An open-label feasibility study of ketamine-assisted therapy in adults with treatment-resistant depression
Open-label, non-randomised feasibility study (n=30) of three weekly IM ketamine sessions (with optional small supplemental dose) combined with preparatory and integration psychotherapy for adults with treatment-resistant depression.
Detailed Description
This single-group feasibility study evaluates ketamine-assisted psychotherapy in adults with treatment-resistant depression across three consecutive weekly intramuscular dosing visits paired with structured preparation and integration psychotherapy sessions.
Dosing is weight-stratified with typical per-session dosing up to 0.75 mg/kg and an optional 20-40 mg supplemental injection 12 minutes after the initial dose; psychotherapy sessions are two hours for preparation and two hours for each integration visit. Outcomes include change in MADRS with follow-ups 1 day after each administration, 1 week, 1 month, 3 months and 6 months after final administration.
Study Protocol
Preparation
Dosing
Integration
Therapeutic Protocol
Study Arms & Interventions
Ketamine-assisted therapy
experimentalThree weekly intramuscular ketamine dosing sessions combined with structured psychotherapy (preparation and integration sessions).
Interventions
- Ketamine0.5 - 0.75 mg/kgvia IM• weekly• 3 doses total
Weight-stratified dosing: sessions 1–3 typically 0.5–0.75 mg/kg for 50–100 kg (session1 initial 0.5 mg/kg); participants >100 kg receive lower initial doses (0.3–0.5 mg/kg). Optional supplemental dose 20–40 mg given ~12 minutes after first injection per protocol; see protocol for full schedule.
Participants
Inclusion Criteria
- Adult patients who meet DSM-5 criteria for Major Depressive Disorder or Bipolar Disorder and:
- 1) Willing and able to give informed consent for participation in the study
- 2) Male or female, aged 18 years or above and less than age 70
- 3) If Bipolar Disorder, must be on a mood-stabilising medication for the duration of the study
- 4) Current depressive episode for at least three months
- 5) MADRS ≥ 20
- 6) Inadequate response to at least two antidepressant treatments, one of which can include the current episode
- 7) Must be stable on any psychotropic medication for at least four weeks prior to the study day.
Exclusion Criteria
- Female participant who is pregnant, lactating or planning pregnancy during the course of the trial
- Significant renal or hepatic impairment
- Cardiovascular conditions including severe cardiovascular disease, heart failure, severe or poorly controlled hypertension, recent myocardial infarction, history of stroke, cerebral trauma, or intracerebral mass or haemorrhage
- Abnormal heart rate or blood pressure checked at screening
- Participants who have participated in another research trial involving an investigational product in the past 12 weeks
- History of significant psychotic episode(s)
- Any unstable medical or neurologic condition
- Planned major changes to psychotropic medication
- Imminent risk of suicide as determined by the CSSRS and MADRS/clinical interview
- Planned or probable use of ECT
- Active substance use disorder in the previous 6 months
- Regular use of any medication deemed to be contraindicating as judged by the attending study physicians
- Inability to speak or read English
- Any history of abuse of ketamine or phencyclidine
- Contraindication to the use of ketamine according to manufacturer guidelines including hypersensitivity to the drug or its components
- Planned use of ketamine, for example, for pain control
- Unable to fast for four hours prior to administration of ketamine
- Any other condition judged by the treating clinician as likely to impact on the ability of the participant to complete the trial
- Body-weight <50 kg or >120 kg
- Current use of the following medications: memantine / amantadine / rimantadine / dextromethorphan / procyclidine / lamotrigine.
Study Details
- StatusRecruiting
- PhasePhase NA
- Typeinterventional
- DesignNon-randomized
- Target Enrollment30 participants
- TimelineStart: 2022-08-08End: 2024-05-20
- Compound
- Topic