Predicting ketamine response in adolescent patients...

A recent, small midazolam-controlled crossover trial of ketamine for adolescents with treatment-resistant depression published in the Journal of Child and Adolescent Psychopharmacology was undertaken by researchers from the Yale School of Medicine.

A video presentation by the lead author Alice Lineham can be viewed here.

Initial evidence suggests that a more likely response to ketamine amongst adolescent patients may be be expected in those with a shorter duration of their current depressive episode, those who have been subjected to fewer antidepressant and augmentation treatment trials, and those not taking SSNRI's (as opposed to only an SSRI).

KetaMIND's medical director, Dr Alan Howard, believes that these findings are in line with his views about earlier utilization of ketamine infusion in the management of MDD, rather than relentless, compounded prescription of monoaminergic agents. (See the short opinion editorial below).

Predictive modeling is very much in the spotlight. A paper in Psychiatry Research published in March 2024 presents a 'non-response' predictive model with a NPV of over 96% based purely on baseline depressive symptoms.

Link to the abstract here

A review of ketamine's efficacy for eating disorders...

Authors of a review paper exploring the utility of ketamine in the treatment of eating disorders (ED) conclude that results point to therapeutic value. Specifically, the authors note that the greatest benefit may be to clinical non-responders resistant to more standard interventions. Ongoing psychotherapy (ie: KAP) remains essential to compliment the normalization of glutamatergic dysfunction implicated in ED.

Link to the article

Does infusion duration affect outcome? The 'Bio-K' trial suggests not...

Published in the Journal of Affective Disorders earlier this year, authors investigated outcomes among 75-patients with TRD who each received 3 ketamine infusions of differing durations (40 or 100-mins, or a combination of both).

Overall, response and remission rates were excellent and duration of infusion did not statistically affect outcomes.

Link to the abstract

‘Fool me once’ – how STAR*D and the monoamine deficiency hypothesis continues to deny many suicidally-depressed patients a real shot at remission…

'In my opinion' - perspectives from KetaMIND's National Medical Director

In a previous newsletter, I explained why the moniker ‘treatment resistant’ for depression (or any condition) is anathema to me. Now consider how we have been duped for years by the serotonin deficiency hypothesis (SDH) as the basis for clinical depression, and how SSRI’s whose prescription has been predicated upon this flawed hypothesis in the first instance were the cornerstones of STAR*D that has now, itself, been roundly discredited as fraudulent ...

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..

Ketamine and the complement system...

It is widely accepted that neuroinflammation plays a crucial role in the pathophysiology of depression.

Co-authored by the 'father' of ketamine for MDD, Carlos Zarate, a review article published in Molecular Psychiatry examines ketamine's immunoregulatory mechanism and focuses on the role of the complement system in mediating these effects.

Crucially, the complement system plays a fundamental role in synaptic plasticity and synaptic pruning.

Studies have shown increased C3 expression in the prefrontal cortex of depressed and suicidal patients.

Anti-inflammatory effects of ketamine have been discussed in a previous newsletter.

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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