The Johns Hopkins University School of Medicine, Center for Psychedelic and Consciousness Research, Department of Psychiatry and Behavioral Sciences, Baltimore, MD, United States of America; Sattva Medicine - Psychiatry/Psychotherapy Practice, Miami, FL, United States of America.
Institute for Psycholinguistics and Digital Health, United States of America.
J Affect Disord. 2024 Sep 15;361:198-208. doi: 10.1016/j.jad.2024.05.131. Epub 2024 May 27.
Improving safe and effective access to ketamine therapy is of high priority given the growing burden of mental illness. Telehealth-supported administration of sublingual ketamine is being explored toward this goal.
In this longitudinal study, moderately-to-severely depressed patients received four doses of ketamine at home over four weeks within a supportive digital health context. Treatment was structured to resemble methods of therapeutic psychedelic trials. Patients receiving a second course of treatment were also examined. Symptoms were assessed using the Patient Health Questionnaire (PHQ-9) for depression. We conducted preregistered machine learning and symptom network analyses to investigate outcomes (osf.io/v2rpx).
A sample of 11,441 patients was analyzed, demonstrating a modal antidepressant response from both non-severe (n = 6384, 55.8 %) and severe (n = 2070, 18.1 %) baseline depression levels. Adverse events were detected in 3.0-4.8 % of participants and predominantly neurologic or psychiatric in nature. A second course of treatment helped extend improvements in patients who responded favorably to initial treatment. Improvement was most strongly predicted by lower depression scores and age at baseline. Symptoms of Depressed mood and Anhedonia sustained depression despite ongoing treatment.
This study was limited by the absence of comparison or control groups and lack of a fixed-dose procedure for ketamine administration.
At-home, telehealth-supported ketamine administration was largely safe, well-tolerated, and associated with improvement in patients with depression. Strategies for combining psychedelic-oriented therapies with rigorous telehealth models, as explored here, may uniquely address barriers to mental health treatment.
鉴于精神疾病负担不断增加，提高氯胺酮治疗的安全有效途径是当务之急。正在探索远程医疗支持下的舌下氯胺酮给药，以实现这一目标。
在这项纵向研究中，中度至重度抑郁患者在支持性数字健康环境中在家中接受四周内四次氯胺酮治疗。治疗方法模仿了治疗性迷幻药物试验的方法。还检查了接受第二疗程治疗的患者。使用患者健康问卷（PHQ-9）评估抑郁症状。我们进行了预先注册的机器学习和症状网络分析，以调查结果（osf.io/v2rpx）。
对 11441 名患者进行了分析，显示出非重度（n=6384，55.8%）和重度（n=2070，18.1%）基线抑郁水平的患者均有典型的抗抑郁反应。在 3.0-4.8%的参与者中检测到不良事件，主要是神经或精神方面的性质。对初始治疗反应良好的患者进行第二次治疗有助于延长改善。改善最强烈地预测为较低的抑郁评分和基线时的年龄。尽管持续治疗，但情绪低落和快感缺失等症状仍会持续存在抑郁。
本研究的局限性在于缺乏比较或对照组，以及缺乏氯胺酮给药的固定剂量程序。
远程医疗支持下的家庭氯胺酮给药在很大程度上是安全的，耐受性良好，并与抑郁症患者的改善相关。这里探索的将迷幻药物导向疗法与严格的远程医疗模式相结合的策略，可能会独特地解决心理健康治疗的障碍。
