Psychiatric Unit, Social Security Institute for Public Servants of the State of Minas Gerais (Instituto de Previdência dos Servidores do Estado de Minas Gerais - IPSEMG), Belo Horizonte, Minas Gerais, Brazil.
Geriatric Unit, Social Security Institute for Public Servants of the State of Minas Gerais (Instituto de Previdência dos Servidores do Estado de Minas Gerais - IPSEMG), Belo Horizonte, Minas Gerais, Brazil.
CNS Spectr. 2023 Jun;28(3):313-318. doi: 10.1017/S1092852922000773. Epub 2022 May 2.
Depression in older adults with multiple medical comorbidities can contribute to clinical deterioration, and increased mortality. Electroconvulsive therapy (ECT) is the first-line treatment for these patients. This study aimed to evaluate the effectiveness and safety of subcutaneous (SC) ketamine as an alternative to ECT. We reviewed the medical records of all consecutive older inpatients with severe depression and multiple medical comorbidities who were referred for ECT but treated with SC ketamine over 1 year in our institution. Demographic data, DSM-5 diagnosis, MÅDRS score, and CGI score were analyzed. Twelve patients aged 67-94 years were included. All patients were rated as severely ill, 83% were women, with a mean of 12.6 (SD, 1.4) medical comorbidities. Remission was achieved in 75% of the intention-to-treat population and 100% of treatment completers. The number of sessions ranged from 1 to 6, and days until remission from 1 to 16. Patients remained without relapse for 8-28 months. SC ketamine was safe and well tolerated, and most adverse events were mild and transient. Although limited by the retrospective open-label design of the study and small sample size, our findings provide a potential new indication for ketamine: treatment of severe depression, not necessarily resistant to antidepressants, in older patients with multiple medical comorbidities, at risk of clinical deterioration, and referral for ECT. SC ketamine was highly effective in this population, with no relapse and good tolerance. Randomized controlled trials are needed to adequately test the use of ketamine in this specific group.
老年患者合并多种医学共病时出现的抑郁可能导致临床恶化和死亡率增加。电抽搐治疗（ECT）是这些患者的一线治疗方法。本研究旨在评估皮下（SC）氯胺酮作为 ECT 的替代疗法的有效性和安全性。我们回顾了在我院接受 ECT 但在 1 年内接受 SC 氯胺酮治疗的所有连续患有严重抑郁症和多种医学共病的老年住院患者的病历。分析了人口统计学数据、DSM-5 诊断、MÅDRS 评分和 CGI 评分。共纳入 12 名年龄 67-94 岁的患者。所有患者均被评为病重，83%为女性，平均合并 12.6（SD，1.4）种医学共病。意向治疗人群中 75%的患者达到缓解，100%的患者完成治疗。治疗次数为 1-6 次，缓解时间为 1-16 天。患者在 8-28 个月内无复发。SC 氯胺酮安全且耐受良好，大多数不良事件轻微且短暂。尽管受研究的回顾性开放性设计和样本量小的限制，但我们的研究结果为氯胺酮提供了一个潜在的新适应症：治疗合并多种医学共病、有临床恶化风险且需要 ECT 转诊的老年严重抑郁症患者，且这些患者对抗抑郁药可能不敏感。SC 氯胺酮在该人群中非常有效，无复发且耐受良好。需要随机对照试验来充分测试氯胺酮在这一特定人群中的使用。
