Hope in Treatment-Refractory Depression

Bret Stetka, MD; David Feifel, MD, PhD


January 10, 2013

Editorial Collaboration

Medscape &

In This Article

How Safe Is Ketamine?

Medscape: Aside from the dissociative phenomena, does ketamine come with any serious potential adverse effects?

Dr. Feifel: We have not seen any significant adverse events. There is, of course, a transient impairment in their cognitive abilities and sedation, so we do not let our patients drive themselves home, and we ask them not to plan any activities for the rest of the day. There is also typically mild elevation in blood pressure and heart rate during the infusion. We do know from the nondepression ketamine literature that a small percentage of patients can become dysphoric and agitated due to the dissociative experience, but we have not encountered that at all yet.

Medscape: Is there potential for addiction?

Dr. Feifel: That's a good question. A concern about ketamine as a treatment has been that it might not be viable because of a potential for addiction. We are, thus far, seeing no evidence of that at all. Although patients generally find the actual "trip" they experience during the treatment enjoyable, we have seen no evidence that they are seeking additional treatments for that experience. Rather, they are seeking additional treatments to reinstate or continue the relief from their depression that they have obtained. For example, we have had patients request to postpone their prescheduled maintenance ketamine treatments because their benefit from the prior treatment was still enduring.

Medscape: What is next for your institution's ketamine research and usage?

Dr. Feifel: We are considering introducing some modifications to our current protocol; for example, a higher-dose infusion in patients who tolerate but don't respond to the 0.5-mg/kg dose. We don't know why some patients don't respond or have a very short duration of response, but some people may simply be less sensitive than others to the drug and require a higher dose.

Medscape: Do you have any final thoughts on ketamine's role in psychiatry?

Dr. Feifel: I hope the exciting promise we are seeing from the research and from the early clinical application of ketamine persists. I have been disappointed with the currently available armamentarium to treat depression. It's humbling to see so many patients with severe depression who haven't responded to any conventional therapies. So it's very exciting to have a drug that seems to represent a whole new level of efficacy. My colleague and fellow UCSD psychiatrist, Dr. Scott Irwin, is using ketamine to treat depression in the hospice population and having similar success. As the use of ketamine evolves, it could usher in a new era in the treatment of depression.