A rapid positive influence of S-ketamine on the anxiety of patients in palliative care: a retrospective pilot study View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2020-01-03

AUTHORS

Eduard Falk, Daniel Schlieper, Patrick van Caster, Matthias J. Lutterbeck, Jacqueline Schwartz, Joachim Cordes, Ina Grau, Peter Kienbaum, Martin Neukirchen

ABSTRACT

BackgroundPatients in palliative care need rapid-acting pharmacological options for psychological distress. N-methyl-D-aspartate antagonist ketamine is known to have a fast onset of anti-depressant and anxiolytic action. Its S-enantiomer S-ketamine (or esketamine) is an analgesic used as a routine treatment for refractory pain as an intravenous infusion (0.25 mg/kg over 45 min). This study investigates whether S-ketamine pain therapy has a positive impact on psychological distress caused by anxiety and depression in palliative care.MethodsPatient routine data from a palliative care unit of a tertiary care hospital were used in a retrospective analysis after positive ethics approval. Eight patients, who received analgesic S-ketamine treatment, were compared to a control group matched by gender and age. The main analysis was conducted using three-way mixed MANOVA followed by two-way mixed ANOVA. Target variables were the values for anxiety and depression in the state-trait anxiety-depression inventory STADI. The predictor variables were the time of measurement before (T1) and after (T2) S-ketamine application and group membership.ResultsComparison of the S-ketamine group (n = 8; 4 male, 4 female; average age 52 years) with the control group (n = 8; 3 male, 5 female; average age 55 years) revealed a significant multivariate effect on anxiety and depression F(1, 14) = 4.78; p = 0.046; r = 0.50. The univariate comparisons showed a significant reduction of the anxiety scores from T1 to T2 in the S-ketamine group compared to the control group F(1, 14) = 10.14; p = 0.007; r = 0.65. With regard to depression, there was no significant reduction from T1 to T2 in the group comparison F(1, 14) = 1.60; p = 0.23; r = 0.32. No long-lasting effects on pain were found.ConclusionsOur findings show that psychological distress of patients in palliative care may improve after a single administration of S-ketamine, which mainly alleviates anxiety in those patients. Limitations of this study arise from non-randomization, retrospective analysis and low sample size. Therefore, further prospective and ideally randomized studies are necessary. More... »

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URI

http://scigraph.springernature.com/pub.10.1186/s12904-019-0499-1

DOI

http://dx.doi.org/10.1186/s12904-019-0499-1

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1123814189

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/31900221


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29 schema:description BackgroundPatients in palliative care need rapid-acting pharmacological options for psychological distress. N-methyl-D-aspartate antagonist ketamine is known to have a fast onset of anti-depressant and anxiolytic action. Its S-enantiomer S-ketamine (or esketamine) is an analgesic used as a routine treatment for refractory pain as an intravenous infusion (0.25 mg/kg over 45 min). This study investigates whether S-ketamine pain therapy has a positive impact on psychological distress caused by anxiety and depression in palliative care.MethodsPatient routine data from a palliative care unit of a tertiary care hospital were used in a retrospective analysis after positive ethics approval. Eight patients, who received analgesic S-ketamine treatment, were compared to a control group matched by gender and age. The main analysis was conducted using three-way mixed MANOVA followed by two-way mixed ANOVA. Target variables were the values for anxiety and depression in the state-trait anxiety-depression inventory STADI. The predictor variables were the time of measurement before (T1) and after (T2) S-ketamine application and group membership.ResultsComparison of the S-ketamine group (n = 8; 4 male, 4 female; average age 52 years) with the control group (n = 8; 3 male, 5 female; average age 55 years) revealed a significant multivariate effect on anxiety and depression F(1, 14) = 4.78; p = 0.046; r = 0.50. The univariate comparisons showed a significant reduction of the anxiety scores from T1 to T2 in the S-ketamine group compared to the control group F(1, 14) = 10.14; p = 0.007; r = 0.65. With regard to depression, there was no significant reduction from T1 to T2 in the group comparison F(1, 14) = 1.60; p = 0.23; r = 0.32. No long-lasting effects on pain were found.ConclusionsOur findings show that psychological distress of patients in palliative care may improve after a single administration of S-ketamine, which mainly alleviates anxiety in those patients. Limitations of this study arise from non-randomization, retrospective analysis and low sample size. Therefore, further prospective and ideally randomized studies are necessary.
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35 schema:keywords ANOVA
36 BackgroundPatients
37 ConclusionsOur findings
38 MANOVA
39 N-methyl-D-aspartate antagonist ketamine
40 ResultsComparison
41 S-ketamine
42 S-ketamine group
43 T1
44 T2
45 action
46 administration
47 age
48 analgesics
49 analysis
50 anxiety
51 anxiety of patients
52 anxiety scores
53 anxiolytic action
54 applications
55 approval
56 care
57 care hospital
58 care unit
59 comparison
60 control group
61 data
62 depression
63 distress
64 effect
65 ethics approval
66 faster onset
67 findings
68 gender
69 group
70 group comparisons
71 group membership
72 hospital
73 impact
74 influence
75 infusion
76 intravenous infusion
77 ketamine
78 limitations
79 low sample size
80 main analysis
81 measurements
82 membership
83 mixed MANOVA
84 multivariate effects
85 onset
86 options
87 pain
88 pain therapy
89 palliative care
90 palliative care unit
91 patients
92 pharmacological options
93 pilot study
94 positive impact
95 positive influence
96 predictor variables
97 psychological distress
98 reduction
99 refractory pain
100 regard
101 retrospective analysis
102 retrospective pilot study
103 routine data
104 routine treatment
105 sample size
106 scores
107 significant multivariate effect
108 significant reduction
109 single administration
110 size
111 study
112 target variables
113 tertiary care hospital
114 therapy
115 time
116 time of measurement
117 treatment
118 two-way
119 units
120 univariate comparisons
121 values
122 variables
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