ABSTRACT
BACKGROUND: The dissociative anesthetic agent ketamine is increasingly being utilized to treat depression, despite not having FDA (Food and Drug Administration) approval for this indication. There are many questions about the potential risks of this treatment and hence the proper setting and degree of monitoring required to ensure patient safety. There is limited data about the cardiovascular safety of ketamine when administered at subanesthetic doses to treat depression. METHODS: 66 patients in the Department of Psychiatry at Emory University received a total of 684 ketamine infusions between 2014 and 2016. Ketamine was dosed at 0.5â¯mg/kg body weight and infused over 40â¯min. Blood pressure was measured every 10â¯min during the infusions and every 15â¯min thereafter. RESULTS: Mean age of the patients was 56.7 years, 87.9% had unipolar depression and 36.1% had essential hypertension. No infusions were discontinued due to instability of vital signs, adverse physiological consequences or acute psychotomimetic effects. The biggest increases in blood pressure were measured at 30â¯min (systolic 3.28â¯mmHg, diastolic 3.17â¯mmHg). Hypertensive patients had higher blood pressure peaks during the infusions. Blood pressures returned to baseline during post-infusion monitoring. There was no development of tolerance to the blood pressure elevating effects of ketamine between the first and sixth infusions. LIMITATIONS: This is a single site, retrospective analysis, of patients who were spontaneously seeking clinical care. CONCLUSIONS: The blood pressure changes observed when ketamine is administered over 40â¯min at 0.5â¯mg/kg for the treatment of depression are small, well tolerated and clinically insignificant.
Subject(s)
Anesthetics, Dissociative/adverse effects , Antidepressive Agents/adverse effects , Depression/drug therapy , Depressive Disorder/drug therapy , Essential Hypertension/chemically induced , Ketamine/adverse effects , Anesthetics, Dissociative/administration & dosage , Antidepressive Agents/administration & dosage , Blood Pressure/drug effects , Depression/physiopathology , Depressive Disorder/physiopathology , Essential Hypertension/epidemiology , Female , Humans , Infusions, Intravenous , Ketamine/administration & dosage , Male , Middle Aged , Retrospective StudiesABSTRACT
Many patients with chronic or recurring major depressive disorder have suboptimal responses to the wide range of antidepressant medications available. When confronted with these patients, clinicians may augment the original antidepressant with other medications, including adjunctive treatment with a second or third antidepressant. Although it is a widely-used practice among psychiatrists and primary care physicians in high-income countries, evidence for the benefits of this type of antidepressant polypharmacy is limited. Care should be taken to utilize this approach only after failure of optimized monotherapy with different classes of antidepressants.
ABSTRACT
This study aims at developing a single numerical measure that represents a depressed patient's individual burden of illness. An exploratory study examined depressed outpatients (n = 317) followed by a hypothesis confirmatory study using the NIMH STAR*D trial (n = 2,967). Eigenvalues/eigenvectors were obtained from the Principal Component Analyses of patient-reported measures of symptom severity, functioning, and quality of life. The study shows that a single principal component labeled as the Individual Burden of Illness Index for Depression (IBI-D) accounts for the vast majority of the variance contained in these three measures providing a numerical z score for clinicians and investigators to determine an individual's burden of illness, relative to other depressed patients.
Subject(s)
Cost of Illness , Depressive Disorder, Major/psychology , Adult , Depressive Disorder, Major/diagnosis , Depressive Disorder, Major/physiopathology , Female , Humans , Male , Middle Aged , Outcome Assessment, Health Care , Principal Component Analysis , Psychometrics/instrumentation , Quality of Life/psychology , Reproducibility of Results , Surveys and QuestionnairesABSTRACT
Most pregnancies in adolescents are unintended and preventable if contraception were utilized. IUDs provide an under-utilized highly effective form of contraception. IUDs are appropriate for nulliparous women, including adolescents. IUDs do not increase: the incidence of Pelvic Inflammatory Disease after the 1st month of insertion, the odds of infertility, nor rate of ectopic pregnancy. Adolesecnts need more education about and increased access to IUDs. Practical points regarding IUD selection and insertion in adolescents are reviewed, including pain prophylaxis, anticipatory guidance, side effects and complications. In summary, IUDs are safe for contraception in most adolescents. IUDs are effective and eliminate the need for ongoing adherence and thus have the potential to decrease unplanned pregnancies.
Subject(s)
Health Services Accessibility , Intrauterine Devices/statistics & numerical data , Pregnancy in Adolescence/prevention & control , Adolescent , Adolescent Health Services , Female , Humans , Practice Guidelines as Topic , Pregnancy , Young AdultABSTRACT
By looking at drug addiction from an evolutionary perspective, we may understand its underlying significance and evaluate its three-fold nature: biology, psychology, and social influences. In this investigation it is important to delve into the co-evolution of mammalian brains and ancient psychotropic plants. Gaining an understanding of the implications of ancient psychotropic substance use in altering mammalian brains will assist in assessing the causes and effects of addiction in a modern-day context. By exploring addiction in this manner, we may move towards more effective treatment early prevention, treating the root of the issue rather than the symptoms.
