Intramuscular Racemic Ketamine Antidepressant Response and Reduced Length of Admission in Psychiatric Inpatients with Treatment Resistant Depression and Borderline Personality

Author(s): Nathan Carter

The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study, the largest study of MDD conducted in the United States, showed that even with enriched resources devoted to treatment, recovery with the first selected SSRI occurred only about 30% of the time. In fact, after initiating antidepressants, the time for an expected response is longer than the typical inpatient psychiatric unit length of stay. Ketamine constitutes a novel, rapid and efficacious treatment choice for patients suffering from moderate to severe treatment resistant depression and exhibits rapid and significant antidepressant and anti-suicidal effects. Intramuscular racemic ketamine, in subanesthetic doses, is an effective, safe, off-label treatment for severe/moderate treatment refractory depression and rapid stabilization of suicidal behaviors/ideations, in under 36 hours, post injection. No consultations warranted from other medical specialties. Larger, heterogeneous studies are needed, which provide historical data of continued response/remission following ketamine, whether from intramuscular or intravenous administration. Comparative studies are needed comparing efficacy between racemic, R-ketamine, and S-ketamine.