Ketamine Therapy for Treatment-resistant Depression in a Patient with Multiple Sclerosis: A Case Report

Conclusion—Ketamine may be an alternative treatment for resistant depression and may have a special use in patients with multiple sclerosis. Introduction Depression is a frequent finding in patients with multiple sclerosis (MS), with the lifetime prevalence rates for major depressive disorder (MDD) ranging from 36 to 54 percent, more than twice of that in the general population.[1] Even with advances in pharmacological options for treating depression, an estimated 33 to 66 percent of patients with MDD in the general population do not respond to the first antidepressant, and a reported 15 to 33 percent of patients do not respond to multiple interventions.[2] For patients with severe or treatment-resistant depression unsuccessfully treated with multiple pharmacological options, electroconvulsive therapy (ECT) is often the only available treatment. A recent review summarized cases of 21 MS patients with various psychiatric conditions treated with ECT and provided limited evidence for effective and safe use of ECT in these patients.[3–5] The majority of these cases reported improved psychiatric status (19/21) and unchanged neurologic status after ECT (17/21).[3] Negative neurologic effects in these patients included delirium, urinary incontinence, muscle weakness, and seizures.[6,7] Despite the apparent efficacy of ECT in treating psychiatric illness in MS patients, long-term effects, including autonomic instability and neurologic deterioration, following ECT are still unclea...
Source: Innovations in Clinical Neuroscience - Category: Neuroscience Authors: Tags: Case Report Current Issue Depression Multiple Sclerosis Neurology Psychiatry Psychopharmacology Electroconvulsive therapy Ketamine major depressive disorder treatment-resistant depression Source Type: research