Use of ketamine for depression and suicidality in cancer and terminal patients: Review of current data

Aderonke Oyetunji; Christian Huelga; Kailee Bunte; Rachel Tao; Val Bellman; Aderonke Oyetunji; Christian Huelga; Kailee Bunte; Rachel Tao; Val Bellman

doi:10.3934/publichealth.2023043

AIMS Public Health

2023, Volume 10, Issue 3: 610-626. doi: 10.3934/publichealth.2023043

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Review

Use of ketamine for depression and suicidality in cancer and terminal patients: Review of current data

1.
University of Missouri Kansas City, Psychiatry Residency Training Program, Kansas City, MO
2.
Kansas City University, College of Osteopathic Medicine, Kansas City, MO
3.
University of Missouri Kansas City, School of Medicine, Kansas City, MO

Received: 29 May 2023 Revised: 04 July 2023 Accepted: 05 July 2023 Published: 21 July 2023

Depression and suicidality are significant challenges faced by cancer patients, particularly those in advanced stages of the disease or nearing the end of life. Conventional antidepressant therapies often have limited effectiveness or delayed onset of action, making the exploration of alternative treatments crucial. The use of ketamine as a potential treatment for depression and suicidality in cancer and terminal patients has gained considerable attention in recent years. This review article aims to provide a comprehensive analysis of the current data regarding the efficacy and safety of ketamine in this specific population. This review presents an overview of clinical trials and case studies investigating the use of ketamine in this population. It explores the effectiveness of ketamine as a standalone treatment or in combination with other interventions. Furthermore, the article addresses the limitations and future directions of research in this field. It highlights the need for larger, well-controlled studies with long-term follow-up to establish the efficacy, safety and optimal treatment parameters of ketamine for depression and suicidality in palliative care.
- ketamine,
- depression,
- suicide,
- cancer,
- terminal illness
Citation: Aderonke Oyetunji, Christian Huelga, Kailee Bunte, Rachel Tao, Val Bellman. Use of ketamine for depression and suicidality in cancer and terminal patients: Review of current data[J]. AIMS Public Health, 2023, 10(3): 610-626. doi: 10.3934/publichealth.2023043

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Abstract

Depression and suicidality are significant challenges faced by cancer patients, particularly those in advanced stages of the disease or nearing the end of life. Conventional antidepressant therapies often have limited effectiveness or delayed onset of action, making the exploration of alternative treatments crucial. The use of ketamine as a potential treatment for depression and suicidality in cancer and terminal patients has gained considerable attention in recent years. This review article aims to provide a comprehensive analysis of the current data regarding the efficacy and safety of ketamine in this specific population. This review presents an overview of clinical trials and case studies investigating the use of ketamine in this population. It explores the effectiveness of ketamine as a standalone treatment or in combination with other interventions. Furthermore, the article addresses the limitations and future directions of research in this field. It highlights the need for larger, well-controlled studies with long-term follow-up to establish the efficacy, safety and optimal treatment parameters of ketamine for depression and suicidality in palliative care.

Acknowledgments

This study is not funded by any agency and is being conducted by the authors independently.

Conflict of Interest

The authors declare no conflict of interest.

