Ketamine for the Management of Depression in Palliative Care: An Update on the Science (FR413)

Abstract

1.Understand the current pharmacological approaches for depression in the hospice and palliative care setting and how they fall short.2.Understand the proposed mechanism of action of ketamine in depression.3.Understand the evidence base for the use of ketamine in depression. Depression is common in the hospice and palliative care population, with prevalence estimates ranging from 17% in the palliative care population to up to 40% in hospice patients. Depressive disorders such as major depression frequently go unrecognized or undertreated, and are associated with significant disability, impaired quality of life, and increased healthcare utilization. Depression is also associated with poor symptom control and often affects pain, appetite, and motivation. Current pharmacological treatment options for depression include more than 20 antidepressants with at least seven different mechanisms of action. An appropriate trial of antidepressant therapy usually requires 4 to 6 weeks, and multiple trials are often necessary. When first line treatment fails, treatment strategies include increasing the dose, augmenting with a second drug, or changing to another agent. These approaches require significant amounts of time and may not be suited to patients with a short prognosis, as in the hospice and palliative care population. A growing body of literature supports the rapid treatment of depressive symptoms with intravenous ketamine. Ketamine is considered one of the World Health Organization's essential medicines for palliative care when used as an adjuvant analgesic. This didactic and interactive session will (a) review the current standards of depression treatment in the palliative care population, (b) compare and contrast the mechanisms of action of ketamine versus other traditional antidepressants, and (c) examine the clinical trial evidence for using ketamine in the treatment of depression.