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Case report reveals successful treatment of adolescent depression with ketamine

March 28, 2017

A case report written by a team of Yale researchers describing ketamine treatment for adolescent depression is featured in April’s Journal of the American Academy of Child & Adolescent Psychiatry.

The report details the successful treatment of a 16-year-old boy diagnosed with major depressive disorder (MDD) and attention-deficit/hyperactivity disorder (ADHD) with repeated infusions of the anesthetic drug ketamine.

The boy was hospitalized for depression with suicidal ideation, had a history of three serious prior suicide attempts, and had failed multiple anti-depressant medications and psychotherapy trials.

“He presented as hopeless about the prospect of psychiatric improvement and complained of persistent thoughts of wanting to die,” wrote Jennifer B. Dwyer, MD, PhD, Clinical Fellow in the Solnit Integrated Training Program and the paper’s first author.

Dwyer and Yale co-authors Robert B. Ostroff, MD; Zheala Qayyum, MD; Michael H. Bloch, MD; and Samuel T. Wilkinson, MD, wrote that the boy and his family consented to ketamine infusion treatment. The boy received seven infusions over an eight-week period. His depressive symptoms were reduced and he no longer reported suicidal ideation.

He was initially discharged to a residential facility, but then moved back home and returned to school with substantial functional improvement. While there is now considerable evidence of ketamine’s efficacy in treatment-refractory adult depression, this is one of the first reports of its use in severe pediatric major depressive disorder.

“Given the potential therapeutic benefits of ketamine and the substantial burden of treatment-refractory adolescent MDD, ketamine deserves further study as a potential treatment in adolescents,” the authors wrote, adding that its study and use should be restricted to treatment settings with appropriate monitoring and supervision, and always with informed consent.

Publication of the article coincided with Dwyer’s receipt of a $25,000 grant from the Thrasher Pediatric Research Fund to support a pediatric depression clinical trial she is working on with Bloch and Gerard Sanacora, MD, PhD, Professor of Psychiatry and Director of the Yale Depression Research Program.

The trial will involve 18 adolescents diagnosed with MDD who have failed at least one adequate trial of a traditional antidepressant. In a crossover design, subjects will received a single infusion of ketamine and placebo over the four-week trial.

Dwyer and Bloch emphasize that “suicide is the second leading cause of death in adolescents and young adults. While current FDA-approved treatments can reduce suicidality over the course of weeks to months, ketamine and related compounds offer the possibility of an effective, acute treatment for this major public health problem.” Dwyer wrote in her proposal, “given the significant health burden of adolescent MDD and suicide, this novel treatment could be very impactful to overall child health.”

Submitted by Christopher Gardner on March 28, 2017