Online Learning > Webinars > Addiction Tox Case Conference > ATCC FAQs > November 2020

November 2020

Case Study: A “Ketamine Clinic” and Depression - Questions From a Patient With Opioid Use Disorder

A 28-year-old F with polysubstance dependence, including a history of heroin/fentanyl, cocaine, cannabis, prescription benzodiazepines and stimulant (both amphetamines and methylphenidate) use, is currently receiving buprenorphine/naloxone in an outpatient addiction treatment program. She is interested in attending a “ketamine clinic” for depression.” She had undergone a “very positive” ayahuasca experience a few years prior, traveling to Brazil to do so, but it wore off and she is hoping her response to ketamine will be similar but more sustained.

Frequently Asked Questions

 

References

Full Case Discussion can be found here: https://youtu.be/h4rMnj-Yufk 

  1. Griffiths RR, Johnson MW, Carducci MA, et al. Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial. J Psychopharmacol. 2016;30(12):1181-1197. doi:10.1177/0269881116675513
  2. Zanos P, Gould TD. Mechanisms of ketamine action as an antidepressant. Mol Psychiatry. 2018;23(4):801-811. doi:10.1038/mp.2017.255
  3. Maher DP, Chen L, Mao J. Intravenous Ketamine Infusions for Neuropathic Pain Management: A Promising Therapy in Need of Optimization. Anesth Analg. 2017;124(2):661-674. doi:10.1213/ANE.0000000000001787
  4. Bowers KJ, McAllister KB, Ray M, Heitz C. Ketamine as an Adjunct to Opioids for Acute Pain in the Emergency Department: A Randomized Controlled Trial. Acad Emerg Med. 2017;24(6):676-685. doi:10.1111/acem.13172
  5. Jones J. Special K: A review of Ketamine. https://emergency.med.ufl.edu/files/2013/02/KetamineReview-JonesVanDillen.pdf. Accessed December 5, 2020.
  6. Gales A, Maxwell S. Ketamine: Recent Evidence and Current Uses. Anesthesia Tutorials of the Week. 2018;381:1-7. doi:https://www.wfsahq.org/components/com_virtual_library/media/3a6c6301ec0cc1faf507f2959ae1ea1a-atow-381-00-01.pdf
  7. Mankowitz SL, Regenberg P, Kaldan J, Cole JB. Ketamine for Rapid Sedation of Agitated Patients in the Prehospital and Emergency Department Settings: A Systematic Review and Proportional Meta-Analysis. J Emerg Med. 2018;55(5):670-681. doi:10.1016/j.jemermed.2018.07.017
  8. Wong A, Benedict NJ, Armahizer MJ, Kane-Gill SL. Evaluation of adjunctive ketamine to benzodiazepines for management of alcohol withdrawal syndrome. Ann Pharmacother. 2015;49(1):14-19. doi:10.1177/1060028014555859
  9. Shah P, McDowell M, Ebisu R, Hanif T, Toerne T. Adjunctive Use of Ketamine for Benzodiazepine-Resistant Severe Alcohol Withdrawal: a Retrospective Evaluation. J Med Toxicol. 2018;14(3):229-236. doi:10.1007/s13181-018-0662-8
  10. Mandal S, Sinha VK, Goyal N. Efficacy of ketamine therapy in the treatment of depression. Indian J Psychiatry. 2019;61(5):480-485. doi:10.4103/psychiatry.IndianJPsychiatry_484_18
  11. Murrough JW, Perez AM, Pillemer S, et al. Rapid and longer-term antidepressant effects of repeated ketamine infusions in treatment-resistant major depression. Biol Psychiatry. 2013;74(4):250-256. doi:10.1016/j.biopsych.2012.06.022
  12. Serafini G, Howland RH, Rovedi F, Girardi P, Amore M. The role of ketamine in treatment-resistant depression: a systematic review. Curr Neuropharmacol. 2014;12(5):444-461. doi:10.2174/1570159X12666140619204251
  13. Patrick M. Wieruszewski, Jonathan G. Leung, Sarah Nelson; Ketamine Use in the Intensive Care Unit. AACN Adv Crit Care 1 January 2018; 29 (2): 101–106. doi: https://doi.org/10.4037/aacnacc2018448
  14. Hamill J, Hallak J, Dursun SM, Baker G. Ayahuasca: Psychological and Physiologic Effects, Pharmacology and Potential Uses in Addiction and Mental Illness. Curr Neuropharmacol. 2019;17(2):108-128. doi:10.2174/1570159X16666180125095902
  15. Frecska E, Bokor P, Winkelman M. The Therapeutic Potentials of Ayahuasca: Possible Effects against Various Diseases of Civilization. Front Pharmacol. 2016;7:35. Published 2016 Mar 2. doi:10.3389/fphar.2016.00035
  16. Griffiths RR, Johnson MW, Carducci MA, et al. Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial. J Psychopharmacol. 2016;30(12):1181-1197. doi:10.1177/0269881116675513
  17. Nutt D. Psychedelic drugs-a new era in psychiatry? Dialogues Clin Neurosci. 2019;21(2):139-147. doi:10.31887/DCNS.2019.21.2/dnutt