adults with treatment-resistant depression. Ketamine treatment was comparable to treatment in the previous year.

1. Introduction

Since March of 2020, many countries have adopted public health measures to prevent the spread of COVID-19. However, evidence shows that these measures increase the risk of negative mental health outcomes, especially among vulnerable groups such as individuals with pre-existing mood disorders. Despite the negative effects of social isolation measures on overall health outcomes, no study has yet investigated the impact of social isolation measures on individuals receiving antidepressant therapies.

Intravenous ketamine is a rapid-acting treatment option for adults with treatment-resistant depression who have not responded to multiple other treatment trials. It may be a lifesaving treatment for some individuals.

In Ontario, Canada, prolonged social isolation measures were adopted by patients receiving ketamine therapy. The effects of ketamine were similar in patients receiving treatment prior to the pandemic.

2. Methods

We performed a retrospective case series analysis of adults who received IV ketamine for TRD in an outpatient clinic in Ontario, Canada to evaluate treatment response during COVID-19.

During COVID-19, the clinic followed provincial and regional public health guidelines to protect patients and staff members, and all patients were required to wear personal protective equipment (PPE). The clinic returned to pre-COVID-19 capacity in May 2020, and infusion booking times decreased from 60 minutes to 45 minutes.

Mixed models were performed to compare changes in depressive symptoms, suicidal ideation, anxiety symptoms, and functional disability from pre-treatment to post-infusion 4 and post-infusion 3. Bonferroni corrections were used to account for multiple post-hoc between-group comparisons.

3. Results

We analyzed data from 267 subjects, including 107 patients who received ketamine treatment during the COVID-19 pandemic and 160 comparators who received ketamine treatment before the COVID-19 pandemic. We found that patients who received repeated infusions of ketamine experienced significant reductions in depressive symptoms, SI, anxiety, and function.

4. Discussion

In this study, adults with TRD who received four IV ketamine infusions during the COVID-19 pandemic experienced commensurate symptomatic improvements compared to patients who received the same treatment prior to the pandemic.

Patients with serious mental illness, including treatment-resistant depression, may be at increased risk for contracting COVID-19 and may experience adverse health outcomes if hospitalized. Treatment for serious mental illness may reduce adverse outcomes related to COVID-19.

Disclosures

JDR is the medical director of the Braxia Health, a center that provides ketamine and esketamine treatment for depression. He has received research grant support from several organizations.

RSM, YL, KK, AA, EHC, WS, and LW have received grant support, speaker/consultation fees, and personal fees from Lundbeck, Janssen, Purdue, Pfizer, Otsuka, Takeda, Neurocrine, Sunovion, Bausch Health, Novo Nordisk, and Braxia Scientific Corp.

CRediT authorship contribution statement

Joshua D. Rosenblat, Orly Lipsitz, Nelson B. Rodrigues, Kevin Kratiuk, Mehala Subramaniapillai, Anil K. Arekapudi, Amir Abrishami, Edmond H. Chau, Witold Szpejda, Leslie Wong, Rodrigo B. Mansur, Roger S. McIntyre contributed to this article.