Title : A New Methodological Approach to Improve the "Real Word" Effectiveness of Ketamine Infusion Therapy for Treatment-Resistant Depression
Objective: Ketamine is recognized as a rapidly acting antidepressant; however, discrepancies exist between the "Efficacy" reported in research studies (70-85%) versus significantly lower "Effectiveness" (18.3-45.5%) reported in community-based settings. To offset the "Efficacy-Effectiveness" gap a novel, clinically applicable methodology (RESTORE) was developed to improve both effectiveness and durability.
Here we report the results of a 60-month, retrospective study of 87 patients who received RESTORE for TRD and compare outcomes to community based-studies utilizing the "standard" ketamine infusion.
Methods: Patient eligibility was determined by a three-step patient evaluation and suitability protocol. Patients received 3 infusions over 3 days and were dosed with the amount of ketamine, based on pharmacokinetic modeling, to achieve optimal blood concentrations. The medication was administered intravenously via a multimodal, variable rate infusion over 30 minutes. Following induction, patients received two additional infusions within 3-6 months before entering the maintenance phase. Symptom severity was determined utilizing the Beck Depression Index-II (BDI-II).
Results: 78 of 87 (89.4%) patients completed the 2-phase infusion protocol, of which 88.4% responded and 56.3% remitted by the fifth infusion. This compares favorably to the 18.3-45.5% response and 27.3% remission rate reported in other studies. Most notably, the average period between protocol completion and the need for maintenance infusion was 245 days compared to 26 days with ketamine infusion.
Conclusions: The novel RESTORE infusion protocol represents a clinically applicable methodological approach to ketamine infusion therapy that results in significantly improved effectiveness by 3-fold and response durability by 9-fold compared to the standard ketamine infusion
What will the audience learn from your presentation?
- What are the expected rates of response and remission following ketamine infusion therapy?
- What is the therapeutic durability of ketamine therapy in treatment-resistant depression?
- How to improve the overall effectiveness of ketamine infusion therapy in community-based settings.
- Where to obtain additional training in the use of ketamine therapy?