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34 – SA PSYCH August 2020 – Ketamine, COVID & Suicidality a perfect fit for a perfect storm

Molly (not her real name) was a 50-something frequent flyer in our Emergency Department in the North West of Ireland. A habitual self-harmer and polypharmacy overdoser, she was the quintessential treatment resistant depressive with co-existing Axis ll issues. The psychiatry unit had all but washed their hands of her, and all those involved in her frequent care simply went through the motions, presentation after presentation, month after month. I lost count of the sutures I had placed in her self-inflicted wounds and would have recognised her by her glottis, so often had she been tubed in our ED.That she lived literally minutes from our Emergency Department had undoubtedly played a role in the longevity of this troubled soul.

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38 – SA PSYCH August 2020 – A Ketamine Clinic in the hills

Our flagship ketamine clinic is located just off the N3 in the undulating hills of the Natal Midlands. Notwithstanding the fact that any new initiative always takes time to gather momentum and that COVID forced us to all but close for several weeks, we have administered over 700 infusions to more than 120 patients in around six months of operation. Our patients have ranged in age from 14 to 73.

Read More


56 – SA PSYCH AUG 2021 – Ketamine Clinics Beyond the Hills

In the August 2020 edition of South African Psychiatry, I penned two articles titled Ketamine COVID & Suicidality – a perfect fit for a perfect storm and A Ketamine Clinic in the Hills, the latter describing the establishment of our flagship outpatient ketamine infusion clinic in the Natal Midlands.

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Depression and Suicidality

KetECT trial

Depression is a debilitating disorder affecting millions globally (Kessler and Bromet 2013), causing severe suffering and reduced life expectancy due to associated somatic co-morbidities and elevated suicide risk (Laursen et al., 2016).

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Ketamine for the acute treatment of severe suicidal ideation: double blind, randomised placebo controlled trial

To confirm the rapid onset anti-suicidal benefits of ketamine in the short term and at six weeks, overall and according to diagnostic group.

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Is Ketamine living up to the promise for depression?

After years of dormancy, psychiatric drug development is showing signs of life. There is the novel antipsychotic lumateperone, recently approved for adults with schizophrenia. Brexanolone was approved last year for postpartum depression. And perhaps generating the most attention lately among psychiatrists – and people with depression – is the use of ketamine and esketamine for depression.

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Distinct trajectories of antidepressant response to intravenous ketamine

The N-methyl-D-aspartate receptor antagonist ketamine is potentially effective in treatment resistant depression. However, its antidepressant efficacy is highly variable, and there is little information about predictors of response.

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Ketamine preventing PPD

Ketamine helps prevent postpartum depression.

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Prevalence of Perinatal Depression and Anxiety in Both Parents

Prevalence of perinatal depression and anxiety in both parents. A systemic review and meta-analysis.

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Evaluation of Early Ketamine Effects on Belief-Updating Biases in Patients With Treatment-Resistant Depression

Clinical research has shown that persistent negative beliefs maintain depression and that subanesthetic ketamine infusions induce rapid antidepressant responses.

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2022 Review Ketamine Crisis Management Depression

Ketamine and esketamine for crisis management in patients with depression: Why, whom, and how?

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Neurocognitive effects of repeated ketamine infusion treatments in patients with treatment resistant depression

Major depressive disorder (MDD) is a common and disabling mental condition that affects up to one in five adults in the United States during their lifetime, and more than 300 million people worldwide at any given time, according to the World Health Organization.

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Depression and Suicidality in Adolescents and Children

Depression is a common mental health disorder in children and adolescents. The prevalence is around 3% in younger children and about 8% in adolescents.

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Patients’ recovery and non-recovery narratives after intravenous ketamine for treatment-resistant depression

For many patients with major depressive disorder (MDD) and bipolar disorder (BD), conventional pharmacotherapy is not effective. Up to one-third of patients with MDD do not respond to conventional anti-depressants and treatment resistance often occurs for patients with BD depression despite extensive trials with numerous pharmacologic agents.

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Ketamine for depressive symptoms: A retrospective chart review of a private ketamine clinic

This retrospective chart review reports the clinical response (change in Patient Health Questionnaire – 7 score) to an initial infusion series of ketamine added to usual treatment, and the pattern of its subsequent maintenance use, for depressive symptoms.

