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Activity Dates: 06/12/2014 - 04/28/2017

Target Audience

This course is designed for pharmacists, nurse practitioners or other healthcare professionals involved in the comprehensive medication management of psychiatric and/or neurological patients.

Session Summary

The glutamate N-methyl-D-aspartate (NMDA) receptor antagonist ketamine, a dissociative anesthetic agent with potential abuse liability, has shown rapid antidepressant effects, but small sample sizes and inadequate control conditions in prior studies have precluded a definitive conclusion. This talk will summarize recent work related to ketamine's antidepressant properties and will discuss hypotheses regarding its putative mechanism of action in depression. Data will be presented from a NIH funded two-site, parallel-arm, randomized controlled trial of a single infusion of ketamine compared to an active placebo control condition (e.g. the anesthetic midazolam) in 73 patients with treatment-resistant major depression experiencing a major depressive episode. The primary outcome was change in depression severity at 24 hours following drug administration, as assessed by the Montgomery-Åsberg Depression Rating Scale (MADRS). We found that the ketamine group had greater improvement in the MADRS score at the primary study outcome (24 hours post-treatment) compared to the midazolam group (P<0.0014). After adjusting for baseline scores and site, ketamine was superior to midazolam in improving the MADRS score by 7.95 points (95% confidence interval [CI], 3.20 to 12.71). Treatment with ketamine increased the likelihood of response at 24 hours compared to midazolam (odds ratio, 2.18, 95% CI, 1.21 to 4.14; P<0.006; response rate 64% vs. 28%). This study found that ketamine demonstrated rapid antidepressant effects in an optimized study design, further supporting NMDA receptor modulation as a novel mechanism for accelerated improvement in severe and chronic forms of depression. However, more information on response durability and safety is required prior to implementation in clinical practice.

Course Requirements

You will proceed through the following steps to satisfactorily complete this course:

  • Review the full content of the activity and reflect upon its teachings.
  • Complete the post-test at the end of the activity no later than the closing activity date. (login first)
  • Complete the evaluation at the end of the activity. (login first)
  • If necessary, complete the post-test retest no later than the closing activity date. (login first)
  • Receive a passing grade (70%).
  • Provide the necessary details in your profile to ensure correct reporting by CPNP to CPE Monitor. (login first)

This course is provided online at cpnp.org and consists of the speaker audio and slides. A PDF file of the slides is also provided and access is available to participants indefinitely although ACPE credit is available only through the course expiration date.

Participants in this course must complete an examination and achieve a score of 70% or greater. Successful completion of the course also requires the completion of a course evaluation. ACPE statements of credit can be retrieved by participants online at cpnp.org immediately upon successful completion of the course.

Faculty Information and Disclosures

Learning Objectives

  1. Define and discuss treatment resistant depression.
  2. Review current approaches to patients with treatment resistant depression.
  3. Understand the mechanism of NMDA receptor modulation in treatment resistant depression and assess the current evidence for use of NMDA antagonists.
  4. Discuss future directions for use of NMDA antagonists in depression treatment.

Continuing Education Credit and Disclosures

Activity Dates: 06/12/2014 - 04/28/2017
ACPE Contact Hours: 1.0
ACPE Number: 0284-0000-14-009-H01-P (Knowledge)
Nursing Credit Reminder: Note that ACPE credit is accepted for certification renewal.

ACPEThe College of Psychiatric and Neurologic Pharmacists is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This course provides 1.0 contact hours (0.10 CEUs) of knowledge-based continuing education credit. The ACPE universal program number assigned to this course is 0284-0000-14-009-H01-P (1.0 contact hours).