Date of Award

2018

Document Type

Thesis

Degree Name

Bachelors

Department

Social Sciences

Second Department

Natural Sciences

First Advisor

Cook, Peter

Area of Concentration

Biopsychology

Abstract

Major depressive disorder is a debilitating and chronic mental illness that impacts hundreds of millions of people worldwide. Depression is a treatable condition, but many patients are resistant to antidepressants despite multiple trials of adequate dose and duration. After accumulating evidence suggesting that the glutamatergic system plays a role in the pathology of depression, Berman and colleagues assessed ketamine, an anesthetic drug with mechanisms of action very different to conventional antidepressants, for its potential antidepressant properties and found that it was significantly more effective than placebo 72 hours after administration (Berman et al., 2000). Although no large scale clinical studies have been conducted on ketamine for treatment resistant depression, several smaller scale studies have assessed its antidepressant efficacy. This thesis is a systematic review of the literature of controlled studies evaluating the antidepressant efficacy of ketamine for patients with treatment resistant depression. Additionally, this thesis also includes interviews with a ketamine clinic anesthesiologist and patient undergoing ketamine treatments. The findings of the qualitative analysis suggest that ketamine does have effective antidepressant properties for some patients with treatment resistant depression. Single treatments seem to be effective for some patients, but treatment may be optimized if ketamine is administered on multiple sequential administrations. Additionally, 0.5 mg/kg of intravenous infusions are the ‘gold standard’ in the industry according to the anesthesiologist interviewed, but lower doses and different routes of administration are also feasible options. Augmentation with riluzole and lamotrigine neither prevented relapse better than ketamine alone nor mitigated psychomimetic side effects. Ultimately, the goal of the mental health industry right now should be to conduct large-scale high quality studies on ketamine for depression. Until then, future smaller scale studies should consider studying the efficacy of ketamine in conjunction with therapy.

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