Stanford University School of Medicine, Stanford, CA, USA; Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.
Osmind, San Francisco, CA, USA.
J Affect Disord. 2023 Aug 15;335:484-492. doi: 10.1016/j.jad.2023.04.141. Epub 2023 May 16.
Ketamine intravenous therapy (KIT) appears effective for treating depression in controlled trials testing a short series of infusions. A rapidly proliferating number of clinics offer KIT for depression and anxiety, using protocols without a strong evidence basis. Controlled comparison of mood and anxiety from real-world KIT clinics, and the stability of outcomes, is lacking.
We performed a retrospective controlled analysis on patients treated with KIT in ten community clinics across the US, between 08/2017-03/2020. Depression and anxiety symptoms were evaluated using the Quick Inventory of Depressive Symptomatology-Self Report 16-item (QIDS) and the Generalized Anxiety Disorder 7-item (GAD-7) scales, respectively. Comparison data sets from patients who did not undergo KIT were obtained from previously published real-world studies.
Of 2758 patients treated, 714 and 836 met criteria for analysis of KIT induction and maintenance outcomes, respectively. Patients exhibited significant and concordant reduction in both anxiety and depression symptoms after induction (Cohen's d = -1.17 and d = -1.56, respectively). Compared to two external datasets of KIT-naive depressed patients or patients starting standard antidepressant therapy, KIT patients experienced a significantly greater reduction in depression symptoms at eight weeks (Cohen's d = -1.03 and d = -0.62 respectively). Furthermore, we identified a subpopulation of late-responders. During maintenance, up to a year post-induction, increases in symptoms were minimal.
Due to the retrospective nature of the analyses, interpreting this dataset is limited by incomplete patient information and sample attrition.
KIT treatment elicited robust symptomatic relief that remained stable up to one year of follow-up.
在一系列针对短期输注的对照试验中，静脉注射氯胺酮（KIT）疗法似乎对治疗抑郁症有效。越来越多的诊所提供 KIT 治疗抑郁症和焦虑症，使用的方案缺乏强有力的证据基础。缺乏对现实世界 KIT 诊所的情绪和焦虑的对照评估，以及结果的稳定性。
我们对美国 10 家社区诊所 2017 年 8 月至 2020 年 3 月期间接受 KIT 治疗的患者进行了回顾性对照分析。使用 16 项快速抑郁症状自评量表（QIDS）和 7 项广泛性焦虑症量表（GAD-7）分别评估抑郁和焦虑症状。未接受 KIT 治疗的患者的对照数据集来自以前发表的真实世界研究。
在 2758 名接受治疗的患者中，714 名和 836 名患者符合 KIT 诱导和维持治疗结果分析的标准。患者在诱导后表现出明显且一致的焦虑和抑郁症状缓解（Cohen's d=-1.17 和 d=-1.56）。与两个 KIT 初治抑郁患者或开始标准抗抑郁治疗的患者的外部数据集相比，KIT 患者在 8 周时的抑郁症状显著减轻（Cohen's d=-1.03 和 d=-0.62）。此外，我们还确定了一个迟发反应者亚群。在维持期，即诱导后一年，症状增加很小。
由于分析的回顾性性质，对这组数据的解释受到患者信息不完整和样本流失的限制。
KIT 治疗引起了显著的症状缓解，在一年的随访中保持稳定。
