title: Combination of intravenous S-ketamine and oral tranylcypromine in treatment-resistant depression: A report of two cases.
abstract: Ketamine, a rapid-acting antidepressant and anti-suicidal agent, is thought to increase brain monoamine levels by enhancing monoamine release or inhibiting presynaptic monoamine-reuptake. Here we present two female inpatients suffering from treatment-resistant depression with recurrent severe suicidal crises receiving a combination of intravenous S-ketamine and oral tranylcypromine, which is a well-known irreversible monoamine oxidase (MAO) inhibitor. Since inhibition of monoamine-reuptake with concurrent blockade of MAO might trigger sympathomimetic crisis, this combination is considered hazardous. Nonetheless, cardiovascular parameters remained stable in both patients, while good anti-suicidal effects were observed. Hence, we put serious doubt on whether monoamine-reuptake inhibition is a relevant pharmacological effect of ketamine in humans.
authors: Division of Biological Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria.
authors: Lucie
authors: L
authors: Bartova
authors: Division of Gynecological Oncology, Department of Gynecology and Obstetrics, Medical University of Vienna, Austria.
authors: Sonja E
authors: SE
authors: Vogl
authors: Division of Biological Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria.
authors: Mara
authors: M
authors: Stamenkovic
authors: Division of Biological Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria.
authors: Nicole
authors: N
authors: Praschak-Rieder
authors: Division of Biological Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria.
authors: Angela
authors: A
authors: Naderi-Heiden
authors: Division of Biological Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria.
authors: Siegfried
authors: S
authors: Kasper
authors: Division of Biological Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria. Electronic address: matthaeus.willeit@meduniwien.ac.at.
authors: Matthaeus
authors: M
authors: Willeit
mesh_terms: D061605:Administration, Intravenous; D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000008:administration & dosage*; D061218:Depressive Disorder, Treatment-Resistant / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007297:Inpatients; D007649:Ketamine / Q000008:administration & dosage*; D008996:Monoamine Oxidase Inhibitors / Q000008:administration & dosage; D014191:Tranylcypromine / Q000008:administration & dosage*; D000092864:Suicide Prevention
chemical_list: D000928:Antidepressive Agents; D008996:Monoamine Oxidase Inhibitors; D014191:Tranylcypromine; D007649:Ketamine
keywords: Irreversible monoamine oxidase inhibition; Ketamine; Monoamine-reuptake inhibition; Tranylcypromine; Treatment-resistant depression