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Other mood disorders

Ketamine for refractory anxiety

Anxiety disorders are common, associated with significant burden of disease, and have high levels of treatment resistance.

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The Ketamine and Me project Journal of affective disorders

Some people diagnosed with major depressive disorder (MDD) are poor or non-responders to widely used antidepressant medica- tion, such as selective serotonin reuptake inhibitors (SSRIs), serotonin- norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) (Henkel et al., 2009). These drugs are often not fast-acting, having a typical time lag of 2–4 weeks initially, and 6–12 weeks for maximum effect (Niciu et al., 2015).

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The Antidepressant Effect of Ketamine Is Dampened by Concomitant Benzodiazepine Medication

The rapid antidepressant effect of ketamine has become a breakthrough in the research and treatment of depression. Although predictive and modulating factors of the response to ketamine are broadly studied, little is known about optimal concurrent medication protocols.

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Physician suicide / Depression in doctors

At some point in their career, at least a third of doctors suffer personal health problems such as injury, aging, or physical and mental illness, which detract from their ability to function properly and to practice medicine safely. In most, impairment is amenable to intervention, treatment, recovery or resolution. However, some conditions, notably depression, may be overrepresented in the medical profession, under-recognized, stigmatised and undertreated, which may have fatal consequences.

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Ketamine treatment for refractory anxiety: A systematic review

There is a growing interest in the psychiatric properties of the dissociative anaesthetic ketamine, as single doses have been shown to have fast-acting moodenhancing and anxiolytic effects, which persist for up to a week after the main psychoactive symptoms have diminished. Therefore, ketamine poses potential beneficial effects in patients with refractory anxiety disorders, where other conventional anxiolytics have been ineffective.

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Long term structural and functional neural changes following a single infusion of Ketamine in PTSD

NMDA receptor antagonists have a vital role in extinction, learning, and reconsolidation processes. During the reconsolidation window, memories are activated into a labile state and can be reconsolidated in an altered form. This concept might have significant clinical implications in treating PTSD.

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Ketamine can reduce harmful drinking by pharmacologically rewriting drinking memories

Maladaptive reward memories (MRMs) are involved in the development and maintenance of acquired overconsumption disorders, such as harmful alcohol and drug use. The process of memory reconsolidation – where stored memories become briefly labile upon retrieval – may offer a means to disrupt MRMs and prevent relapse.

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Ketamine to treat cocaine dependence

Research has suggested that subanesthetic doses of ketamine may work to improve cocaine-related vulnerabilities and facilitate efforts at behavioral modification.

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Diverse types of pain

Phantom Limb pain case study

Treatment for phantom limb pain is difficult and challenging. There is often suboptimum treatment with fewer than 10% receiving lasting relief.

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Ketamine for Refractory Chronic Pain: a 1-year follow up study

Ketamine is often used in pain clinics for refractory chronic pain, but its long-term efficacy is poorly reported. The main objective was to assess the long-term effect of ketamine on pain and health variables in patients with refractory chronic pain. A prospective, multicenter, 1-year follow-up observational study (NCT03319238) was conducted in 30 French pain clinics where ketamine is commonly prescribed.

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Assessment of Initial Depressive State and Pain Relief With Ketamine in Patients With Chronic Refractory Pain

Repeated ketamine administration is common in treatment-refractory chronic pain, but ketamine analgesic and antidepressant effects are poorly understood in patients with chronic pain with depression symptoms.

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CRPS

Ketamine protocols for CRPS

To find and reach a consensus on the usage of ketamine in the treatment of complex regional pain syndrome and to determine a reference protocol for future studies.

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Sympathetic Blocks as a Predictor for Response to Ketamine Infusion in Patients with Complex Regional Pain Syndrome

Ketamine infusions are frequently employed for refractory complex regional pain syndrome (CRPS), but there are limited data on factors associated with treatment response. Sympathetic blocks are also commonly employed in CRPS for diagnostic and therapeutic purposes and generally precede ketamine infusions.

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Cancer Related Pain

′Impressed With Impact′ of Ketamine in Cancer Palliative Care

Like many in her field, Toronto psychiatrist Madeline Li, MD, PhD, was skeptical when one of her psychiatry residents suggested they launch a study into the effects of ketamine for depression in cancer palliative care.

