Off-label use of transmucosal ketamine as a rapid-acting antidepressant: a retrospective chart review.
OBJECTIVE
This study evaluated the effectiveness and safety of subanesthetic doses of ketamine using an off-label, transmucosal administration route in patients with treatment-resistant depression.


METHODS
A retrospective chart review was conducted to identify patients who met the inclusion criteria for treatment-resistant major depressive disorder. Seventeen such patients who received subanesthetic doses of ketamine were included. Patient demographics, efficacy (drug refill, clinician notes), side effects, and concurrent medications were assessed.


RESULTS
Benefit from low-dose transmucosal ketamine was noted in 76% of subjects (average age 48 years, 88% female), with a dose duration lasting 7-14 days. No notable side effects were noted. The most common classes of concurrent medications to which ketamine was added were serotonin-norepinephrine reuptake inhibitors (59%), stimulants (47%), folate replacement (47%), and benzodiazepines (47%).


CONCLUSIONS
Our results provide preliminary evidence of the effectiveness and safety of low-dose transmucosal ketamine in treatment-resistant patients. A controlled, prospective pilot study is warranted to validate these findings.
Department of Pharmaceutical Sciences, School of Pharmacy, West Virginia University, Morgantown, WV, USA ; Department of Behavioral Medicine and Psychiatry, School of Medicine, West Virginia University, Morgantown, WV, USA.
Linda
L
Nguyen
Department of Behavioral Medicine and Psychiatry, School of Medicine, West Virginia University, Morgantown, WV, USA.
Patrick J
PJ
Marshalek
Department of Pharmaceutical Sciences, School of Pharmacy, West Virginia University, Morgantown, WV, USA.
Cory B
CB
Weaver
Department of Behavioral Medicine and Psychiatry, School of Medicine, West Virginia University, Morgantown, WV, USA ; Doctor of Nursing Practice Program, Robert Morris University, Moon Township, PA, USA.
Kathy J
KJ
Cramer
Department of Behavioral Medicine and Psychiatry, School of Medicine, West Virginia University, Morgantown, WV, USA ; Department of Behavioral Health, West Park Hospital, Cody, WY, USA.
Scott E
SE
Pollard
Department of Pharmaceutical Sciences, School of Pharmacy, West Virginia University, Morgantown, WV, USA ; Department of Behavioral Medicine and Psychiatry, School of Medicine, West Virginia University, Morgantown, WV, USA ; College of Pharmacy, Touro University California, Vallejo, CA, USA.
Rae R
RR
Matsumoto
NMDA receptor; depression; glutamate; ketamine; mood disorder; treatment resistance