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Cited by 57Treatment of Major DepressionPalliative and Oncologic CarePain Management and Opioid Use

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

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Falk, Eduard, Schlieper, Daniel, van Caster, Patrick, Lutterbeck, Matthias J., Schwartz, Jacqueline, Cordes, Joachim, Grau, Ina, Kienbaum, Peter +1 more·2020·BMC Palliative Care
DOI 10.1186/s12904-019-0499-1PMC PMC6942257
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Abstract

Background: Patients 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. Methods: Patient 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. Results: Comparison 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. Conclusions: Our 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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  • Besides Falk et al. (2020), none of the ketamine studies included an active placebo other than lower doses of ketamine.

    “Furthermore, it is important to note that besides Falk et. al. (2020), none of the ketamine studies included an active placebo other than lower doses of ketamine.”

    From Psychedelics for the treatment of depression, anxiety, and existential distress in patients with a terminal illness: a systematic review (2022) · cites this paper as Falk et al., 2020

    The Methods (Study design; page unavailable) describe a retrospective comparison, not an active-placebo-controlled study. Falk et al. state that the control group received the same specialized palliative care but was not treated with S-ketamine; the paper therefore does not support the claim that Falk et al. were an exception that used an active placebo. It does not establish what placebos the other ketamine studies used. (LLM, conf=0.88)

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  • In Falk et al. (2020), there was a significant group effect on anxiety with a larger reduction in the ketamine group, but no significant group effects on depression or pain.

    “They found a significant group effect on anxiety with a larger reduction of anxiety in the ketamine group, but no significant group effects on depression or pain.”

    From Psychedelics for the treatment of depression, anxiety, and existential distress in patients with a terminal illness: a systematic review (2022) · cites this paper as Falk et al., 2020

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Authors
Falk, E., Schlieper, D., van Caster, P., Lutterbeck, M. J., Schwartz, J., Cordes, J., Grau, I., Kienbaum, P., & Neukirchen, M.
Affiliations
  • Heinrich Heine University Düsseldorf (DE)
  • University of Bonn (DE)
Corresponding author
Schwartz, Jacqueline
ORCID
Venue
BMC Palliative Care
Publisher
Springer Science and Business Media LLC
Published
2020-01-03
Volume
19
Issue
1
Pages
1-1
ISSN
1472-684X (ISSN-L)
DOI
10.1186/s12904-019-0499-1
PMC
PMC6942257
OpenAlex
W3003956960
Cited by
57
References
72
Citations by year
2026: 3 · 2025: 13 · 2024: 9 · 2023: 8 · 2022: 10 · 2021: 8 · 2020: 6
FWCI
4.79
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Palliative Care (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
Keywords
esketamine, palliative care, anxiety, depression, psychological distress, NMDA receptor antagonists, refractory pain, analgesia, rapid-acting antidepressants, end-of-life care, delirium, hallucinations, sedation, Delirium Rating Scale, quality of life
MeSH terms
Adult, Aged, Analysis of Variance, Anxiety, Female, Humans, Ketamine, Male, Middle Aged, Palliative Care, Pilot Projects, Retrospective Studies, Anti-Anxiety Agents

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