Skip to main navigation menu Skip to main content Skip to site footer

Antidepressant effect of intranasal ketamine in the palliative care of terminally ill cancer patients

Efecto antidepresivo de la Ketamina intranasal en el cuidado paliativo de pacientes con cáncer terminal





Section
Research Articles

How to Cite
González Pardo, S., González-Longoria Boada, L., & López Muñoz, F. (2023). Antidepressant effect of intranasal ketamine in the palliative care of terminally ill cancer patients. Archivos De Medicina (Manizales), 23(1). https://doi.org/10.30554/archmed.23.1.4532.2023
Download Citation

Dimensions
PlumX

How to Cite

González Pardo, S., González-Longoria Boada, L., & López Muñoz, F. (2023). Antidepressant effect of intranasal ketamine in the palliative care of terminally ill cancer patients. Archivos De Medicina (Manizales), 23(1). https://doi.org/10.30554/archmed.23.1.4532.2023

Download Citation

Secundino González Pardo
Lourdes González-Longoria Boada
Francisco López Muñoz

Background: patients with cancer are more likely to have affective disorders. Antide-pressant treatments take weeks to work. Evidence suggests that ketamine delivered by any route treats these symptoms, making it a recommendable option for oncologic patients what are they presenting depression, anxiety, and suicidal ideation. Material and methods: a randomized, double-blind, placebo-controlled study was conduc-ted in 142 participants with cancer. Ketamine at 0.5 mg / kg and 1m of placebo at 0.9% were administered intranasally every six hours for 3 days. The criterion used to evaluate efficacy was the total score on the Montgomery-Åsberg Depression rating scale. In addition, response time and adverse events to treatment were analyzed. Results: the mean age was 69.11 ± 9.77 years. The most frequent carcinoma was the pancreatic head tumor (44.37%). Affective disorders improved significantly only in Group A (p <0.001). Group B presented improvements induced by the placebo effect, but no significant differences were found (p = 0.32). The main side effect was nausea in both cases. Conclusions: ketamine administered intranasally is a safe, effective, and rapid therapy to reduce antidepressant effects and improve the quality of life of cancer patients. The response rate is similar to other studies. The adverse effects may limitation for its application.