References

[1]	Polsky D, Doshi JA, Marcus S, et al. (2005) Long-term risk for depressive symptoms after a medical diagnosis. Arch Intern Med 165: 1260-1266. https://doi.org/10.1001/archinte.165.11.1260
[2]	Fan CY, Chao HL, Lin CS, et al. (2018) Risk of depressive disorder among patients with head and neck cancer: A nationwide population-based study. Head Neck 40: 312-323. https://doi.org/10.1002/hed.24961
[3]	Rasic DT, Belik SL, Bolton JM, et al. (2008) Cancer, mental disorders, suicidal ideation and attempts in a large community sample. Psychooncology 17: 660-667. https://doi.org/10.1002/pon.1292
[4]	Honda K, Goodwin RD (2004) Cancer and mental disorders in a national community sample: findings from the national comorbidity survey. Psychother Psychosom 73: 235-242. https://doi.org/10.1159/000077742
[5]	(2022) APADiagnostic and statistical manual of mental disorders. Washington: American Psychiatric Association Publishing: 187-188.
[6]	Miller K, Massie MJ (2019) Oncology. Washington: American Psychiatric Association Publishing: 625.
[7]	Sullivan DR, Forsberg CW, Ganzini L, et al. (2016) Depression symptom trends and health domains among lung cancer patients in the CanCORS study. Lung Cancer 100: 102-109. https://doi.org/10.1016/j.lungcan.2016.08.008
[8]	McIntyre RS (2010) When should you move beyond first-line therapy for depression?. J Clin Psychiatry 1: 16-20. https://doi.org/10.4088/JCP.9104su1c.03
[9]	Sanacora G, Frye MA, McDonald W, et al. (2017) A consensus statement on the use of ketamine in the treatment of mood disorders. JAMA Psychiatry 74: 399-405. https://doi.org/10.1001/jamapsychiatry.2017.0080
[10]	Zhang Y, Ye F, Zhang T, et al. (2021) Structural basis of ketamine action on human NMDA receptors. Nature 596: 301-305. https://doi.org/10.1038/s41586-021-03769-9
[11]	Orhurhu VJ, Vashisht R, Claus LE, et al. Ketamine Toxicity (2023). Available from: https://www.ncbi.nlm.nih.gov/books/NBK541087/
[12]	Rosenblat JD, Carvalho AF, Li M, et al. (2019) Oral ketamine for depression: a systematic review. J Clin Psychiatry 80: 13514. https://doi.org/10.4088/JCP.18r12475
[13]	Dean RL, Hurducas C, Hawton K, et al. (2021) Ketamine and other glutamate receptor modulators for depression in adults with unipolar major depressive disorder. Cochrane Database Syst Rev 9: CD011612. https://doi.org/10.1002/14651858.CD011612
[14]	Andrade Chittaranjan (2017) Ketamine for depression, 3: Does chirality matter?. J Clin Psychiatry 78: e674-e677. https://doi.org/10.4088/JCP.17f11681
[15]	Derakhshanian S, Zhou M, Rath A, et al. (2021) Role of ketamine in the treatment of psychiatric disorders. Health Psychol Res 9: 25091. https://doi.org/10.52965/001c.25091
[16]	Ignácio ZM, Réus GZ, Arent CO, et al. (2016) New perspectives on the involvement of mTOR in depression as well as in the action of antidepressant drugs. Br J Clin Pharmacol 82: 1280-1290. https://doi.org/10.1111/bcp.12845
[17]	Tang L, He Y, Pang Y, et al. (2022) Suicidal ideation in advanced cancer patients without major depressive disorder. Psychooncology 31: 1941-1950. https://doi.org/10.1002/pon.6033
[18]	Sauer C, Grapp M, Bugaj TJ, et al. (2022) Suicidal ideation in patients with cancer: Its prevalence and results of structural equation modelling. Eur J Cancer Care (Engl) 31: e13650. https://doi.org/10.1111/ecc.13650
[19]	Manojna Konda, Rohan Sharma, Arya Mariam Roy, et al. (2019) Risk factors associated with suicide in patients with prostate cancer in the United States. J Clin Onc 37: 84. https://doi.org/10.1200/JCO.2019.37.31_suppl.84
[20]	Hopko DR, Armento ME, Robertson SM, et al. (2011) Brief behavioral activation and problem-solving therapy for depressed breast cancer patients: randomized trial. J Consult Clin Psychol 79: 834-849. https://doi.org/10.1037/a0025450
