Addressing treatment resistant depression

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Currumbin Clinic Introduces Oral Ketamine for Treatment Resistant Depression

Owned by HealtheCare Australia, Currumbin Clinic on the Gold Coast in collaboration with the Australian Institute for Suicide Research and Prevention will be facilitating a pilot project utilising oral Ketamine for treatment resistant depression.  The Oral Ketamine treatment program is scheduled to commence at Currumbin Clinic in October 2014.

According to the Australian Bureau of Statistics 2009 one in seven Australians will experience depression in their lifetime. Depression is ranked as the third highest burden of all diseases in Australia at 13.3%. Treatment resistant depression presents major challenges for both patients and clinicians with the chances of remission decreasing significantly after two failed treatment trials.

Ketamine, a NMDA receptor antagonist is predominately used for induction and maintenance of anaesthesia, analgesia (including chronic pain management) and procedural sedation.  Emerging evidence suggests rapid antidepressant effect at sub-anaesthetic doses in people with bi-polar depression, treatment resistant depression and suicidal ideation.

‘Most of the research to date has focussed on effects when Ketamine is administered intravenously on its own.  The results to date have been encouraging; however the benefits Ketamine offers are consistently reported as short lived,’ according to Dr De Gioannis, Consultant Psychiatrist at the Life Promotion Clinic at Griffith University.

The study being introduced at Currumbin Clinic aims to demonstrate that oral Ketamine as an augmentation treatment offers significantly higher benefits and greater chances of remission than intravenous Ketamine on its own.

Inclusion Criteria:

  • Treatment resistant depression
  • Two failed trials on anti-depressant medications from different sub-categories
  • Completion of psychotherapy
  • Participants must be aged between 18 – 65 years

Oral Ketamine Treatment Program

  • An initial outpatient assessment will be conducted on all patients who are referred to the program to determine suitability for inclusion.
  • Patients who are eligible will then be offered a three week planned inpatient admission during which time additional screening will be undertaken and dose titration will commence.
  • The administration of oral Ketamine during both the inpatient and day patient phases of the treatment will be by a Psychiatrist.
  • Patients will then transition to a day patient program for ongoing dosing this will generally require a weekly attendance. In addition to Ketamine administration the patients enrolled in the program will be engaged in Emotion Modulation Therapy.

What is Emotion Modulation Therapy

Emotion Modulation Therapy (EMT) is a mode of psychotherapy developed at the Australian Institute for Suicide Research and Prevention.  It is a cognitive behavioural intervention with theoretical underpinnings in performance psychology.  To date, EMT has been applied to a range of mental health disorders, including mood, anxiety and personality disorders. EMT is aimed at assisting individuals to improve their ability to cope with the problems that they face in life and reduce the discomfort associated with challenges that occur in everyday life.

All patients will be offered up to six months of treatment with the possibility of continuing if clinically appropriate and beneficial.  Patients will remain under the care of a hospital–accredited Psychiatrist who collaborates with the referring Medical Practitioner. Currumbin Clinic is excited to provide this cutting edge treatment alternative for patients who experience this debilitating illness and where other treatments have proven unsuccessful.

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