Innovations In Clinical Neuroscience

JAN-FEB 2017

A peer-reviewed, evidence-based journal for clinicians in the field of neuroscience

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Innovations in CLINICAL NEUROSCIENCE [ V O L U M E 1 4 , N U M B E R 1 – 2 , J A N U A R Y – F E B R U A R Y 2 0 1 7 ] 56 ABSTRACT Objective: Depression is a common condition among patients with multiple sclerosis and often becomes resistant to oral antidepressants. We report a patient with multiple sclerosis who developed severe treatment-resistant depression and who was successfully treated with intravenous ketamine over the period of two years. Methods: Ketamine treatment protocol included an initial series of six treatments administered every other day, followed by a maintenance schedule. Ketamine was administered intravenously at 0.5mg/kg of ideal body weight over 40 minutes. Depression symptoms were measured using Beck Depression Index. Results: The patient's Beck Depression Index score prior to initiating ketamine treatment was 38, corresponding to severe depression. Response to treatment, defined as 50- percent reduction in Beck Depression Index score, was observed after five treatments. For this patient, the maintenance schedule ranged from a weekly treatment to one treatment every three weeks. During the two-year observation period, this patient was able to maintain a stable non-depressed mood and had no worsening of her MS symptoms. Conclusion: Ketamine may be an alternative treatment for resistant depression and may have a special use in patients with multiple sclerosis. INTRODUCTION Depression is a frequent finding in patients with multiple sclerosis (MS), with the lifetime prevalence rates for major depressive disorder (MDD) ranging from 36 to 54 percent, more than twice of that in the general population. 1 Even with advances in pharmacological options for treating depression, an estimated 33 to 66 percent of patients with MDD in the general population do not respond to the first antidepressant, and a reported 15 to 33 percent of patients do not respond to multiple interventions. 2 For patients with severe or treatment- resistant depression unsuccessfully treated with multiple pharmacological options, electroconvulsive therapy (ECT) is often the only available treatment. A recent review summarized cases of 21 MS patients with various psychiatric conditions treated with ECT and provided limited evidence for effective and safe use of ECT in these patients. 3–5 The majority of these cases reported improved psychiatric status (19/21) and unchanged neurologic status after ECT (17/21). 3 Negative neurologic effects in these patients included delirium, urinary incontinence, muscle weakness, and seizures. 6,7 Despite the apparent efficacy of ECT in treating psychiatric illness in MS patients, long-term effects, including autonomic instability by MICHAEL M. MESSER, MD, and IRINA V. HALLER, PhD, MS Dr. Messer is with Behavioral Health Department, Essentia Health, Duluth, MN, and Dr. Haller is with Essentia Institute of Rural Health, Essentia Health, Duluth, MN, USA. Innov Clin Neurosci. 2017;14(1–2):56–59 FUNDING: This research had no grant funding from any funding agency in the public, commercial, or non-profit sectors. FINANCIAL DISCLOSURES: The authors have no conflicts of interest relevant to the content of this article. ADDRESS CORRESPONDENCE TO: Dr. Irina V. Haller, Essentia Health, Essentia Institute of Rural Health, Division of Research, 6AV-2, 502 East Second Street, Duluth, MN 55805; Phone: 218-786-8185; Fax: 218-727- 8159; email: KEY WORDS: Multiple sclerosis, major depressive disorder, treatment-resistant depression, ketamine, electroconvulsive therapy C A S E R E P O R T Ketamine Therapy for Treatment-resistant Depression in a Patient with Multiple Sclerosis: A Case Report

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