[21]	Leal-Hernández D A, Sandoval L, Palacios-Espinosa X, et al. (2014) Proposed scales for measuring suicidal ideation in adult cancer patients. Open J Med Psychology 3: 79-86. https://doi.org/10.4236/ojmp.2014.31010
[22]	Tanriverdi D, Cuhadar D, Ciftci S (2014) Does the impairment of functional life increase the probability of suicide in cancer patients?. Asian Pac J Cancer Prev 15: 9549-9553. https://doi.org/10.7314/apjcp.2014.15.21.9549
[23]	Men VY, Emery CR, Lam TC, et al. (2022) Suicidal/self-harm behaviors among cancer patients: a population-based competing risk analysis. Psychol Med 52: 2342-2351. https://doi.org/10.1017/S0033291720004250
[24]	Hagezom HM, Amare T, Hibdye G, et al. (2021) Magnitude and associated factors of suicidal ideation among cancer patients at Ayder Comprehensive Specialized Hospital, Mekelle, Ethiopia, 2019: Cross-sectional study. Cancer Manag Res 13: 4341-4350. https://doi.org/10.2147/CMAR.S268669
[25]	Pitman A, Suleman S, Hyde N, et al. (2018) Depression and anxiety in patients with cancer. BMJ 361: k1415. https://doi.org/10.1136/bmj.k1415
[26]	Ristevska-Dimitrovska G, Stefanovski P, Smichkoska S, et al. (2015) Depression and resilience in breast cancer patients. Open Access Maced J Med Sci 3: 661-665. https://doi.org/10.3889/oamjms.2015.119
[27]	Nakamura Y, Kanemoto E, Kajizono M, et al. (2017) Investigation of Mental Disorders in Lung Cancer Outpatients: A Retrospective Analysis. Yakugaku Zasshi 137: 241-246. https://doi.org/10.1248/yakushi.16-00226
[28]	Tosic Golubovic S, Binic I, Krtinic D, et al. (2022) Risk factors and predictive value of depression and anxiety in cervical cancer patients. Medicina (Kaunas) 58: 507. https://doi.org/10.3390/medicina58040507
[29]	Barrera I, Spiegel D (2014) Review of psychotherapeutic interventions on depression in cancer patients and their impact on disease progression. Int Rev Psychiatry 26: 31-43. https://doi.org/10.3109/09540261.2013.864259
[30]	Huang RW, Chang KP, Marchi F, et al. (2022) The impact of depression on survival of head and neck cancer patients: A population-based cohort study. Front Oncol 12: 871915. https://doi.org/10.3389/fonc.2022.871915
[31]	Widiyono W, Setiyarini S, Effendy C (2019) Self-selected individual music therapy for depression during hospitalization for cancer patients: Randomized controlled clinical trial study. Indones J Cancer 13: 59-68. https://doi.org/10.33371/ijoc.v13i3.632
[32]	Sherrill C, Smith M, Mascoe C, et al. (2017) Effect of treating depressive disorders on mortality of cancer patients. Cureus 9: e1740. https://doi.org/10.7759/cureus.1740
[33]	Lloyd-Williams M, Dennis M, Taylor F (2004) A prospective study to determine the association between physical symptoms and depression in patients with advanced cancer. Palliat Med 18: 558-563. https://doi.org/10.1191/0269216304pm923oa
[34]	Pinquart M, Duberstein PR (2010) Depression and cancer mortality: a meta-analysis. Psychol Med 40: 1797-1810. https://doi.org/10.1017/S0033291709992285
[35]	Rodin G, Lloyd N, Katz M, et al. (2007) The treatment of depression in cancer patients: a systematic review. Supportive Care in Cancer 15: 123-136. https://doi.org/10.1007/s00520-006-0145-3
[36]	Lloyd-Williams M, Payne S, Reeve J, et al. (2013) Antidepressant medication in patients with advanced cancer--an observational study. QJM 106: 995-1001. https://doi.org/10.1093/qjmed/hct133
[37]	Olin J, Masand P (1996) Psychostimulants for depression in hospitalized cancer patients. Psychosomatics 37: 57-62. https://doi.org/10.1016/S0033-3182(96)71599-2
[38]	Stefanczyk-Sapieha L, Oneschuk D, Demas M (2008) Intravenous ketamine “burst” for refractory depression in a patient with advanced cancer. J Palliat Med 11: 1268-1271. https://doi.org/10.1089/jpm.2008.9828
[39]	Irwin SA, Iglewicz A, Nelesen RA, et al. (2013) Daily oral ketamine for the treatment of depression and anxiety in patients receiving hospice care: A 28-day open-label proof-of-concept trial. J Palliat Med 16: 958-965. https://doi.org/10.1089/jpm.2012.0617
