Depression is a common mental health disorder affecting individuals of all ages, genders, and backgrounds. However, elderly individuals are at a higher risk of developing depression due to factors such as social isolation, chronic illness, and bereavement. Additionally, treating depression in the elderly population can be challenging as they may be more susceptible to the adverse effects of medications commonly used for depression.
Recently, IV ketamine has gained attention as a potential treatment option for resistant depression in the elderly population. IV ketamine is a dissociative anesthetic that has been used for decades for sedation and pain relief. In recent years, studies have shown that IV ketamine has rapid antidepressant effects, even in patients who have failed multiple traditional antidepressant medications.
The mechanism of action of IV ketamine in treating depression is not entirely understood. Still, it is believed to work by blocking the N-methyl-D-aspartate (NMDA) receptor in the brain, leading to increased production of neurotransmitters such as glutamate and dopamine. Additionally, IV ketamine has been shown to increase brain-derived neurotrophic factor (BDNF), which promotes the growth and survival of neurons in the brain.
New Studies About Ketamine Infusions
Two new studies suggest that intravenous (IV) ketamine is an effective treatment for geriatric patients with treatment-resistant depression (TRD). The response rate was found to be similar to that observed in younger adult patients. The findings are important because research on the effects of IV ketamine has not been well documented in geriatric patients, who have high rates of depression and TRD.
First Study
The first study was conducted by Jonathan Kim, of Emory University, and his team. They conducted a retrospective chart review of 91 older patients with TRD who received IV ketamine treatment between October 2016 and August 2022. Patients were divided into two groups – those older than 60 years and those younger than 60. Participants in each age group received six ketamine infusions over 6 weeks. Results showed that there was no difference in the response to the treatment between the treatment-resistant geriatric and non-geriatric patients. The study was presented at the American Association for Geriatric Psychiatry (AAGP) 2023.
Second Study
The second study was conducted by Hanadi Ajam Oughli, MD, a health sciences assistant clinical professor in the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA. The study evaluated additional key outcomes in geriatric patients treated with IV ketamine as part of a larger open-label late-life trial on TRD. The secondary analysis of the trial focused on 23 patients who had been initially treated with twice-a-week IV ketamine for 4 weeks. Overall, 48% of participants achieved a response, and 24% achieved remission of depressive symptoms following the first 4 weeks of twice-weekly treatment. This effect was maintained during the continuation phase of the study.
The studies show that IV ketamine is an effective treatment for geriatric patients with TRD. Ketamine has traditionally been used as an anesthetic that blocks N-methyl-D- aspartate (NMDA) glutamate receptors. In the treatment of TRD, an infusion of 0.5 mg/kg is typically administered over 40 minutes, producing a rapid antidepressant response. Recent research shows the drug reduces suicidality and improves mood and quality of life.
Ketamine Nasal Spray vs IV Administration
A more recent intranasal formulation of ketamine, esketamine, was approved by the US Food and Drug Administration for TRD in 2019. In the previous TRANSFORM-3 study, a placebo-controlled randomized trial, there was no difference between esketamine, used in conjunction with an antidepressant, and placebo for geriatric patients.
However, the drug’s high cost and poor bioavailability in comparison with IV ketamine remains an issue, said Oughli. IV ketamine is administered by a healthcare professional and is typically covered by insurance, whereas esketamine is self-administered and may not be covered by insurance.
Safety and Tolerability Of Ketamine
“There are some safety and tolerability concerns which may lead some older adults and their clinicians to be reluctant to pursue IV ketamine treatment,” said Oughli. However, in both studies, patients tolerated ketamine well, and there were no serious adverse events. Adverse events, including hypertension, dissociated effects, and cravings, were rare and did not prevent the continued use of IV ketamine by older adults.
Benefits of IV Ketamine For Resistant Depression In Older Adults
IV ketamine has gained attention as a potential treatment option for resistant depression in the elderly population due to its rapid onset of action and potential lack of significant adverse effects. The benefits of IV ketamine for resistant depression in the elderly include:
Rapid onset of action
Traditional antidepressant medications can take several weeks or even months to produce significant clinical improvement. IV ketamine, on the other hand, has been shown to have rapid antidepressant effects, with significant reductions in depression scores observed after the first treatment.
High remission rates
Studies have shown that IV ketamine has high remission rates in elderly patients with resistant depression. In a recent study published in the Journal of Clinical Psychiatry, 62% of elderly patients achieved remission of their depression symptoms after six IV ketamine treatments over two weeks.
Lack of significant adverse effects
Traditional antidepressant medications can have significant adverse effects, especially in elderly patients who may be more susceptible to adverse effects due to comorbidities or polypharmacy. However, IV ketamine has been shown to have a relatively low risk of adverse effects, making it an attractive option for elderly patients with resistant depression.
Potential to improve quality of life
Depression in the elderly population can significantly impact quality of life, leading to social isolation, reduced physical activity, and increased healthcare utilization. By rapidly improving depressive symptoms, IV ketamine may help to improve quality of life in elderly patients with resistant depression.
Unique treatment option
For elderly patients with resistant depression who have failed multiple traditional antidepressant medications, IV ketamine offers a unique treatment option with potential benefits. It may be particularly useful for patients who have comorbid medical conditions that make traditional antidepressant medications challenging to use.
Conclusion
IV ketamine may be a safe and effective treatment option for elderly patients with resistant depression. The rapid onset of action, high remission rates, and lack of significant adverse effects make IV ketamine an attractive option for this population.
While more research is needed to evaluate the long-term efficacy and safety of IV ketamine for treating depression in the elderly, the initial studies show significant promise for this unique treatment option.
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