Case Report: Ketamine for Pain and Depression in Advanced Cancer

Introduction

Patients with advanced cancer frequently experience both severe physical pain and depressive symptoms that substantially reduce quality of life. Traditional pharmacologic options have limitations in the end-of-life setting: antidepressants such as SSRIs and SNRIs often require weeks to produce benefit, opioids can cause sedation and respiratory depression and may be less effective for neuropathic pain, and methadone has a complex pharmacology with risks such as QTc prolongation. Ketamine, a rapidly acting dissociative anaesthetic with NMDA-receptor antagonist activity, has been used off-label for both neuropathic pain and treatment-resistant depression and is of interest in the palliative context because of its fast onset of action. Blinderman and colleagues present a single-case report addressing a clinical gap: whether a continuous low-dose intravenous ketamine infusion used for pain might also produce rapid improvement in severe, treatment-naïve depression in a patient with advanced cancer. The report describes the clinical course, dosing rationale, and outcomes for a patient treated at a tertiary academic centre, and situates the case within the sparse literature on ketamine for depression at the end of life.