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The new way to treat depression, anxiety and chronic neuropathic pain
Newsletter No 19 (9th March 2023)
Neurocognitive effects of repeated KIT in patients with TRD...
Research conducted by the Department of Psychiatry at Harvard Medical School in Boston, USA examined the effect of repeated ketamine infusions on cognition and was published in BMC Psychiatry last year.
In a naturalistic sample of patients with TRD, repeated ketamine infusion therapy at an escalating dose protocol with 8–10 infusion sessions significantly improved depression and did not impair cognitive performance.
There was a moderate association between baseline cognition and antidepressant response from repeated intravenous ketamine treatments.
A higher baseline MoCA score may predict a better antidepressant outcome.
Choosing a Ketamine infusion provider can be minefield...
As has happened in the USA, since the endorsement of ketamine infusion therapy (KIT) as an effective treatment for Resistant Depression (TRD) by the likes of the American Psychiatric Association (APA), it is anticipated that there will be an explosion of ketamine providers in South Africa in the near term. There are already early signs of this.
Nasal esketamine was approved by the FDA back in 2019 and recently (under stringent conditions) by SAHPRA here in South Africa. An 'Implementation Checklist' was published in the American Journal of Psychiatry, and similar guidance on outpatient ketamine administration has been released by the South African Society of Psychiatrists (SASOP).
There is little that can be done to regulate the off-label use of racemic ketamine for TRD. Inadequately experienced and unqualified providers will be (and have already begun) jumping on the outpatient ketamine bandwagon. Administration of intramuscular ketamine in an unmonitored environment, administration of ketamine by nurses, combining ketamine with other compounds and administering high-dose intravenous boluses are some of the practices that can place patients at risk.
Representatives from SOKePSA, the KetaMIND group and SASOP are in advanced discussions with major funders (like Discovery Health) to develop guidance and oversight that will lead to benefits for appropriately selected patients at accredited outpatient clinics.
Click on the link to view helpful guidance for patients when it comes to selecting a safe ketamine provider.
- Is the clinic accredited by SOSPOSA?
- Is the route of administration endorsed by SASOP?
- Does the provider make unsupported claims about efficacy?
- Does the clinic monitor patient progress and provide feedback?
- Will the clinic motivate for and assist with claims from funders?
Dr Mike Smit - dispensing HOPE to those 'heart-sink' patients...
The Clinical Director at KetaMIND Constantia believes 'wholeheartedly' in what he is doing.
With over 35-years of general practice under the belt and certification in anxiety and depression management to compliment his anaesthesiology diploma, Dr Mike Smit is, happy to share with us that his reward comes from the early results he sees with KIT, and the turnaround in suicidal intent of his patients.
Read about Dr Mike Smit's background and why he is passionate about his work
Ketamine infusion for suicidal adolescents and children - case studies...
Dr Maria Dobreva is a specialist psychiatrist in private practice and a member of the KetaMIND National Care Team. She points out that the paucity of published research examining the efficacy of ketamine in depressed, suicidal children does not mean the treatment should be overlooked.
Made available online in advance of publication in the May Edition of South African Psychiatry, you can link to Maria's article and case studies below.
In a past newsletter, we examined suicidality in children in some detail, and it is in this cohort of patients that we experience some of the most heartwarming outcomes at our clinics across the country.
"I felt happy and my heart was warm. I never
saw the spooky dark faces I used to see before”. (Piet, 11)
“Before Ketamine, I felt hopeless and constantly
down, like there was no point to continue. During the
Ketamine treatment I felt so happy and free, I felt like I
didn’t have any worries and that nothing should have
the power to get me down." (Angela, 13)
"I only realized how sad I was until I was happy. Ketamine worked really well and I can't wait for the rest of this year." (Belinda, 14)
Dr Maria Dobreva has practiced in the Natal Midlands for over 25-years.
Sister Marie - at the helm at the KetaMIND Clinic in Umhlanga...
Sister Marie Naude runs a tight ship at KetaMIND's Umhlanga clinic.. The clinical areas are always spotless and Marie is meticulous about all she does.
As the lead nurse at the Umhlanga clinic since its inception over two-years ago, Marie describes how excited she was when she realized that one of her early patients would not be alive today had it not been for KetaMIND Umhlanga!
Marie offers sound advice to patients in the brief Q&A below.
KetaMIND clinics currently offer outpatient ketamine infusions at the following locations:
BEDFORDVIEW (GP)
CONSTANTIA (WC)
UMHLANGA (KZN)
HILTON (KZN)
In the next newsletter..
How great is the risk of psychiatric illness among spouses of patients with cancer? With MDD chief among them, a study released in JAMA Network Open in January this year highlights the increased risk of psychiatric illness in spouses of cancer patients. In a cohort of more than 500 000 spouses in the exposed group, risk of first-onset psychiatric disorders increased by 30% during the first year after cancer diagnosis compared with the control group. In the next newsletter we focus on depression in spouses of cancer patients. Clinical awareness and surveillance is crucial. |
How did KCSA start in South Africa?
KetaMIND Clinics of South Africa (KCSA) was founded by Dr Alan Howard, a Consultant in Emergency Medicine who returned home permanently to his native South Africa from Ireland in 2019. To read more about Dr Howard and KCSA's flagship clinic in the Natal Midlands in two informative articles published in South African Psychiatry click on the link below. Dr Howard is a member of the Society of sedation Practitioners of South Africa (SOSPOSA) and an associate member of The South African Society of Psychiatrists (SASOP). |
