Bryant Kelly A, Altinay Murat, Finnegan Nora, Cromer Kim, Dale Roman M
Center for Behavioral Health, Cleveland Clinic, Cleveland, OH.
J Clin Psychopharmacol. 2019 Mar/Apr;39(2):158-161. doi: 10.1097/JCP.0000000000001006.
There is an immediate need for more sustainable, effective therapies for treatment-resistant depression in patients who do not respond to traditional psychopharmacology. The aim of this study was to determine the efficacy and safety of intravenous ketamine infusions on the elderly population by using a case series of 6 geriatric patients with treatment-resistant depression.
Eligible patients aged 65 to 82 were given a subanesthetic ketamine hydrochloride dose of 0.5 mg/kg delivered intravenously over 40 minutes twice weekly for an acute series. If patients reported a 50% decrease in depression symptoms after the acute series of 2 to 4 infusions, they would be moved to a maintenance series of infusions, which would occur every 2 to 6 weeks on an individual basis.
Of the 6 patients given ketamine, 1 failed to respond to the acute treatment phase, 4 responded to the acute infusion phase but failed to sustain a response after a range of 8 to 22 maintenance infusions, and 1 responded to the infusions but relapsed into alcohol use; therefore, treatment was discontinued.
The relative safety of intravenous ketamine in the elderly was demonstrated by the mild, transient adverse effects seen by this patient group. The geriatric population is unable to maintain an antidepressant response to intravenous ketamine over time, signifying that ketamine has low efficacy for the elderly.
对于那些对传统心理药理学无反应的难治性抑郁症患者，迫切需要更具可持续性、更有效的治疗方法。本研究的目的是通过对6例老年难治性抑郁症患者的病例系列研究，确定静脉注射氯胺酮对老年人群的疗效和安全性。
符合条件的65至82岁患者在急性治疗阶段，每周两次，每次40分钟内静脉注射0.5mg/kg亚麻醉剂量的盐酸氯胺酮。如果患者在2至4次输注的急性治疗阶段后报告抑郁症状减轻50%，他们将进入维持输注阶段，此阶段将根据个人情况每2至6周进行一次。
在接受氯胺酮治疗的6例患者中，1例在急性治疗阶段无反应，4例在急性输注阶段有反应，但在8至22次维持输注后未能维持反应，1例对输注有反应，但复发饮酒；因此，停止治疗。
该患者组出现的轻度、短暂的不良反应证明了静脉注射氯胺酮在老年人中的相对安全性。老年人群无法长期维持对静脉注射氯胺酮的抗抑郁反应，这表明氯胺酮对老年人的疗效较低。
