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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EData from a randomized clinical trial show that patients with moderate to severe depressive symptoms treated with a single dose of ketamine show rapid improvement of depressive symptoms compared to patients treated with a psychoactive placebo control. This article discusses outcomes of the Antidepressant Efficacy of Ketamine in Treatment-Resistant Major Depression: A Two-Site Randomized Controlled Trial [Murrough JA et al. \u003Cem\u003EAm J Psychiatry\u003C\/em\u003E 2013].\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EPsychiatry Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EMood Disorders\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EPsychiatry\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPsychiatry Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EMood Disorders\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EData from a randomized clinical trial show that patients with moderate to severe depressive symptoms treated with a single dose of ketamine show rapid improvement of depressive symptoms compared to patients treated with a psychoactive placebo control.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003ESanjay J. Mathew, MD, Baylor College of Medicine, Houston, Texas, USA, and Michael E. Debakey, VA Medical Center, Houston, Texas, USA, reported on outcomes of the Antidepressant Efficacy of Ketamine in Treatment-Resistant Major Depression: A Two-Site Randomized Controlled Trial [Murrough JA et al. \u003Cem\u003EAm J Psychiatry\u003C\/em\u003E 2013], a two-site, parallel-arm, double-blind, randomized controlled trial that evaluated the rapid antidepressant efficacy of ketamine compared with an active placebo control (ie, midazolam) in patients with treatment-resistant major depression.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe study included patients with a primary diagnosis of major depressive disorder randomized in a 2:1 ratio to a single intravenous infusion of ketamine (0.5 mg\/kg; n=47) or midazolam (0.045 mg\/kg; n=25) between November 2010 and August 2012. Patient characteristics and demographics were similar between the two groups, with all patients showing chronic, treatment-resistant depression with moderate to severe symptom severity.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EAn anesthesiologist administered the 40-minute infusion and monitored continuous vital signs throughout the infusion. After 24 hours, all patients were discharged and sent home. They then were followed at 2, 3, and 7 days. At Day 7, patients who did not respond to treatment resumed prior treatment. Patients who did respond were invited to participate in a follow-up exploratory phase of the trial for an additional 4 weeks.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EThe primary outcome of the study was change in depression severity 24 hours after drug administration based on the clinically administered Montgomery-Asberg Depression Rating Scale (MADRS). Nonresponders were defined as patients with \u0026lt;50% improvement from baseline in the score on the MADRS.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EAt 24 hours, the researchers found that patients treated with ketamine had a significant reduction in depressive symptoms compared with those treated with midazolam based on the MADRS score that was 7.95 points lower in the ketamine group (mean 14.77 vs 22.72; p\u22640.0014). Patients in the ketamine group were also more likely to have a response at 24 hours compared with the midazolam group (64% vs 28%; p\u22640.006).\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EDr. Mathew highlighted that among the significant improvements in depressive symptoms in the ketamine group, improvements in the inability to feel and lassitude were particularly robust.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EThe study also found that the patients who responded to ketamine generally maintained improvement in depressive symptoms for several days beyond the initial 24 hours.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EAt Day 7, 21 patients who had responded to ketamine and 4 who had responded to midazolam participated in an exploratory phase of the trial that looked at time to relapse in these patients given a single infusion of ketamine or midazolam. These results also showed a more durable benefit in the ketamine group.\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EAccording to Dr. Mathew, secondary analyses of these data are under way. Results of one study on the impact of ketamine on suicidal ideation showed a reduction in suicidal thoughts with ketamine versus midazolam [Price RB et al. \u003Cem\u003EDepress Anxiety\u003C\/em\u003E 2014].\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/8\/17.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzp8e2\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}