[40]	Irwin SA, Iglewicz A (2010) Oral ketamine for the rapid treatment of depression and anxiety in patients receiving hospice care. J Palliat Med 13: 903-908. https://doi.org/10.1089/jpm.2010.9808
[41]	Iglewicz A, Morrison K, Nelesen RA, et al. (2015) Ketamine for the treatment of depression in patients receiving hospice care: A retrospective medical record review of thirty-one cases. Psychosomatics 56: 329-337. https://doi.org/10.1016/j.psym.2014.05.005
[42]	Rosenblat JD, deVries FE, Doyle Z, et al. (2023) A phase II, open-label clinical trial of intranasal ketamine for depression in patients with cancer receiving palliative care (INKeD-PC Study). Cancers (Basel) 15: 400. https://doi.org/10.3390/cancers15020400
[43]	Wilkinson ST, Ballard ED, Bloch MH, et al. (2018) The effect of a single dose of intravenous ketamine on suicidal ideation: A systematic review and individual participant data meta-analysis. Am J Psychiatry 175: 150-158. https://doi.org/10.1176/appi.ajp.2017.17040472
[44]	Fan W, Yang H, Sun Y, et al. (2017) Ketamine rapidly relieves acute suicidal ideation in cancer patients: a randomized controlled clinical trial. Oncotarget 8: 2356-2360. https://doi.org/10.18632/oncotarget.13743
[45]	Grunebaum MF, Galfalvy HC, Choo TH, et al. (2018) Ketamine for rapid reduction of suicidal thoughts in major depression: A midazolam-controlled randomized clinical trial. Am J Psychiatry 175: 327-335. https://doi.org/10.1176/appi.ajp.2017.17060647
[46]	Ballard ED, Ionescu DF, Vande Voort JL, et al. (2014) Improvement in suicidal ideation after ketamine infusion: relationship to reductions in depression and anxiety. J Psychiatr Res 58: 161-166. https://doi.org/10.1016/j.jpsychires.2014.07.027
[47]	Yang C, Qu Y, Fujita Y, et al. (2017) Possible role of the gut microbiota–brain axis in the antidepressant effects of (R)-ketamine in a social defeat stress model. Transl Psychiatry 7: 1294. https://doi.org/10.1038/s41398-017-0031-4
[48]	Chang L, Toki H, Qu Y, et al. (2018) No Sex-specific differences in the acute antidepressant actions of (R)-ketamine in an inflammation model. Int J Neuropsychopharmacol 21: 932-937. https://doi.org/10.1093/ijnp/pyy053
[49]	Qu Y, Yang C, Ren Q, et al. (2017) Comparison of (R)-ketamine and lanicemine on depression-like phenotype and abnormal composition of gut microbiota in a social defeat stress model. Sci Rep 7: 15725. https://doi.org/10.1038/s41598-017-16060-7
[50]	Bonaventura J, Lam S, Carlton M, et al. (2021) Pharmacological and behavioral divergence of ketamine enantiomers: Implications for abuse liability. Mol Psychiatry 26: 6704-6722. https://doi.org/10.1038/s41380-021-01093-2
[51]	Price RB, Mathew SJ (2015) Does ketamine have anti-suicidal properties? Current status and future directions. CNS Drugs 29: 181-188. https://doi.org/10.1007/s40263-015-0232-4
[52]	Abbar M, Demattei C, El-Hage W, et al. (2022) Ketamine for the acute treatment of severe suicidal ideation: double blind, randomised placebo controlled trial. BMJ 376: e067194. https://doi.org/10.1136/bmj-2021-067194
[53]	Vidal S, Gex-Fabry M, Bancila V, et al. (2018) Efficacy and safety of a rapid intravenous injection of ketamine 0.5 mg/kg in treatment-resistant major depression: An open 4-week longitudinal study. J Clin Psychopharmacol 38: 590-597. https://doi.org/10.1097/JCP.0000000000000960
[54]	Weber G, Yao J, Binns S, et al. (2018) Case report of subanesthetic intravenous ketamine infusion for the treatment of neuropathic pain and depression with suicidal features in a pediatric patient. Case Rep Anesthesiol 2018: 9375910. https://doi.org/10.1155/2018/9375910
[55]	Zhu W, Ding Z, Zhang Y, et al. (2016) Risks associated with misuse of ketamine as a rapid-acting antidepressant. Neurosci Bull 32: 557-564. https://doi.org/10.1007/s12264-016-0081-2

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