Ketamine is non-inferior to ECT for TRD, a new study shows...

In Newsletter 11 this somewhat controversial topic was raised and discussed. A new study published last month in the NEJM concludes that ketamine infusion is non-inferior to ECT for treatment resistant major depression. There was a higher response rate in the ketamine arm, and ECT was associated with a decrease in memory recall after three-weeks of treatment - not the case with Ketamine Infusion Therapy (KIT).

“The finding that six-sessions of ketamine was no less effective than nine sessions of ECT and produced milder side effects than ECT, has enormous implications for guiding which treatment should be recommended when patients fail to improve with first-line treatments” ...

says independent commentator Prof David Feifel, PhD, neuropsychiatrist and director of the Kadima Neuropsychiatry Institute.

As it becomes more widely accepted that neuromodulation should be offered much earlier to those patients who don't respond to traditional monoamine class antidepressants, KIT is poised to displace ECT as a more effective, less costly and generally a more readily accepted alternative for most patients.

The challenge remains convincing funders, who cover ECT, that there is a wealth of evidence supporting ketamine's efficacy. This latest study certainly helps.

Read the NEJM article

Dr Sameenah Hashim - celebrating 'small victories'...

Sameenah Hashim has a postgraduate diploma in anaesthesiology and works at KetaMIND in Constantia. She shares some of her views with us in a quick fire Q&A...

We asked Sameenah to respond to some quick fire questions...

Click on the link below to learn what she finds most satisfying about treating her patients with ketamine infusions.

Read how 'small victories' can only truly be appreciated by those working in the mental health field.

"If it seems like there are no options left, try to have some hope " ... is her advice to patients presenting for KIT.

Read the Q & A's

'In my opinion'... perspectives from the KCSA founder...

'Treatment Resistant Depression' - is it appropriate to ascribe the moniker 'treatment resistant' to any medical diagnosis? KCSA Medical Director and founder, Dr Alan Howard, thinks perhaps not.

'It is a ludicrous construct', says Dr Howard.

'If pneumonia doesn't improve when you prescribe a cough syrup, it's not 'treatment resistant pneumonia'. Simply put, cough syrup is crappy treatment for pneumonia."

'Treatment Resistance' seems to transfer some blame or responsibility to the patient who supposedly should be getting better on the prescribed medication. (A 'Big-Pharma' decree perhaps?) Making the target of the treatment responsible for its failure, rather than the treatment itself makes no sense.

With the clearer understanding we have now that not all MDD is created equal and that monoamine deficiency is not the be-all and end-all, ... read more

Sympathetic blocks and ketamine for CRPS patients - is there a useful link?

Patients with CRPS who respond to sympathetic blocks (SB's) are more likely to derive sustained benefit from ketamine infusions, a study finds.

The affective component of chronic pain is often overlooked. Is this perhaps partly responsible for the efficacy of ketamine infusions in Complex Regional Pain Syndrome (CRPS) patients? CRPS was discussed in a previous newsletter.

A study published in Pain Medicine concludes that response to SB's (and, interestingly, obese patients), is predictive of an increased efficacy of ketamine infusion therapy (KIT) for CRPS.

Read the article

Navigating Medical Aid Schemes - what progress has been made securing benefits for ketamine infusions for members?

Representatives from KetaMIND, SOKePSA, SASOP and PsychMG have, to date, held two meetings in Sandton since September last year with Discovery's Head of Clinical Excellence and her team.

Drs Alan Howard, Kobus Roux, Eugene Allers, Prof Christopher Szabo and Devon Nash all advocated for the regulated administration of KIT along the SASOP and SASA (SOSPOSA) guidelines (espoused by SOKePSA), at accredited clinics.

With the release of the new MDD Care Pathway by the SASOP / PsychMG team anticipated before mid-year ... read more

KetaMIND clinics currently offer outpatient ketamine infusions at the following locations:

BEDFORDVIEW (GP)

CONSTANTIA (WC)

UMHLANGA (KZN)

HILTON (KZN)

HILLCREST (KZN)

PAARL (WC) (Opening soon...)

Contact a KCSA branch

In the next newsletter..

Serial ketamine infusions for MDD change white matter microstructure...

New research out of the University of California has found that ketamine infusions lead to significant changes in the microstructural features of neurites within occipitotemporal tracts and changes in neurite density within tracts connecting the basal ganglia, thalamus, and cortex that relate to improvements
in anhedonia.

This research compliments what we already know about ketamine's proven effect on hippocampal subfield volumes and other structural changes in the brains of depressed patients.

"Ketamine's ability to kickstart neuroplasticity and synaptogenesis in brains damaged by chronic dysthymia cannot be stressed enough," says Dr Howard, KCSA's founder and National Medical Director ... "and this study further validates this fact".

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. Read more about Dr Howard and KCSA's flagship clinic in the Natal Midlands in two informative articles published in South African Psychiatry A follow-up article, Ketamine Clinics beyond the Hills can be accessed here.

Dr Howard is a member of the American Society of Ketamine Physicians (ASKP3), The Society of Sedation Practitioners of South Africa (SOSPOSA) and is an associate member of the South African Society of Psychiatrists (SASOP). He also serves on the KZN Advanced Trauma Life Support (ATLS) faculty. He founded the Society of Ketamine Practitioners of South Africa (SOKePSA) in 2020.

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