Article visits 628 | PDF visits 304


Downloads

Download data is not yet available.
  1. 1. Nayak M, George A, Vidyasagar M, Mathew S, Nayak S, Nayak B, et al. Quality of Life among Cancer Patients. Indian journal of palliative care.2017; 23(4): p. 445-450. 2. Vrinten C, McGregor L, Heinrich M, von Wagner C, Waller J, Wardle J, et al. What do people fear about can-cer? A systematic review and meta-synthesis of cancer fears in the general population. Psycho-oncology.2017; 26(8): p. 1070-1079. 3. Kwekkeboom K, Tostrud L, Costanzo E, Coe C, Serlin R, Ward S, et al. The role of inflammation in the pain, fatigue, and sleep disturbance symptom cluster in advanced cancer. Journal of pain and symptom mana-gement.2018; 55(5): p. 1286-1295. 4. Omran S, Mcmillan S. Symptom Severity, Anxiety, Depression, Self- Efficacy and Quality of Life in Patients with Cancer. Asian Pacific journal of cancer prevention : APJCP.2018; 19(2): p. 365–374. 5. Pendergrass C, Targum S, Harrison J. Cognitive impairment associated with cancer: a brief review. Innova-tions in clinical neuroscience.2018; 15(1-2): p. 36–44. 6. Zhang Y, Li W, Zhang Z, Sun H, Garg S, Yang Y, et al. Suicidal ideation in newly-diagnosed Chinese cancer patients. Frontiers in psychiatry.2020; 11: p. 1-8. 7. Khaustova O. Resistant depression: criteria for determination, risk factors and therapeutic strategies.Psychosomatic Medicine and General Practice.2017; 2(3): p. 1-14. 8. Tundo A, de Filippis R, Proietti L. Pharmacologic approaches to treatment resistant depression: evidences and personal experience. World journal of psychiatry.2015; 5(3): p. 330-341. 9. Duclot F, Kabbaj M. Epigenetic mechanisms underlying the role of brain-derived neurotrophic factor in depression and response to antidepressants.The Journal of experimental biology.2015; 218(1): p. 21–31. 10. Musazzi L, Marrocco J. The many faces of stress: implications for neuropsychiatric disorders.Neural Plas-ticity.2016; 2016(8389737): p. 1-2. 11. Harmer C, Duman R, Cowen P. How do antidepressants work? New perspectives for refining future treatment approaches. Lancet Psychiatry. 2017; 4(5): p. 409-418. 12. Arabzadeh S, Hakkikazazi E, Shahmansouri N, Tafakhori A, Ghajar A, Jafarinia M, et al. Does oral administration of ketamine accelerate response to treatment in major depressive disorder? Results of a double-blind controlled trial.Journal of affective disorders. 2018; 235: p. 236-241.13. Gupta A, Dhar R, Patadia P, Funaro M, Bhattacharya G, Farheen S, et al. A systematic review of ketamine for the treatment of depression among older adults. International Psychogeriatrics.2021; 33(2): p. 179-191.14. Murrough J, Burdick K, Levitch C, Perez A, Brallier J, Chang L, et al. Neurocognitive effects of ketamine and association with antidepressant response in individuals with treatment-resistant depression: a randomized controlled trial. Neuropsychopharmacology. 2015; 40(5): p. 1084-1090. 15. Rosenblat J, Carvalho A, Li M, Lee Y, Subramanieapillai M, McIntyre R. Oral ketamine for depression: a sys-tematic review. The Journal of clinical psychiatry.2019; 80(3): p. 13514. 16. Irwin S, Iglewicz A, Nelesen R, Lo J, Carr C, Romero S, et al. Daily oral ketamine for the treatment of depres-sion and anxiety in patients receiving hospice care: a 28-day open-label proof-of-concept trial. Journal of palliative medicine.2013; 16(8): p. 958-965. 17. Gao M, Rejaei D, Liu H. Ketamine use in current clinical practice. Acta Pharmacologica Sinica.2016; 37: p. 865-872. 18. Abdollahpour A, Saffarieh E, Zoroufchi B. A review on the recent application of ketamine in management of anesthesia, pain, and health care. Journal of family medicine and primary care.2020; 9(3): p. 1317–1324. 19. Kurdi M, Theerth K, Deva R. Ketamine: Current applications in anesthesia, pain, and critical care. Anesthesia, essays and researches.2014; 8(3): p. 283–290. 20. Lapidus K, Levitch C, Perez A, Brallier J, Parides M, Soleimani L, et al. A randomized controlled trial of intra-nasal ketamine in major depressive disorder. Biological psychiatry. 2014; 76(12): p. 970–976.21. Fan W, Yang H, Sun Y, Zhang J, Li G, Zheng Y, et al. Ketamine rapidly relieves acute suicidal ideation in cancer patients: a randomized controlled clinical trial. Oncotarget.2017; 8(2): p. 2356–2360.22. Iglewicz A, Morrison K, Nelesen R, Zhan T, Iglewicz B, Fairman N, et al. Ketamine for the treatment of de-pression in patients receiving hospice care: a retrospective medical record review of thirty-one cases. Psychosomatics.2015; 56(4): p. 329–337. 23. Cohen S, Bhatia A, Buvanendran A, Schwenk E, Wasan A, Hurley R, et al. Consensus Guidelines on the Use of Intravenous Ketamine Infusions for Chronic Pain From the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, and the American Society of Anesthesiolo-gists. Regional Anesthesia & Pain Medicine.2018; 43(5): p. 521–546. 24. Matveychuk D, Thomas R, Swainson J, Khullar A, MacKay M, Baker G, et al. Ketamine as an antidepressant: overview of its mechanisms of action and potential predictive biomarkers. Therapeutic advances in psy-chopharmacology.2020; 10: p. 1-21. 25. Canuso C, Singh J, Fedgchin M, Alphs L, Lane R, Lim P, et al. Efficacy and safety of intranasal esketamine for the rapid reduction of symptoms of depression and suicidality in patients at imminent risk for suici-de: results of a double-blind, randomized, placebo-controlled study. American Journal of Psychiatry.2018; 175(7): p. 620-630. 26. Goldman N, Frankenthaler M, Klepacz L. The efficacy of ketamine in the palliative care setting: a compre-hensive review of the literature. Journal of palliative medicine. 2019; 22(9): p. 1154-1161. 27. Sexton J, Atayee R, Bruner H. Case report: ketamine for pain and depression in advanced cancer. Journal of palliative medicine. 2018; 21(11): p. 1670-1673. 28. Kirsch I. Placebo effect in the treatment of depression and anxiety. Frontiers in Psychiatry. 2019; 10(407): p. 1-9. 29. Frisaldi E, Shaibani A, Benedetti F. Understanding the mechanisms of placebo and nocebo effects. Swiss Medical Weekly. 2020; 150(3536): p. 1-10. 30. Zanos P, Moaddel R, Morris P, Georgiou P, Fischell J, Elmer G, et al. NMDAR inhibition-independent antide-pressant actions of ketamine metabolites. Nature. 2016; 533(7604): p. 481-486. 31. Shiroma P, Johns B, Kuskowski M, Wels J, Thuras P, Albott C, et al. Augmentation of response and remis-sion to serial intravenous subanesthetic ketamine in treatment resistant depression. Journal of Affective Disorders. 2014; 155: p. 123-129. 32. Khavanin A, Moezzi M, Motamed H, Parozan S, Hosseini A. Intranasal Ketamine Versus Intravenous Ketoro-lac for Pain Control in the Renal Colic: A Randomized Clinical Trial Study. Jundishapur Journal of Chronic Disease Care. 2021; 10(3): p. e114775. 33. Mathew S, Shah A, Lapidus K, Clark C, Jarun N, Ostermeyer B, et al. Ketamine for treatment-resistant unipolar depression. CNS drugs. 2012; 26(3): p. 189-204. 34. Singh J, Fedgchin M, Daly E, De Boer P, Cooper K, Lim P, et al. A double-blind, randomized, placebo-controlled, dose-frequency study of intravenous ketamine in patients with treatment-resistant depression. American Journal of Psychiatry. 2016; 173(8): p. 816-826. 35. Mercadante S, Arcuri E, Tirelli W, Casuccio A. Analgesic Effect of Intravenous Ketamine in Cancer Patients on Morphine Therapy: A Randomized, Controlled, Double-Blind, Crossover, Double-Dose Study. Journal of pain and symptom management. 2000; 20(4): p. 246-252.