Ketamine for depression: Clinical use and media accounts

Abstract

This thesis comprises two research studies, one of which is a clinical trial.

Study 1: Pilot randomised controlled trial: Ketamine as an adjunctive therapy for major depression, the Karma-Dep Trial (NCT03256162). The aim of this study was to conduct a pragmatic randomised controlled pilot trial of four once-weekly ketamine infusions as an adjunctive therapy for depression. The main objective was to assess trial procedures to inform a future definitive trial. The primary clinical outcome was the 24-item Hamilton Rating Scale for Depression (HRSD-24). Trial participants were patients admitted to St Patrick?s Mental Health Services for treatment of a depressive episode. 125 patients were eligible to participate in this trial of which 25 (20%) consented. 13 were randomly assigned to the ketamine arm and 12 to the midazolam arm. Changes in HRSD-24 scores were similar between the two groups. The infusions were generally safe and well tolerated. This is the first pragmatic trial of adjunctive serial ketamine infusions for hospitalised depression, an important possible use of ketamine. This study suggests that a definitive trial of adjunctive ketamine is feasible.

Study 2: Exploratory descriptive study: Online news media reporting of ketamine as a treatment for depression from 2000 to 2017. The aim of this study was to examine how ketamine has been portrayed in online media in recent years. I identified articles regarding ketamine?s use in depression from the 30 most popular English-language online news-generating sources over 18 years (2000-2017). I found that the discussion of ketamine as an antidepressant in online news media needs to be interpreted with caution as it often fails to discuss negative aspects of ketamine and makes unsubstantiated claims about the superiority of ketamine over currently available antidepressants.