A rapid positive influence of S-ketamine on the anxiety of patients in palliative care: a retrospective pilot study
A retrospective pilot study of eight palliative care patients given an intravenous S-ketamine infusion (0.25 mg/kg) found a rapid, significant reduction in anxiety compared with matched controls, with no significant change in depression or lasting analgesic effects. Findings are limited by the small, non-randomised retrospective design and need confirmation in prospective randomised trials.
Authors
- Falk, E.
- Schlieper, D.
- Van Caster, P.
Published
Abstract
Background
Patients in palliative care need rapid-acting pharmacological options for psychological distress. N-methyl-D-aspartate antagonist ketamine is known to have a fast onset of anti-depressant and anxiolytic action. Its S-enantiomer S-ketamine (or esketamine) is an analgesic used as a routine treatment for refractory pain as an intravenous infusion (0.25 mg/kg over 45 min). This study investigates whether S-ketamine pain therapy has a positive impact on psychological distress caused by anxiety and depression in palliative care.
Methods
Patient routine data from a palliative care unit of a tertiary care hospital were used in a retrospective analysis after positive ethics approval. Eight patients, who received analgesic S-ketamine treatment, were compared to a control group matched by gender and age. The main analysis was conducted using three-way mixed MANOVA followed by two-way mixed ANOVA. Target variables were the values for anxiety and depression in the state-trait anxiety-depression inventory STADI. The predictor variables were the time of measurement before (T1) and after (T2) S-ketamine application and group membership.
Results
Comparison of the S-ketamine group (n = 8; 4 male, 4 female; average age 52 years) with the control group (n = 8; 3 male, 5 female; average age 55 years) revealed a significant multivariate effect on anxiety and depression F(1, 14) = 4.78; p = 0.046; r = 0.50. The univariate comparisons showed a significant reduction of the anxiety scores from T1 to T2 in the S-ketamine group compared to the control group F(1, 14) = 10.14; p = 0.007; r = 0.65. With regard to depression, there was no significant reduction from T1 to T2 in the group comparison F(1, 14) = 1.60; p = 0.23; r = 0.32. No long-lasting effects on pain were found.
Conclusions
Our findings show that psychological distress of patients in palliative care may improve after a single administration of S-ketamine, which mainly alleviates anxiety in those patients. Limitations of this study arise from non-randomization, retrospective analysis and low sample size. Therefore, further prospective and ideally randomized studies are necessary.
Research Summary of 'A rapid positive influence of S-ketamine on the anxiety of patients in palliative care: a retrospective pilot study'
Introduction
Patients in palliative care commonly experience intertwined physical and psychological symptoms, and rapid-acting treatments for anxiety and depression are often needed because conventional antidepressants take weeks to act and benzodiazepines carry problematic side effects. Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, has been shown to produce rapid antidepressant and anxiolytic effects; its S-enantiomer (S-ketamine, or esketamine) is used intravenously for refractory pain at 0.25 mg/kg over 45 minutes and has greater NMDA-blocking potency with reportedly fewer psychotomimetic effects than the racemate. Earlier research indicates ketamine’s potential to reduce psychological distress in palliative populations, but data specifically on the purified S-enantiomer in this setting are lacking. Falk and colleagues therefore conducted a retrospective pilot study of routine clinical data from a specialised palliative care unit to test whether an analgesic S-ketamine infusion is associated with short-term reductions in anxiety and depression compared with matched controls. The main hypothesis was that a single S-ketamine infusion would reduce psychological distress (measured as anxiety and depression on the STADI) from before to after administration, and that this effect would persist after adjustment for potential confounders such as pain, need for care, psychological support, days on antidepressants and concurrent medications.
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Study Details
- Study Typeindividual
- Journal
- Compounds
- Topics
- APA Citation
Falk, E., Schlieper, D., van Caster, P., Lutterbeck, M. J., Schwartz, J., Cordes, J., Grau, I., Kienbaum, P., & Neukirchen, M. (2020). A rapid positive influence of S-ketamine on the anxiety of patients in palliative care: a retrospective pilot study. BMC Palliative Care, 19(1). https://doi.org/10.1186/s12904-019-0499-1
References (3)
Papers cited by this study that are also in Blossom
Berman, R. M., Cappiello, A., Anand, A. et al. · Biological Psychiatry (2000)
Glue, P., Medlicott, N. J., Harland, S. et al. · Journal of Psychopharmacology (2017)
Murrough, J. W., Wan, L., Levitch, C. F. et al. · Journal of Clinical Psychiatry (2015)
Cited By (3)
Papers in Blossom that reference this study
Petridis, P. D., Grinband, J., Agin-Liebes, G. et al. · Nature Mental Health (2024)
Niles, H., Fogg, C., Kelmendi, B. et al. · BMC Palliative Care (2021)
Asim, M., Wang, B., Hao, B. et al. · Neurochemistry International (2021)
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