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Ketamine as augmentation for the treatment of major depression and suicidal risk in advanced cancer: Case report
- Source :
- Palliative and Supportive Care. 18:110-112
- Publication Year :
- 2019
- Publisher :
- Cambridge University Press (CUP), 2019.
-
Abstract
- ObjectiveMajor depressive disorder (MDD) is common in patients diagnosed with advanced cancer (AC), with a prevalence of 16.5%. It is associated with great disability and worsened quality of life, increased number and intensity of physical symptoms, and lower survival. It is the main factor for the presence of suicidal ideation. Antidepressants show modest efficacy, and response requires several weeks. Ketamine has demonstrated a fast and robust antidepressant effect in subanesthetic doses. This effect may prove useful in patients with AC, MDD, and suicidal risk.MethodWe report a case of a patient with advanced cervical cancer who presented with uncontrollable pain, MDD, and a suicide attempt.ResultA 39-year-old woman diagnosed with cervical cancer stage IVB presented to the Emergency Department after a suicide attempt by hanging. Upon evaluation by the palliative care psychiatrist, she reported intense pain, unresponsive to analgesics, and had a history of persistent suicidal ideation. Antidepressant treatment was started (sertraline 50mg/d) after a single dose of ketamine hydrochloride IV (0.5 mg/kg) was administered. Treatment response was measured using the Brief Edinburgh Depression Scale before and after the intervention. The depressive symptoms decreased by 17% on day 1, 39% on day 3, and 72% on day 17.Significance of resultsThis case report shows ketamine's efficacy as an augmentation agent alongside conventional antidepressant treatment in patients with AC. Moreover, it shows rapid response in suicidal ideation that has not been achieved with treatment as usual. More clinical trials are needed to support the potential benefit and safety of ketamine in patients with AC, MDD, and persisting suicidal ideation.
- Subjects :
- Adult
Suicide Prevention
medicine.medical_specialty
Palliative care
Uterine Cervical Neoplasms
03 medical and health sciences
0302 clinical medicine
Internal medicine
medicine
Humans
030212 general & internal medicine
Suicidal ideation
General Nursing
Depression (differential diagnoses)
Cervical cancer
Depressive Disorder, Major
Sertraline
Suicide attempt
business.industry
Ketamine hydrochloride
General Medicine
medicine.disease
Antidepressive Agents
Drug Combinations
Suicide
Psychiatry and Mental health
Clinical Psychology
030220 oncology & carcinogenesis
Quality of Life
Major depressive disorder
Female
Ketamine
medicine.symptom
business
medicine.drug
Subjects
Details
- ISSN :
- 14789523 and 14789515
- Volume :
- 18
- Database :
- OpenAIRE
- Journal :
- Palliative and Supportive Care
- Accession number :
- edsair.doi.dedup.....f28899b7861ed4c18460c10825dd29e3