1. Clinical use in major depression
MATS LINDSTRÖM, MD, PHD, ASSOCIATE PROFESSOR, PSYCHIATRY MALMÖ, LUND UNIVERSITY

2. Ketamine – clinical use in major depression
Vision for the future:

3. 1. Are new antidepressants needed?
• Yes, definitely!
• Major depressive disorder (MDD) is common
• 25 % of patients with MDD are therapy resistant
• Suffering and reduced function is a great problem
• Suicide prevention is needed

4. 2. Expectations on ketamine?
• Huge!
• More Rapid and Effective?
• Less Side effects?
• Less Cognitive (memory) side effects than ECT?
• Long term: reduced risk for Relapse and/or Recurrence?

5. 3. What do we know today?
• It started with Berman et al 2000, Biol Psychiatry
• Low dose iv during 40 minutes (0.5 mg/kg)
• Dissociative side effects of short duration (< 2 hours)
• Immediate antidepressive effect after 3-4 hours
• Significant effect of ketamine vs placebo within 72 hours

6. Berman et al, Biol Psychiatry 2000
Ketamine Placebo Sign
Base-line
HDRS score
33.0 + 6.7 26.9 + 5.8 NS
Post treat
HDRS score
decrease
within 72 hrs
14 + 10 0 + 12 sign

7. Anders
Tingström
Pouya
Movahed
Joakim
Ekstrand
Jonas ÅkesonMats Humble
KetECT

8. 4. Should Guidelines be revised?
• No!
• SBU concluded in March 2017 that:
– The scientific knowledge is limited (few studies, few patients)
– Studies of repeated infusions with long-time follow up are needed
– Studies of bipolar depression are needed

9. 5. Possible pitfalls?
Cognition?
Psychosis?
Mania?
Cystitis?
Abuse?

10. 6. What is KetECT?
• A naturalistic, multicenter, open RCT with 200 patients
• Low dose (racemic) ketamine adm iv during 40 min (0.5 mg/kg)
or ECT (3 times/week; up to 12 treatments)
• Inclusion: Patients with MDD, MADRS > 20, m/w, 18-85 years
• Exclusion: coercive care, abuse, bipolar depr, complicated personality
syndrom, psychosis, severe somatic disease, pregnancy, breast-feeding

11. 7. Anything else?
• ELECT-D
–400 patients with severe resistant depression
–Randomized to ketamine or ECT
–Yale, Mount Sinai, Cleveland, Houston
–Started 2017 and planned to be complete in 2022
• Janssen Cilag-study of nasal inhalation of S-ketamin

12. 8. Take home message?
• KetECT will be back with results!
• More research is needed!

14. Ketamine – current practice and
emerging concepts
WORKSHOP AT 34TH SSAI, MALMÖ, SEPTEMBER 6, 2017

15. Workshop ”Ketamine – current practice and
emerging concepts”
• Jan Persson Analgesia – mechanisms and current practice
• Jonas Åkeson Anaesthesia – mechanisms and current practice
• Anders Tingström Mechanisms for therapeutic management of
depressive disorders
• Mats Lindström Clinical use in major depression