But now, after treating about 15 patients, she’s a convert.

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Intravenous Ketamine for Cancer Pain Management Including Flares During the COVID-19 Pandemic: A Retrospective Study

Cancer-related neuropathic pain (CNP) affects an increasing proportion of cancer patients given improved survival but remains difficult to treat. There are no studies on an extended intravenous (IV) ketamine protocol and its synergies with common neuropathy treatments to treat CNP.

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Migraine


Fibromyalgia


Neuralgias

Ketamine Neurotoxicology study

With the increasing use of ketamine as an off-label treatment for depression and the recent FDA approval of (S)- ketamine for treatment-resistant depression, there is an increased need to understand the long-term safety profile of chronic ketamine administration.

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PJ Allen analysis

A rapid survey of outcomes amongst patients with major depressive disorders.

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Ketamine and Lamotrigine Combination in Psychopharmacology: Systematic Review

Ketamine is a rapid-acting antidepressant with proven efficacy as an add-on agent in unipolar and bipolar treatment-resistant depression. Although many studies have been published, there is still not enough data on the effect of ketamine in combination with other medications. Particularly interesting is the combination of ketamine and lamotrigine, and its potential role in bipolar depression.

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The Pharmacokinetics of Ketamine in the Breast Milk of Lactating Women: Quantification of Ketamine and Metabolites

Ketamine is a general anesthetic with over 50 years of safe administration that is in increasing use for psychiatric indications. This is evidenced by the recent FDA approval of intranasal esketamine (the S-enantiomer) for the treatment of depression.

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Intravenous ketamine for depression: A clinical discussion reconsidering best practices in acute hypertension management

Ketamine is a versatile medication with an emerging role for the treatment of numerous psychiatric conditions, including treatment resistant depression. Current psychiatry guidelines for its intravenous administration to treat depression recommend regular blood pressure monitoring and an aggressive approach to potential transient hypertensive episodes induced by ketamine infusions.

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NMDAR blockade and tinnitus in an animal model

Chronic tinnitus has no broadly effective treatment. Identification of specific markers for tinnitus should facilitate the development of effective therapeutics.

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Glutamatergic mechanisms of sleep

Ketamine, a drug with rapid antidepressant effects and well-described effects on slow-wave sleep (SWS), is a useful intervention for investigating sleep–wake mechanisms involved in novel therapeutics.

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Racemic ketamine more effective than esketamine

Depression is the leading cause of disability in the world, affecting nearly 300 million individuals globally (Charlson et al., 2019; Herrman et al., 2019). Although depressive symptoms may be reduced within several weeks following the initiation of conventional antidepressants, approximately one-third of patients fail to achieve meaningful recovery (Corriger and Pickering, 2019).

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Anti-inflammatory effects of ketamine – J of Psychopharmacology

Ketamine is a novel rapid-acting antidepressant with high efficacy in treatment-resistant patients. Its exact therapeutic mechanisms of action are unclear; however, in recent years its anti-inflammatory properties and subsequent downstream effects on tryptophan (TRP) metabolism have sparked research interest.

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Ketamine in COVID 19 – J of Medical Virology

Coronavirus disease 2019 (COVID‐19), identified as the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), was recognized as a public health emergency by World Health Organization, and declared a pandemic on March 11, 2020.

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Therapeutic values of Ketamine for COVID-19 – Int J A & Crit Care

Ketamine has long been used in the field of anesthesia [1]. Its rapid and long-acting analgesic effects associated with its dissociative properties have also established its use in pre-hospital and emergency department patients [2].

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Ketamine and Fatigue – J Affect Dis – ‘Read about the trial’

Fatigue is a multidimensional condition that is difficult to treat with standard monoaminergic antidepressants. Ketamine, an N-methyl-D-aspartate receptor (NMDAR) antagonist produces rapid and robust improvements in depressive symptoms in treatment-resistant depression.

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COVID the brain and ketamine – Jama Psychiatry

COVID-19 has resulted in more than 120 million cases and 2.6 million deaths to date. Respiratory and gastrointestinal symptoms are accompanied by short- and long-term neuropsychiatric symptoms (NPs) and long-term brain sequelae.

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The neurexin gene deletion

Ketamine may be promising for autism.

