A retrospective analysis of ketamine intravenous therapy for depression in real-world care settings
This retrospective analysis (n=537) assessed the effectiveness of intravenous ketamine therapy in community-based practices i.e real-world care settings. Over half of the participants showed a response at 14-31 days post-infusion and 28.9% remitted while 73% exhibited a reduction in suicidal ideation. However, remission status was weakly inversely correlated with depression severity.
Authors
- Boris Heifets
- Charles Debattista
Published
Abstract
Background
Outcomes of ketamine intravenous therapy (KIT) for depression in real-world care settings have been minimally evaluated. We set out to quantify treatment response to KIT in a large sample of patients from community-based practices.
Methods
We retrospectively analyzed 9016 depression patients who received KIT between 2016 and 2020 at one of 178 community practices across the United States. Depression symptoms were evaluated using the Patient Health Questionnaire-9 (PHQ-9). The induction phase of KIT was defined to be a series of 4-8 infusions administered over 7 to 28 days.
Results
Among the 537 patients who underwent induction and had sufficient data, 53.6% of patients showed a response (≥ 50% reduction in PHQ-9 score) at 14-31 days post-induction and 28.9% remitted (PHQ-9 score drop to < 5). The effect size was d = 1.5. Among patients with baseline suicidal ideation (SI), 73.0% exhibited a reduction in SI. A subset (8.4%) of patients experienced an increase in depressive symptoms after induction while 6.0% of patients reported increased SI. The response rate was uniform across 4 levels of baseline depression severity. However, more severe illness was weakly correlated with a greater drop in scores while remission status was weakly inversely correlated with depression severity. Kaplan-Meier analyses showed that a patient who responds to KIT induction has approximately 80% probability of sustaining response at 4 weeks and approximately 60% probability at 8 weeks, even without maintenance infusions.
Conclusion
KIT can elicit a robust antidepressant response in community clinics; however, a small percentage of patients worsened.
Research Summary of 'A retrospective analysis of ketamine intravenous therapy for depression in real-world care settings'
Introduction
Ketamine intravenous therapy (KIT) is established as a rapid treatment for depressive symptoms, but most controlled evidence comes from single-infusion studies conducted at academic centres. Those trials typically show rapid symptomatic improvement within 24 hours and high short-term response rates after a single infusion, but relapse is common within two weeks. As community-based ketamine clinics have proliferated and commonly use repeated-infusion “induction” regimens (typically 4–8 infusions over 2–4 weeks) followed by variable maintenance dosing, there remains limited systematic time-course data using standardised clinical instruments from these real-world settings. Mcinnes and colleagues set out to quantify outcomes of KIT in community clinics across the United States by analysing a large, de-identified dataset collected via a measurement-based care software platform. The primary aim was to evaluate antidepressant response and remission after a KIT induction series using the Patient Health Questionnaire-9 (PHQ-9) and to estimate the short-term durability of response prior to any maintenance infusions. The analysis focuses on patients treated between 2016 and 2020 and emphasises treatment delivered in independent private practices rather than academic trials.
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Study Details
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- APA Citation
McInnes, L. A., Qian, J. J., Gargeya, R. S., DeBattista, C., & Heifets, B. D. (2022). A retrospective analysis of ketamine intravenous therapy for depression in real-world care settings. Journal of Affective Disorders, 301, 486-495. https://doi.org/10.1016/j.jad.2021.12.097
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Cited By (6)
Papers in Blossom that reference this study
Hack, L. M., Zhang, X., Heifets, B. D. et al. · Nature Communications (2023)
Hietamies, T. M., Mcinnes, L. A., Klise, A. J. et al. · Journal of Affective Disorders (2023)
Heifets, B. D., Olson, D. E. · Neuropsychopharmacology (2023)
Mathai, D. S., Nayak, S., Yaden, D. B. et al. · Psychopharmacology (2023)
Hull, T. D., Malgaroli, M., Gazzaley, A. et al. · Journal of Affective Disorders (2022)
Price, R., Kissel, N., Baumeister, A. et al. · Molecular Psychiatry (2022)
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