Does age matter? Ketamine for treatment-resistant depression in the elderly

Elderly Depression-

Over recent years, there has been a boom in scientific studies regarding the use of ketamine for treatment-resistant depression. These studies have shown time and time again that ketamine is a powerful and rapid anti-depressant that can significantly decrease suicidal thoughts and improve depressive symptoms. These studies and the scientific community urge strict oversight from a mental health professional during the treatment infusions, but it is undeniable that ketamine works. A few questions remain, however, one of them being: does age matter? When reading these scientific studies coming out of well-respected institutions such as Columbia University Medical Center and Massachusetts General Hospital, the patients included are generally 18 to 65 years old. But older adults can have treatment-resistant depression as well, so why isn’t this demographic included in these studies? There are many reasons, namely risk of deteriorating physical and cardiovascular health as well as cognitive function decline. Scientists have to be very strict in what patients they accept into their research studies, and while these rigorous inclusion criteria ensure patient safety and that the goal of the study is met, it can leave us with some unanswered questions.

Although there have not been any large studies conducted on ketamine infusions for treatment-resistant depression in older adults (i.e. >60 years old), there have been some smaller studies and individual case studies. While these smaller studies cannot give us a concrete answer, it does give us some insight as whether age matters for this treatment. A report of two case studies published in December 2017 in Current Psychiatric Reports, as well as a small 16-patient randomized control trial published in November 2017 in American Journal of Geriatric Psychiatry shows promising data in the use of ketamine in older adults. It is known that ketamine’s potential side effects can include cognitive and dissociative effects, elevated blood pressure and heart rate, urinary problems and liver inflammation, although the latter two have only been associated with long-term use. In the older adult who may not be as physically robust as a younger patient, it is important to research exactly how ketamine affects the body overall. The two studies that explored this found that by titrating the patients’ ketamine dose (i.e. starting at a lower dose and increasing the dose slightly at every infusion), the response rate is similar and adverse effects can be minimized. While this patient population is still in need of further studies with a much larger number of study participants, this data is reassuring and reinforces that ketamine infusions are an option in treating major depression in all adult age groups.

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