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The new way to treat depression, anxiety and chronic neuropathic pain
Newsletter No 16 (21st November 2022)
A systematic review of ketamine for Refractory Anxiety
In the first review of its kind, single-dose infusions of ketamine showed significant treatment outcomes for patients with refractory anxiety disorders, including GAD and SAD, with reduced irritability and panic.
Clinical data on the efficacy of ketamine in treating refractory anxiety is limited by comparison with the literature on its efficacy for depression and suicidality. This review is a collaborative effort between researchers from the UK, USA and Sweden.
The purpose of the review is to systematically examine the restricted number of clinical trials and a case study, which show early signs that ketamine is an effective treatment option for refractory anxiety.
SOKePSA - setting the standards for outpatient ketamine infusion..
The Society of Ketamine Practitioners of South Africa (SOKePSA) was founded by Dr Alan Howard in September 2020. The Society (with a multidisciplinary board) is committed to establishing and promoting best-practice guidelines for outpatient ketamine infusion therapy (KIT) for TRD and suicidality. Formally launching and developing the society was hampered by COVID, but it has now gained a new lease on life.
Since the release of both the SASA and SASOP position statements on KIT for TRD (both adopted by the Society), a process has been started to include SOKePSA under the auspices of the Interventional Psychiatry Special Interest Group of SASOP. As such, it will invite membership (clinical, non-clinical, and associate) from medical practitioners, therapists, professional nurses and allied mental health professionals who espouse the safe and regulated administration of KIT for TRD and suicidality. SOKePSA will play a vital role guiding best practice in the interests of appropriate patient selection and safety. A directory of accredited providers
will be established. The new website is currently under construction.
Accreditation of members by SOKePSA will pave the way to the granting of benefits for KIT by Medical Aid Schemes.
Contact: admin@sokepsa.co.za
The Strelitzia is native to South Africa and is emblematic of the nature of ketamine infusion therapy. The colours are psychedelic and its shape represents reawakening of a mind held captive by debilitating depression and suicidal ideation.
An appraisal of studies investigating ketamine's efficacy for suicidal ideation and behaviours...
Ketamine has been shown to rapidly reverse suicidal ideation in a majority of patients. How biased have studies been in arriving at this conclusion?
In a deep dive analysis of 27-studies using the AMSTAR-2 tool to evaluate quality, two thirds of the studies were found to be of low quality. However the authors conclude that ketamine is safe and effective in the short term for this indication. In nine studies investigating esketamine for this indication, five demonstrated significant benefit.
KetaMIND clinics currently offer outpatient ketamine infusions at the following locations:
BEDFORDVIEW (GP)
CONSTANTIA (WC)
UMHLANGA (KZN)
HILTON (KZN)
Researchers in France and the United Kingdom have evaluated the effects of ketamine on belief-updating, and how these cognitive effects are associated with the clinical effects of ketamine.
What happens to a patient's belief systems after ketamine infusion?
Persistent negative beliefs maintain depression.
This case-control study in patients with TRD showed that belief-updating became more optimistically biased as soon as 4-hours after a first ketamine infusion.
Patients with TRD were observed 24 hours before single ketamine infusion, 4 hours after the infusion, and 4 hours after the third infusion, which was 1 week after the first infusion. The findings provide novel insights into the cognitive mechanisms of the action of ketamine in patients with TRD.
"After priming the brain with ketamine, training positive self-associations could provide an efficient, low-cost, portable, noninvasive, and highly dissemination-ready
strategy for leveraging and extending ketamine’s rapid antidepressant effects".
(AJP in Adv. (doi: 10.1176/appi.ajp.20220216)
Leveraging the benefit of neuroplasticity after ketamine infusion...
Ketamine infusion is known to rapidly promote and enhance neuroplasticity (dendritic sprouting and synaptogenesis). Is there a way to extend the durability of the clinical response?
Researchers at the University of Pittsburgh School of Medicine have demonstrated that by augmenting a single ketamine infusion with brief (<20-min) 'Automated Self-Assessment Training' (ASAT) sessions for 4-days, these sub and supraliminal positive self-associations extend ketamine's antidepressant effect.
The article is scheduled for publication in the American Journal of Psychiatry.
KetaMIND Clinics around the country have safely administered 5000-ketamine infusions...
"On reaching this milestone, I would like to thank each and every one of our doctors, nurses and support staff for their dedication and commitment to patient safety."
(Dr Alan Howard, Founder and National Medical Director)
In the next newsletter..
Is there risk of causing a hypertensive emergency with low-dose ketamine infusion? In an open access article in Frontiers in Psychiatry, this review from the perspective of an emergency physician, defines and summarizes the currently recommended approach to hypertensive emergency, asymptomatic hypertensive urgency, and discusses their relevance to intravenous ketamine therapy. Clarity is needed on what level of concern is necessary regarding hypertension associated with sub-anaesthetic KIT. Hypertensive emergency has not been documented in IV ketamine trials, so may be considered an extremely rare, though very serious potential adverse event. |
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. |
