If you’re interested in Ketamine treatment, please read the following inclusion/exclusion critera carefully.
Inclusion Criteria for IV Ketamine
- Adult patients 18 years of age and older.
- Patients with documented *Treatment Resistant Depression as defined below, who have current moderate to severe depressive symptoms, will be considered for ketamine.
- The primary diagnosis, as defined by the DSM-5, is Major Depressive Episode (MDD), or Bipolar 2 Disorder, depressive phase. The patient may have another DSM-5 diagnosis, but this diagnosis cannot be the primary focus of treatment,
- Individuals with suicidal ideation, as a symptom of the current episode of MDE, as defined by the DSM-5, and the above criteria, are eligible.
- Individuals who have had previous ECT or rTMS and meet the above requirements are eligible.
- All patients must complete a medical form and be cleared for intravenous ketamine at TKC by the TKC anesthesiologist. The anesthesiologist reviews the completed patient medical form prior to the first infusion and any identified medical concerns are addressed prior to the first infusion, where possible, or the patient is declined from moving forward with ketamine treatment.
- All patients must have capacity to sign a written, informed, consent for treatment.
*Treatment Resistant Depression (TRD)
An inadequate response, or failed response, to 2 or more antidepressants, from the same or different classes, during the same depressive episode, and achieving at least the minimum effective antidepressant dose for a period of 6-8 weeks after the target dose has been reached, and medication compliance to these medications. (Pharmacotherapeutic treatment guidelines are found in the CANMAT MDD Guidelines.)
Exclusion Criteria for IV Ketamine Treatment
- Patients with a primary diagnosis other than MDD or Bipolar 2 Disorder (depressive phase), are not eligible.
- Patients who are diagnosed with psychosis, even if it is a symptom of an MDE.
- Patients with neurocognitive disorders, including dementias.
- Patients who have traumatic brain injury that is symptomatic.
- Patients who, within the previous three months, meet the DSM-5 criteria for Alcohol Use Disorder, or other Substance Use Disorder.
- Patients who do not meet the DSM-5 criteria for Substance Use Disorder, but who use illicit substances, must stop all illicit substances for a minimum period of 1 month prior to the first infusion at TKC and remain free from substance use during the treatment time.
- Patients who have a primary diagnosis, other than MDD or BD. As noted above, individual consideration will be given on a case-by-case basis for adults with either PTSD or OCD
- Patients who are unable to provide written consent for ketamine treatment.
- Patients who are not able to abide by the pre-treatment and post-treatment clinic protocol such as: food intake, abstaining from certain medications, unable to remain in the clinic post-treatment for a minimum of 20 minutes or longer for observation, if they insist on driving immediately post-treatment, and cannot provide the TKC with the name and phone number of the party who will pick them up post-treatment).
- Patients with uncontrolled hypertension, allergies to ketamine, a previous reaction to ketamine, have a Body Mass Index greater than 35, are pregnant or planning to become pregnant within 12 weeks of treatment completion, hepatic impairment (Class-Pugh b or c), history of recent heart attack, vascular disease, or any other medical conditions that may be deemed by the anesthetist as a contraindication to receiving ketamine.
- Individuals who are symptomatic for infection, or who have had contact with someone with an acute contagious illness.
- Individuals who are not Canadian residents or do not have a most responsible physician (MRP) in Canada.
- Individuals who do not have a community most responsible physician (MRP) are not eligible.
- Individuals who demonstrate verbal, physical or emotional aggression toward TKC staff or other patients.