TRD, Borderline Personality Disorder & Ketamine...

Mood disorders are frequently comorbid in patients with Borderline Personality Disorder (BPD). Resistant depression (TRD) is a common bedfellow. Comorbid BPD and TRD is associated with a poorer response to traditional antidepressants... but what about ketamine?

Research out of Canada published in Psychiatry Research in May this year conducted on a sample size of 100 after four ketamine infusions concluded:

"Patients with TRD and comorbid BPD receiving ketamine exhibited a significant reduction in symptoms of depression, borderline personality, suicidality, and anxiety".

"This research is extremely relevant," says Dr Alan Howard, founder and National Medical Director of KCSA. "We have perhaps been overcautious in the past administering KIT to patients with comorbid BPD, expecting sub-par outcomes. This is exciting news."

Link to the article

We are opening in the Winelands...

KetaMIND will open its 6th clinic in Paarl in the Cape Winelands in August.

KetaMIND will open it's 6th clinic nationally and its second in the Western Cape during the coming weeks.

"We are delighted to announce the opening of our Paarl facility to compliment our Constantia clinic in the Western Cape," says Dr Alan Howard, founder of KCSA. "We wish Kathryn Mann and her team every success."

Invitations to the launch will soon be sent out to regional psychiatrists, GPs and other mental health professionals.

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

Ketamine-related changes in brain activity in
TRD have been reported in prior studies. This new study demonstrates significant changes in neurite features and density in tracts linked to anhedonia.

Exciting research out of the Department of Neurology, University of California, examines white matter neuroplasticity linked to clinical improvement in depressed patients following four ketamine infusions.

The authors conclude that:

"Serial ketamine infusion leads to significant changes in the microstructural features of neurites within occipitotemporal tracts. Changes in neurite density within tracts connecting the basal ganglia, thalamus, and cortex relate to improvements in anhedonia".

Read the article

Is ketamine infusion an alternative for those patients who don't respond to TMS?

Transcranial Magnetic Stimulation (TMS) is a highly effective treatment option for patients with resistant depression (TRD) - but, as with ketamine infusion and other novel treatments, not all will respond.

Learn more about TMS in South Africa

Advances in interventional psychiatry have lead to several novel treatment options for TRD, TMS and ketamine infusion amongst the most effective. All have their pros and cons, and all will have non-responders.

Researchers in Montreal studied the effects of a standard series of ketamine infusions in 21 TMS 'non-responders' with TRD. Mean baseline MADRS scores improved by 35%.

Given the global TRD epidemic, integration of the various treatments and cooperation between providers is essential to curb its spread.

Read the article in the JAD

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..

Can a single ketamine infusion provide long-term benefit in PTSD?

Compared with a control group receiving a midazolam infusion, PTSD patients randomly assigned to a single ketamine infusion showed a lower amygdala and hippocampal reactivation to trauma memories.

Together with other demonstrable effects in these patients, researchers from the Yale University School of Medicine conclude that ketamine may modulate the fear response for at least 30-days post-extinction.

In the next newsletter we will link to the American College of Neuropsychopharmacology article published in Nature in June 2023.

Finding the 'sweet spot' in the timing of KIT and psychotherapy for PTSD patients warrants further study.

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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