Inpatients and hospice
Ketamine is particularly useful for hospitalized depressed and suicidal patients and usually allows for faster discharge. “Ketamine offers patients who are in the hospital with a severe exacerbation of their depression an opportunity to receive an intervention they can’t normally get in an office visit,” Feifel said. Ketamine(Drug information on ketamine) is also starting to be used at UCSD Medical Center for patients on the medical/surgical floors whose profound depression may be interfering with their medical treatment or their ability to consent to treatment.
At San Diego Hospice and the Institute for Palliative Medicine, another UCSD-affiliated psychiatrist, Scott Irwin, MD, PhD, and his team are evaluating the efficacy and tolerability of oral ketamine for depressed hospice patients. “These are hospice care patients who meet the criteria for clinical depression—about 15% of the patient population,” he said. These patients don’t have the 12 weeks to try a standard antidepressant, and if you look at the STAR*D (Sequenced Treatment Alternatives to Relieve Depression) trial, 70% of people failed to achieve remission after 12 weeks on a standard antidepressant.”
Irwin said they use psychostimulants as first-line treatment for hospice patients with MDD, but if there is a significant anxiety component, they often use ketamine. “With ketamine, we are finding about a 70% response rate for depression and 100% response rate for anxiety.”
In 2010, Irwin and Iglewicz8 published a report of oral ketamine given to 2 patients in hospice care. Recently, Irwin and his team conducted an open-label trial involving 14 patients, which is in the process of being published. Overall, oral ketamine has been given to some 50 patients. The oral drug is given daily, usually at night. The patients are at home or in a hospice unit. According to Irwin, there are few adverse effects—sleepiness is the primary side effect.
Irwin said that numerous changes have been seen in the patients, and the changes are quite dramatic. “People who weren’t getting out of bed are getting up and doing productive things. They are re-engaging with their families, and they are focusing on things they want to accomplish before they die.”