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Ketamine Articles

Article #1 – Ketamine: Quo Vadis?

The editorial by Dr Nemeroff supports our clinic design of having a psychiatrist evaluate patients to confirm diagnosis of treatment resistant depression and having anesthesiologists administer the ketamine infusion

While benefits of decreased suicidal ideation are seen with IV administration of ketamine (versus midazolam) the exact mechanism of action is obscure and outrageous claims should not be made at this point

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Article #2 – Attenuation of antidepressant effects of ketamine by opioid receptor antagonism

Results of this study show ketamine acts on the  mu, kappa, and delta opioid receptors as an agonist (we already know ketamine acts on the NMDA receptor as an antagonist). The study conclusion shows that activation of the opioid receptors by ketamine is necessary for its antidepressant effects.

The study proved the above findings by administering study patienst naltrexone (an opioid receptor antagonist) prior to the administration of IV ketamine therapy. Those subjects that received naltrexone prior to receiving the IV ketamine infusion therapy showed decreased effects of the ketamine on depressive symptoms.

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Article #3 – (Case Study) Ketamine infusion yields chronic pain dividend In the perioperative period

In summary, NMDA receptors are unregulated in chronic pain states, especially in the dorsal horn of the spinal cord, leading to central sensitization

NMDA antagonism may help decrease spontaneous pain, hyperalgesia, and allodynia (ketamine is an NMDA antagonist and has proven benefit)

Ketamine has a role to decrease the development of chronic pain states in the perioperative period.

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Article #4 – Ketamine for acute pain: highlights from the new guidelines

Perioperative use of ketamine is on the rise because of its benefits with pain management and the goals of seeking opioid free pain therapies

ASRA (Anesthesia Society on Regional Anesthesia) has consensus guidelines for the infusion of subanesthetic doses of ketamine for pain conditions

The guidelines also outline indication, contraindications, and promote adequate monitoring and administration by trained professionals only.

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Article #5 – Major adverse cardiac events and mortality associated with electroconvulsive therapy

Electroconvulsive therapy (ECT) is a procedure used to treat patients with major depression, treatment resistant depression, and depression with suicidal ideation

The procedure delivers an electrical stimulus to the brain initiating a seizure which is what brings about beneficial changes for the patient. This procedure is done under anesthesia

The brief hemodynamics changes that occur while administering this therapy can cause cardiac morbidity and mortality.

This systematic review found that in every 1/200-1/500 ECT procedures there were cases of cardiac morbidity (1/50 ECT patients)

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Article #6 – NMDA receptor blockade at rest triggers rapid behavioural antidepressant responses

Clinical studies consistently demonstrate that a single subanesthetic dose of ketamine (NMDA receptor antagonist) produces fast acting antidepressant response if the patient is suffering a major depressive episode, although the mechanism remains unclear

The effects of the ketamine are seen within 2 hours of the infusion

The benefits are seen immediately which is in contrast to tradition oral antidepressant therapy which can take weeks for effect

The benefit of ketamine is particularly good in cases of major depression with suicidal ideation

Elucidating the exact mechanism of ketamine’s action requires further studying

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Article #7 – Effects of ketamine on major depressive disorder in a patient with posttraumatic stress disorder

This is a case report showing dramatic improvement of symptoms and reversal of suicidal ideation in a combat veteran with major depressive disorder and PTSD (post traumatic stress  disorder)

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Article #8 – Intravenously administered ketamine shown to reduce symptoms of chronic post-traumatic stress disorder

The article summarizes a randomized, double blind crossover study at the Mount Sinai Medical center showing proven benefits of IV ketamine administration in patients suffering from PTSD vs placebo.

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