Abstract
Depression is a common mental disorder that affects many people worldwide, while a significant proportion of patients remain non-responsive to antidepressant medications. Alternative treatment options such as ketamine therapy and repetitive transcranial magnetic stimulation (rTMS) therapy are offered nowadays. This study aims to describe and compare the acute antidepressive efficacy of both, intramuscular ketamine and rTMS in depression patients seeking help in a naturalistic clinical mental health setting. The clinical records of 24 patients with treatment resistant depression were collected from the clinical base of a real life clinic. Twelve patients were treated with intramuscular ketamine, twice weekly for 8 sessions, and twelve patients were treated with 30 sessions of left dorsolateral prefrontal cortex – intermittent theta-burst stimulation (DLPFC-iTBS). Using three clinical assessments (HDRS, HAM-A, BDI-II), our data reveal that both therapies led to significant improvement in symptoms from pre- to post- treatment, as well as that the two experimental groups did not differ significantly with respect to pre- to post- depressive and anxiety symptoms, indicating that the effect of both experimental groups in our sample was equally effective. Furthermore, our results showed high remission and response rates in both groups, with no statistical differences between the patients of ketamine group and rTMS group in remission and response rates. We show a significant pre- to post- treatment reduction in depressive and anxiety symptoms, with no significant differences between the two experimental groups, indicating that the effect of both therapies was equally effective in our limited sample.
Highlights
Depression is a common mental disorder that affects more than 264 million people worldwide, irrespective of age [1]
Twelve patients were treated with IM ketamine and twelve patients were treated with repetitive transcranial magnetic stimulation (rTMS) therapy using the Intermittent TBS (iTBS) protocol
The clinical records of twenty-four treatment resistant depression (TRD) patients (11 male, mean age 47.9 ± SD 12.7) were collected. From these reports two groups were created, one group which received ketamine therapy and one group which received iTBS therapy. Analysis showed that both groups did not differ in demographic as well as clinical characteristics
Summary
Depression is a common mental disorder that affects more than 264 million people worldwide, irrespective of age [1]. ∼30% of depression patients remain non-responsive to antidepressant medications and are suffering from treatment resistant depression (TRD) [2, 3]. In patients suffering from TRD, the antidepressant effect of ketamine can be observed within a few hours following a single subanesthetic intravenous infusion [7]. As reported by a twosite randomized controlled trial, a single infusion of ketamine was associated with greater improvement in the MontgomeryÅsberg Depression Rating Scale (MADRS) score, compared to an active placebo control condition (anesthetic midazolam), 24 h after treatment [7]. The authors found that repeated ketamine administration induces processes of metaplasticity through post-synaptic functional changes. This may explain why repeated intake of ketamine doses produce sustained effects [10]
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