The SAJP publishes the first data on efficacy and safety of ketamine infusion for depressive symptoms in a real world setting in South Africa...

An independent review conducted by the Discipline of Psychiatry, College of Clinical Medicine, University of KwaZulu-Natal, authored by Dr Vidette Juby (Specialist Psychiatrist) and co-authored by Prof Bonginkosi Chiliza (Former SASOP President), has been published by the South African Journal of Psychiatry.

Data collected from 154-patients who attended a KetaMIND Clinic in KZN were analyzed. Response and remission in those patients who completed an induction series of 6-infusions was 70,6% and 32,4% respectively. Response was deemed a reduction in PHQ-9 score of more than 50%). Median time to response was 15-days. Remission was deemed a PHQ-9 score of less than 5/27. The treatment was found to be 'safe and tolerable, without evidence of overt abuse or dependence.'

"I am delighted that data from our flagship clinic in Hilton KZN has yielded such positive results," says Dr Alan Howard, National Medical Director and founder of the KetaMIND group of clinics. "It is particularly pleasing to note that the response rate after 6-infusions exceeds that found in other internationally published naturalistic studies, as noted by the authors. Given that the cohort of depressed patients we treat has largely been deemed 'treatment resistant' by psychiatrists, reducing symptoms by more than 50% in almost three-quarters in around two-weeks, and realizing complete remission in one third of patients, clearly sets professionally and safely administered ketamine infusion apart from other regular treatments".

Link to the open access SAJP article

Ketamine infusion for neuropathic pain ... one patient's testimonial

"I feel like a brand new person," says Kevin who developed complex reginal pain syndrome (CRPS) in his ankle after 8-surgeries, gangrene and grafting. Sixteen months of opiates and pregablin made no difference at all and "things were worsening by the day."

Dr Mike Smit, clinical director of KetaMIND Constantia shared Kevin's testimonial after 3 low-dose pain infusions.

"Hi. Just wanted to send some feedback on the infusion treatment. So far I've been fully mobile and pain-free for an entire week. I've had no neuropathy at all. I've not needed to take any pain medication at all. I've been very active, walking several kilometers a day on rough terrain. The treatment has exceeded my highest expectations and I'm so grateful. I will certainly be back for a follow-up treatment. Thank you again. I honestly feel like a brand new person". (Kevin)

In Newsletter #9 (please scroll down once opened), we discussed CRPS, aka 'The Suicide Disease'.

What works best for TRD? Intranasal esketamine or intravenous racemic ketamine?

The short answer is that both can be effective. However, the preponderance of research to date suggests that racemic ketamine infusion holds the upper hand.

A recent study published in the Journal of Clinical Psychiatry concludes that the number of treatments required to achieve remission is 'significantly lower' with IV racemic ketamine. A meta-analysis of 1877-patients published in the Journal of Affective Disorders found iv-ketamine twice as effective in respect of response, remission and dropout rate.

Chirality does matter...
In fact, researchers at King's College in the UK conclude that R-ketamine is possibly a more potent and longer-lasting antidepressant than both racemic and S-ketamine.

Link to the JCP abstract

Women with PCOS at much higher risk of suicide...

Polycystic Ovary Syndrome (PCOS) is prevalent in the reproductive years, affecting as many as 10% of women.

Researchers have found that risk of suicide attempt is 8,5-times higher in women with PCOS, attributed to anxiety, persistent psychological distress, body dissatisfaction, and reproductive concerns.

When suicidality becomes a real concern, few treatments can reverse the ideation as rapidly and effectively as ketamine infusion.

Ketamine use for OBGYN patients...

Ketamine infusion has long been recognized as an effective treatment for Post Partum Depression, and this was discussed in Newsletter #6.

It is however important for gynecologists and GP's to also recognize and address depression and suicidality in their patients with PCOS.

Ketamine infusion should certainly be a considered as a safe and effective alternative to traditional antidepressants in selected patients.

Read the Medscape article

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

BEDFORDVIEW (GP)

CONSTANTIA (WC)

UMHLANGA (KZN)

PIETERMARITZBURG (KZN)

HILLCREST (KZN)

PAARL (WC)

New clinics now in planning for: Sandton, Garden Route, Pretoria

Contact a KCSA clinic

In the next newsletter..

Predicting ketamine response in adolescent and paediatric patients...

An exploratory study out of the Yale School of Medicine offers some very useful insights into probable predictors of response to ketamine infusion in adolescent and paediatric TRD. These 'predictors' may differ from the adult population.

Early treatment with ketamine infusion in the course of a depressive episode, fewer medication trials, avoiding SNRI's, and those patients with more severe depression, are all potentially implicated in a more efficacious response to ketamine infusion in this younger cohort.

The authors highlight the relevance of the developing glutamatergic system and brain networks (ie: default mode network) in paediatric patients as a possible reason for the differing 'predictors' of response to ketamine in adults and children.

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), and is an associate member of the South African Society of Psychiatrists (SASOP). He has also served on the Advanced Trauma Life Support (ATLS) KZN faculty for over 25-years. Dr Howard founded the Society of Ketamine Practitioners of South Africa (SOKePSA) in 2020.

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