title: Ketamine for the treatment of depression in patients receiving hospice care: a retrospective medical record review of thirty-one cases.
abstract: BACKGROUND
  Depression is prevalent in patients receiving hospice care. Standard antidepressant medications do not work rapidly enough in this setting. Evidence suggests that ketamine rapidly treats treatment refractory depression in the general population. Ketamine׳s role for treating depression in the hospice population warrants further study.
  
  
  METHODS
  A retrospective medical record review of 31 inpatients receiving hospice care who received ketamine for depression on a clinical basis was conducted. The primary outcome measure was the Clinical Global Impression Scale, which was used retrospectively to rate subjects׳ therapeutic improvement, global improvement, and side effects from ketamine over 21 days. Additionally, time to onset of therapeutic effect was analyzed.
  
  
  RESULTS
  Using the Clinical Global Impression Scale, ketamine was found to be significantly therapeutically effective through the first week after ketamine dosing (p < 0.05), with 93% of patients showing positive results for days 0-3 and 80% for days 4-7 following ketamine dosing. Patients experienced global improvement during all 4 studied time periods following ketamine dosing (p < 0.05). Significantly more patients had either no side effects or side effects that did not significantly impair functioning at each of the 4 assessed time periods following ketamine dosing (p < 0.05). Additionally, significantly more patients experienced their first therapeutic response during days 0-1 following ketamine dosing (p < 0.001) than during any other time period.
  
  
  CONCLUSIONS
  These data suggest that ketamine may be a safe, effective, and rapid treatment for clinical depression in patients receiving hospice care. Blinded, randomized, and controlled trials are required to substantiate these findings and support further clinical use of this medication in hospice settings.
authors.affiliation: Department of Psychiatry and Moores Cancer Center, University of California, La Jolla, CA (AI, RAN, JMH, SAI); San Diego Veterans Affairs Healthcare System, La Jolla, CA (AI).
authors.forename: Alana
authors.initials: A
authors.lastname: Iglewicz
authors.affiliation: Department of Internal Medicine and Inpatient Palliative Medicine Service, University of Colorado, Aurora, CO (KM).
authors.forename: Katherine
authors.initials: K
authors.lastname: Morrison
authors.affiliation: Department of Psychiatry and Moores Cancer Center, University of California, La Jolla, CA (AI, RAN, JMH, SAI).
authors.forename: Richard A
authors.initials: RA
authors.lastname: Nelesen
authors.affiliation: Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA (TZ).
authors.forename: Tingting
authors.initials: T
authors.lastname: Zhan
authors.affiliation: Department of Statistics, Temple University, Philadelphia, PA (BI).
authors.forename: Boris
authors.initials: B
authors.lastname: Iglewicz
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, CA (NF).
authors.forename: Nathan
authors.initials: N
authors.lastname: Fairman
authors.affiliation: Department of Psychiatry and Moores Cancer Center, University of California, La Jolla, CA (AI, RAN, JMH, SAI).
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: Hirst
authors.affiliation: Department of Psychiatry and Moores Cancer Center, University of California, La Jolla, CA (AI, RAN, JMH, SAI). Electronic address: sirwin@ucsd.edu.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Irwin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003866:Depressive Disorder / Q000188:drug therapy* / Q000523:psychology; D018691:Excitatory Amino Acid Antagonists / Q000627:therapeutic use*; D005260:Female; D017051:Hospice Care / Q000523:psychology*; D006801:Humans; D007649:Ketamine / Q000627:therapeutic use*; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D018691:Excitatory Amino Acid Antagonists; D007649:Ketamine