Return to The CPNP Perspective issue main page.< Previous Article  Next Article >

Monday, April 28, 2014, 2:00-3:00 p.m.

Sanjay J. Mathew, M.D., is a psychiatrist with expertise in psychopharmacology and clinical neuroscience. He is a Staff Physician and Director of the Mood Disorders Research Program in the Mental Health Care Line at the Michael E. Debakey VA Medical Center in Houston, Texas. At Baylor College of Medicine, he is the Brown Foundation Chair of Psychopharmacology of Mood Disorders, Associate Professor with Tenure in the Menninger Department of Psychiatry and Behavioral Sciences, and research faculty member at Ben Taub General Hospital.

There is growing interest in the use of ketamine as a treatment for severe, medication-resistant depression. However, very few patients to date have been enrolled in rigorously designed, randomized, double-blind, placebo-controlled investigations, and no parallel-arm studies had been conducted. A major challenge for the field is how to adequately blind the dissociative side effects of ketamine, as all previous clinical trials of ketamine had used normal saline as the control.

Gain a preview to this exciting, emerging treatment session by reviewing the items below which include Dr. Matthew’s commentary and recommended articles on the topic.

Our study published in the American Journal of Psychiatry selected the short-acting benzodiazepine anesthetic midazolam as a control. We found that while midazolam offered a reasonable control for ketamine's sedative, anxiolytic, and amnestic side effects, there were clear differences between the drugs in the magnitude and degree of dissociation. So it is possible that ketamine trials may never be truly blinded. With that important caveat, the rapidity of onset and persistence of benefit of a single subanesthetic dose infusion of ketamine has now been replicated in several independent studies. There has also interest in development of the S-isomer of ketamine, as well as other routes of delivery (IM, intranasal, oral, sublingual). Future research is focused on the feasibility of repeated dose infusions, expansion to additional indications and age groups, and understanding mechanisms of antidepressant activity. A major priority in 2014 is identifying the optimal dose of IV ketamine for depression; surprisingly, despite replicated studies, there has never been a dose-response study. The NIMH has funded a recent contract to study this important question (Maurizio Fava, PI, at MGH).”

Readings

Join us at CPNP 2014 where Dr. Matthews will summarize recent work related to ketamine's antidepressant properties and will discuss hypotheses regarding its putative mechanism of action in depression.

Return to The CPNP Perspective issue main page.< Previous Article  Next Article >