Palliative Care Service, Instituto Nacional de Cancerología, Mexico City, Mexico.
Addiction Research Laboratory, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico.
Palliat Support Care. 2020 Feb;18(1):110-112. doi: 10.1017/S1478951519000580.
Major depressive disorder (MDD) is common in patients diagnosed with advanced cancer (AC), with a prevalence of 16.5%. It is associated with great disability and worsened quality of life, increased number and intensity of physical symptoms, and lower survival. It is the main factor for the presence of suicidal ideation. Antidepressants show modest efficacy, and response requires several weeks. Ketamine has demonstrated a fast and robust antidepressant effect in subanesthetic doses. This effect may prove useful in patients with AC, MDD, and suicidal risk.
We report a case of a patient with advanced cervical cancer who presented with uncontrollable pain, MDD, and a suicide attempt.
A 39-year-old woman diagnosed with cervical cancer stage IVB presented to the Emergency Department after a suicide attempt by hanging. Upon evaluation by the palliative care psychiatrist, she reported intense pain, unresponsive to analgesics, and had a history of persistent suicidal ideation. Antidepressant treatment was started (sertraline 50mg/d) after a single dose of ketamine hydrochloride IV (0.5 mg/kg) was administered. Treatment response was measured using the Brief Edinburgh Depression Scale before and after the intervention. The depressive symptoms decreased by 17% on day 1, 39% on day 3, and 72% on day 17.
This case report shows ketamine's efficacy as an augmentation agent alongside conventional antidepressant treatment in patients with AC. Moreover, it shows rapid response in suicidal ideation that has not been achieved with treatment as usual. More clinical trials are needed to support the potential benefit and safety of ketamine in patients with AC, MDD, and persisting suicidal ideation.
重度抑郁症（MDD）在被诊断患有晚期癌症（AC）的患者中很常见，患病率为 16.5%。它与极大的残疾和生活质量下降、身体症状的数量和强度增加以及生存率降低有关。它是自杀意念存在的主要因素。抗抑郁药显示出适度的疗效，并且需要数周才能起效。氯胺酮在亚麻醉剂量下已显示出快速而强大的抗抑郁作用。这种作用在 AC、MDD 和自杀风险患者中可能很有用。
我们报告了一例晚期宫颈癌患者的病例，该患者出现无法控制的疼痛、MDD 和自杀企图。
一名 39 岁的女性被诊断为 IVB 期宫颈癌，在试图上吊自杀后到急诊科就诊。在姑息治疗精神病医生评估时，她报告说疼痛剧烈，对止痛药无反应，并一直有持续的自杀意念。在给予单剂量盐酸氯胺酮 IV（0.5mg/kg）后，开始使用抗抑郁药（舍曲林 50mg/d）治疗。在干预前后使用简短爱丁堡抑郁量表来衡量治疗反应。抑郁症状在第 1 天减少了 17%，第 3 天减少了 39%，第 17 天减少了 72%。
本病例报告显示，氯胺酮作为增效剂与常规抗抑郁治疗联合使用在 AC 患者中的疗效。此外，它还显示出在常规治疗未达到的情况下对自杀意念的快速反应。需要更多的临床试验来支持氯胺酮在 AC、MDD 和持续自杀意念患者中的潜在益处和安全性。
