Effects of ketamine
Ketamine is an antagonist of the N-methyl-D-asparate receptor (NMDAR) and targets the excitatory neurotransmitter glutamate. Single, slowly administered, sub-anaesthetic ketamine intravenous infusions elicit rapid, though transient, antidepressant responses and target core symptoms in treatment-resistant depression, including suicidal ideation.
Although these findings are remarkable, a definitive role for ketamine in managing depression is not yet agreed and there are concerns about unregulated off-label use and associated lack of oversight.
Our Research Department at St Patrick's Mental Health Services is conducting two trials investigating the use of ketamine as a treatment for depression.
KITE-Dep Trial
It is thought that the anti-depressant effects of both ketamine and ECT when combined increase recovery of patients suffering from treatment-resistant depression.
The Research Department is conducting a pilot trial to assess the safety of slow infusions of ketamine delivered over a period of 40 minutes interleaved with ECT on a separate day. This trial will inform a potential future randomised controlled trial and provide safety and tolerability data on ketamine in this treatment group.
Developing a new therapy for a more rapid recovery from depression will improve quality of life for patients and their families, inform health services’ treatment guidelines, raise public awareness of mental health, and could have a positive socio-economic impact in Ireland and abroad.
- Recruitment status: Recruitment paused due to the COVID-19 pandemic. We anticipate that recruitment will recommence in the new year.
- ClinicalTrials.gov Identifier: NCT04082858
- EudraCT number: 2018-003421-28
KARMA_Dep (2) Trial
This trial investigates if repeated ketamine infusions (twice-weekly; maximum of eight infusions) as adjunctive therapy to routine care will improve depression outcome in patients hospitalized with severe depression. We are investigating if ketamine as an adjunctive therapy is associated with reduced health care costs and improved quality of life. The trial also examines potential biomarkers associated with depression.
Treatments prescribed by the patients’ treating team are continued as usual. The results of the proposed trial should be generalisable to patients with depression hospitalised in industrialised nations, but may be applicable more internationally and to patients with severe depression in general.
- Recruitment status: Ethical approval obtained
- EudraCT number: 2019-003109-92
- Funder: Health Research Board
Sunlight and bipolar disorder
Recent studies have suggested that the age of onset of bipolar affective disorder is younger in areas where there is a larger increase in sunlight in springtime. This appears to be especially true in those with a family history of depression or bipolar disorder.
This study aims to expand on these findings by including service users from almost 23 different international sites, including inpatients at St Patrick’s University Hospital. Recruitment has been ongoing and we aim to complete data collection by the end of December 2020.
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