International Journal of Emergency Mental Health and Human Resilience
Open Access

Abstract

Recent inpatient studies examining the effect of single ketamine infusions in treatmentresistant depression (TRD) have shown promising results in diminishing suicidal ideation (SI). We describe the efficacy of serial titrated ketamine infusions in stopping suicidal ideation and averting hospitalization in a large, naturalistic sample of outpatients with TRD and complex psychiatric comorbidity in a real-world psychiatry practice. Retrospective chart review of 235 adults and adolescents presenting with TRD and complex psychiatric comorbidity in a large realworld psychiatry office practice seeing >5400 visits/year. Each patient underwent a 60-90min comprehensive diagnostic consultation by the single treating psychiatrist. Appropriate patients were treated with 6 sub-anesthetic escalating dose ketamine infusions (0.5-1.2mg/ kg over 40-50min) over 2-3weeks. PHQ-9 was obtained at baseline and before each infusion. The presence, frequency, and intensity of PHQ-9 item 9 was analyzed over the course of treatment and correlated to an overall decrease in PHQ-9. Suicides, attempts, ER visits, and hospitalizations were analyzed over the treatment course and the following 4 weeks. 64% of the patients presented with SI. No suicides, attempts, ER visits or hospitalizations occurred. SI ceased in 68.4% and markedly diminished in 81.8%. Remission of SI was bimodal, occurring after 1 infusion in 30.6%; the remainder required 3.3 infusions and an average dose of 0.75mg/ kg for the remission of SI. Suicidal patients experienced greater response and remission of TRD than non-suicidal patients. This is the first report of using serial ketamine infusions in a real-world psychiatry practice for adults and adolescents with TRD and complex psychiatric comorbidity to safely and rapidly treat severe suicidal ideation and avert hospitalization. It represents the largest number of patients to date reported from a single site in studies of IV ketamine infusions for TRD and suicidality, and a potential breakthrough treatment option for psychiatrists to provide in their offices.

Biography

Lori Calabrese, MD specializes in the comprehensive and state-of-the-art psychiatric evaluation and innovative psychiatric treatment of adults and adolescents at Innovative Psychiatry in Connecticut. She was educated at The Johns Hopkins University School of Medicine, completed her residency at Massachusetts General Hospital/Harvard Medical School, and has served as clinical faculty at Harvard and Yale. She is often thought of like a doctor’s doctor and a leader among her peers. She is the first psychiatrist in CT to offer a full array of treatment options with IV ketamine infusions within the context of a comprehensive outpatient office practice, with TMS, psychopharmacology, and psychotherapy. In 2018, she presented her work with IV ketamine internationally at the First International Conference for Ketamine and Related Compounds for Psychiatric Disorders in Oxford, England and at KRIYA Conference 2018 in San Francisco, California. She is a member of the American Society of Ketamine Physicians.

E-mail: loricalabresemd@gmail.com