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Ketamine as augmentation for the treatment of major depression and suicidal risk in advanced cancer: Case report

Published online by Cambridge University Press:  09 August 2019

Oscar Rodríguez-Mayoral Open the ORCID record for Oscar Rodríguez-Mayoral [Opens in a new window] ,
Rodrigo Pérez-Esparza Open the ORCID record for Rodrigo Pérez-Esparza [Opens in a new window] ,
Georgina Domínguez-Ocadio  and
Silvia Allende-Pérez
Oscar Rodríguez-Mayoral*
Affiliation:
Palliative Care Service, Instituto Nacional de Cancerología, Mexico City, Mexico
Rodrigo Pérez-Esparza
Affiliation:
Addiction Research Laboratory, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
Georgina Domínguez-Ocadio
Affiliation:
Palliative Care Service, Instituto Nacional de Cancerología, Mexico City, Mexico
Silvia Allende-Pérez
Affiliation:
Palliative Care Service, Instituto Nacional de Cancerología, Mexico City, Mexico
*
Address correspondence: Oscar Rodríguez-Mayoral, Servicio de Cuidados Paliativos, Instituto Nacional de Cancerología (INCan), Av. San Fernando No. 22 Col. Sección XVI. Delegación Tlalpan, C.P. 14080Mexico City, Mexico. Email: orodriguezm@incan.edu.mx; oscroma@gmail.com
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Abstract

Objective

Major 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.

Method

We report a case of a patient with advanced cervical cancer who presented with uncontrollable pain, MDD, and a suicide attempt.

Result

A 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 results

This 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.

Keywords

Palliative careadvanced cancerdepressionketaminesuicidal risk
Type
Case Report
Information
Palliative & Supportive Care , Volume 18 , Issue 1 , February 2020 , pp. 110 - 112
Copyright
Copyright © Cambridge University Press 2019

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Footnotes

a

These authors contributed equally to this work.

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