One-third of depressed patients do not achieve an adequate clinical response to available treatment and are considered to have treatment-resistant depression (TRD). As such, there is an urgent need for more rapidly effective pharmacotherapies for major depressive disorder and bipolar disorder (BP) that responds poorly to conventional treatments. Multiple controlled trials have now demonstrated a rapid, non-sustained anti-depressive response to a single intravenous infusion and, more recently, to repeated short-term infusions of ketamine in patients with TRD. The therapeutic potential of ketamine has stimulated considerable excitement among clinicians, patients, advocacy groups, and industry and has led to the increasing use of ketamine as an off-label substitute for ECT and other anti-depressive treatments. The early adoption of intravenous, intranasal and other forms of ketamine into routine clinical practice has included the use of repeated long-term ketamine administration for TRD. A thorough review of the available evidence of clinical effectiveness and safety is timely given the increasing use of ketamine in routine practice, with an eye toward important unanswered questions about ketamine effectiveness and safety for longer-term use. This presentation reviews, in detail, the results of randomized trials of intravenous or intranasal ketamine for treatment-resistant unipolar and bipolar major depression, highlighting methodological limitations of the most important studies and limitations of study findings for long-term ketamine administration. The presenter is a clinician familiar with the use of intravenous ketamine in acute settings at a major academic medical center.
**This content was captured at the 2017 APA Annual Meeting and may reference information from various sources and terminology from previous editions of the DSM.
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- Describe the key findings from the most important studies of the effectiveness and safety of low-dose ketamine for the acute management of treatment-resistant unipolar or bipolar major depression
- Define the principal short- and long-term safety and tolerability concerns regarding the use of low-dose ketamine for the management of treatment-resistant unipolar or bipolar major depression
- Discuss the methods applied at Mayo Clinic and clinical programming steps that have been undertaken in order to develop a ketamine infusion therapy service
Estimated Time to Complete
Estimated Duration: 30 minutes
Begin Date: January 1, 2018
End Date: December 31, 2020
How to Earn Credit
Participants who wish to earn AMA PRA Category 1 Credit ™ or a certificate of participation may do so by completing all sections of the course including the evaluation. A multiple choice quiz is provided based on the content. A passing score of 100% must be achieved. Retakes are available for the test. After evaluating the program, course participants will be provided with an opportunity to claim hours of participation and print an official CME certificate (physicians) or certificate of participation (non-physicians) showing the completion date and hours earned.
The American Psychiatric Association (APA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
The APA designates this enduring CME activity for a maximum of 0.5 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Faculty and Planner Disclosures
- Kathryn M. Schak, M.D., Mayo Clinic. Reports no financial relationships with commercial interests.
- Tristan Gorrindo, M.D., Director of Education, American Psychiatric Association. Reports no financial relationships with commercial interests.
- Ricardo A. Juarez, M.S., Director, District Branch and International Relations, American Psychiatric Association. Reports no financial relationships with commercial interests.
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