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Newsletter No 10 (24th February 2022)
"I want to die and talk to Jesus"
The chilling reality of child-suicide
"When I was first told that a psychiatrist had referred an 8-year-old little girl to our Hilton Clinic for ketamine infusions, I was somewhat surprised."
(Dr Alan Howard, founder and National Medical Director of KCSA.)
Not that administering ketamine to children (the most widely used and safest anaesthetic agent in this age-group worldwide) concerned him, but rather that an understanding of life, death, suicide and the capacity to follow through on suicidal ideation at this tender age was hard to fathom. Until Kayleen's referral, KCSA clinics had treated several suicidal teenagers, but never a pre-teen child. In past newsletters, we have discussed teen suicide and linked to a moving testimonial about a suicidal 14-year-old treated with ketamine.
"I'm so glad we took on Kayleen's case and can share such a remarkable turnaround with our readers," says Dr Howard.
Read more about children as young as five-years-old who have attempted to take their own life and learn about the red flags to look out for.
Read about Kayleen's case, and how ketamine infusions made all the difference, as described by her psychiatrist and therapist.
The largest retrospective analysis of ketamine infusion therapy (KIT) for depression (537-patients)
Alison McInnes is a former associate Professor of Psychiatry at the mount Sinai School of Medicine and completed two research fellowships in psychiatric genetics at UCSF.
She is currently Vice President of Medical Affairs, Osmind, focused on capturing outcomes data on mental health patients.
Currently 'in press' and scheduled for publication in the Journal of Affective Disorders, Alison McInnes is lead author of a paper entitled
"A retrospective analysis of ketamine intravenous therapy for depression in
real-world care settings".
PHQ-9 scores were used to analyze 537-patients who had received 4 to 8 infusions over 7-28 days.
73% exhibited reduction in suicidal ideation, and 53,6% reduced their PHQ-9 scores by 50% or more at 14-31 days after KIT.
Patients who respond to KIT induction have approximately 80% probability of sustaining response at 4 weeks and approximately 60% probability at 8 weeks, even without maintenance infusions.
A small percentage of patients worsened after KIT.
Professor Christopher Szabo talks with KCSA founder and National Medical Director, Dr Alan Howard
Professor Christopher Szabo is Honorary Professor in the Department of Psychiatry, University of the Witwatersrand, and Emeritus Professor in the Faculty of Health Sciences. He is Editor in Chief of South African Psychiatry.
Professor Christopher Szabo, founder and host of the 'Beyond Madness' podcast series says that the podcast is:
"not only for the discipline of psychiatry but importantly, about the discipline."
In this podcast, recorded in mid-January, he engages in conversation with Dr Alan Howard about 'all things ketamine', and talks to a patient about their experience and outcome after treatment at a KCSA clinic.
KCSA offers outpatient ketamine infusions at the following locations:
BEDFORDVIEW (GP)
CONSTANTIA (WC)
UMHLANGA (KZN)
HILTON (KZN)
A recent study highlights the benefit of ketamine infusions for patients with bipolar disorder
A double blind study published earlier this month in the BMJ randomized 156-suicidal adults to placebo or two 40-minute ketamine infusions (0,5mg/kg). Full remission of suicidal ideation was noted in 63% of the ketamine arm at 3-days and 69,5% had no suicidal ideation after 6-weeks..
This study also categorized patients by underlying diagnosis from the spectrum of depressive and anxiety disorders and, interestingly, those with bipolar disorder fared best with 84.6% of this subgroup demonstrating remission of suicidality by day-3.
KCSA reaches another milestone in January - 3000 ketamine infusions
By the end of January this year, KCSA clinics around the country had collectively administered 3080-ketamine infusions. This 2-year milestone was reached in spite of most branches operating reduced clinic days, an essential measure, and legacy of the trying times of COVID.
"As things slowly get back to normal, we hope to return to the pre-COVID numbers we were seeing at our Hilton Clinic, when we were often overbooked"...
says Dr Alan Howard, founder and National Medical Director of KCSA.
"We will engage with Medical Aid Schemes with renewed vigour, as we continue doing all we can to secure benefits for our patients from funders."
Suicide risk increases at exam time
"Teach students to value life." This is the take-home message from a large Chinese study of 6,836 university students. Surprisingly, only a small number of students deemed at risk for suicide met the diagnostic thresholds for depression and anxiety. Over 60% however thought that suicide was a way to end or evade problems.
Learn about the warning signs of teen suicide here.
Ketamine infusion can rapidly reverse suicidal ideation, leading to clarity of thought, and benefits other cognitive domains linked to suicidality. These benefits are particularly relevant at times of academic stress and pressure. Read more about this here.
In the next newsletter..
How effective are costly inpatient programs for affective disorders and suicidality? The risk of suicide is elevated more than 100-times during the first 3-months after discharge from an inpatient treatment facility, compared with the global suicide rate. (JAMA Psychiatry) For less than half of the cost of a 3-week stay in a typical private inpatient facility, KCSA outpatient clinics can offer 6-induction ketamine infusions over 3-weeks, and monthly maintenance infusions for the balance of the year. When combined with outpatient CBT and scheduled psychiatric follow-up, studies show high rates of sustained remission in depressed patients. Read more in the next newsletter... |
How did KCSA start in South Africa?
Ketamine 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.
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