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ADs vs ketamine linkadge

Posted by Mtom on December 27, 2020, at 10:17:40

In reply to Re: Dose increase recommendations vs time for effect?, posted by linkadge on December 26, 2020, at 13:44:50

> The notion that the brain needs time to 'heal' is likely true to an extent. However, things like ketamine, sleep deprivation, ECT can work very quickly. >
> Linkadge
>

However my understanding is that ketamine and ECT are usually given in the context of treatment resistant depression when Antidepressants have not worked even after an adequate trial period (something which is discussed in the above conversation), typically with several different medications.

Which would lead one to believe that those patients depression was not being caused by lack of the usual neurotransmitters the AD's (supposedly) increase activity of and that some other cause and mechanism is involved which responds to ketamine or ECT.

Also, although I had previously heard that some do in fact respond quickly and well to ketamine, this new Nov 2020 paper examining response to ketamine in 85 patients at one centre found rather dismal response rates. 47 (40%) discontinued during or right after the 3 week induction phase. Another 14 (16.5%) discontinued during the maintenance phase. The paper says 3 of 85 discontinued due to side effects, but in the abstract does not say why the 47 discontinued during/after induction.

Fifteen out of 82 patients (18.3%) responded to induction treatment and 6 (7.3%) remained in responder status at the time of data analysis during maintenance. Despite the low response rates and the considerable cost of treamted, the authors noted that almost half the outpatients decided to continue with maintenance ketamine treatment due to perceived significant improvement. (Which is difficult to explain).
https://www.psychiatryadvisor.com/home/topics/mood-disorders/depressive-disorder/use-of-acute-and-maintenance-intravenous-ketamine-in-outpatients-with-trd/
https://www.sciencedirect.com/science/article/abs/pii/S0165032720325349?via%3Dihub


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poster:Mtom thread:1113112
URL: http://www.dr-bob.org/babble/20201025/msgs/1113126.html