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Neglected therapy for Alzheimer’s

Ketamine: A Neglected Therapy for Alzheimer Disease.

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Neuroprotective and Neurocognitive effects

Neuroprotective potential of ketamine prevents developing brain structure impairment.

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Genetics of treatment outcomes

Genetics of Treatment Outcomes in Major Depressive Disorder: Present and Future.

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Ketamine’s Role in Spirituality

How One Synthetic Drug Catalyzes a Natural Experience.

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World Journal of B Psych Ketamine and Thalamic blood flow

Increase in thalamic cerebral blood flow is associated with antidepressant effects of ketamine in major depressive disorder.

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Ketamine activates adult-born immature granule neurons to rapidly alleviate depression-like behaviors in mice

Ketamine treatment decreases depressive symptoms within hours, but the mechanisms mediating these rapid antidepressant effects are unclear. Here, we demonstrate that activity of adult-born immature granule neurons (ABINs) in the mouse hippocampal dentate gyrus is both necessary and sufficient for the rapid antidepressant effects of ketamine.

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Suicide After a Dementia Diagnosis: What Is the Risk?

Mood disorders are one of the most important comorbid conditions among patients with dementia, but what are the prevalence rates of symptoms of depression, anxiety, and apathy among adults with dementia, and does prevalence change as patients advance through different stages of dementia?

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Risk of Psychiatric Disorders Among Spouses of Patients With Cancer in Denmark and Sweden

There is emerging evidence that spouses of patients with cancer may have a higher prevalence of mental illness, but these studies have been limited by pre-post designs, focus on a single mental illness, and short follow-up periods.

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Is Ketamine infusion an alternative for those patients who don’t respond to TMS?

Between 30 and 40 % of patients suffering from major depressive disorder will develop treatment-resistant depression (TRD), classically described as a lack of satisfactory response to two or more adequate antidepressant trials . For these patients, a well-established approach is transcranial magnetic stimulation (TMS).

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Unexpected ketamine effect in a patient with cervical dystonia

Cervical dystonia is the most common form of adult-onset focal dystonia. It is a highly disabling disorder that negatively impacts quality of life.

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Is Polycystic Ovary Syndrome (PCOS) a Risk Factor for Suicidal Ideation?

Polycystic ovary syndrome (PCOS) affects a significant proportion of women during their reproductive years and is characterized by elevated androgen levels that are often associated with insulin resistance.

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34 – SA PSYCH August 2020 – Ketamine, COVID & Suicidality a perfect fit for a perfect storm

Molly (not her real name) was a 50-something frequent flyer in our Emergency Department in the North West of Ireland. A habitual self-harmer and polypharmacy overdoser, she was the quintessential treatment resistant depressive with co-existing Axis ll issues. The psychiatry unit had all but washed their hands of her, and all those involved in her frequent care simply went through the motions, presentation after presentation, month after month. I lost count of the sutures I had placed in her self-inflicted wounds and would have recognised her by her glottis, so often had she been tubed in our ED.That she lived literally minutes from our Emergency Department had undoubtedly played a role in the longevity of this troubled soul.

Read More


38 – SA PSYCH August 2020 – A Ketamine Clinic in the hills

Our flagship ketamine clinic is located just off the N3 in the undulating hills of the Natal Midlands. Notwithstanding the fact that any new initiative always takes time to gather momentum and that COVID forced us to all but close for several weeks, we have administered over 700 infusions to more than 120 patients in around six months of operation. Our patients have ranged in age from 14 to 73.

Read More


56 – SA PSYCH AUG 2021 – Ketamine Clinics Beyond the Hills

In the August 2020 edition of South African Psychiatry, I penned two articles titled Ketamine COVID & Suicidality – a perfect fit for a perfect storm and A Ketamine Clinic in the Hills, the latter describing the establishment of our flagship outpatient ketamine infusion clinic in the Natal Midlands.

Read More

Tinnitus and depression

Tinnitus is a condition that causes distress and impairment across cognitive, functional, and psychiatric spectra.

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Screen time and depression in adolescence

Increases in screen time have been found to be associated with increases in depressive symptoms.

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Call for suspension of ECT

Experts are calling for the immediate suspension of electroconvulsive therapy (ECT) for major depression.

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