'Novel Management of Depression Using Ketamine in the Intensive Care Unit'

BackgroundKetamine, a dissociative anesthetic, induces remission of depression by antagonizing glutaminergic NMDA receptors. Ketamine has been used previously in outpatient setting for treatment-resistant depression, but we showcase its utility in depression management at the Intensive Care Unit (ICU).Research QuestionCan ketamine be used for depression treatment in ICU patients?Study Design and MethodsA retrospective chart review of ICU patients was done at a tertiary center from 2018 to 2021, to assess the ketamine usage. Among the patients reviewed, ketamine was used for depression in 12, and for analgesia & sedation in 2322 patients. Ketamine was administered in doses of 0.5mg/kg & 0.75mg/kg for depression. Each course consisted of 3 doses of ketamine administered over 3 days. 7 in 12 patients received a single course of ketamine. The rest received 3-4 courses 1 week apart.ResultsKetamine was found to improve mood and affect in most of the patients with depression. 11 in 12 patients had a positive response with better sleep. It has a major advantage over conventional anti-depressants since it takes only a few hours to induce remission. Patients who refused to eat and follow treatment protocol, and who would otherwise succumb to death if not for the rapid remission of depression, were administered ketamine.ConclusionA major drawback of ketamine is that the duration of remission is short, with the response lasting only up to 7 days after a single dose. Hence, all the patients in our study were weaned off ketamine with a supporting antidepressant. Ketamine has been documented to cause cardio-neurotoxicity; however, only one patient had worsening lethargy in our study. To conclude, ketamine has a monumental benefit in treating depression in the ICU. Although our study was associated with positive outcomes, there is a need for prospective studies with long-term follow-up assessments.