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. 2020 Jan 3;19(1):1.
doi: 10.1186/s12904-019-0499-1.

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

Eduard Falk  1 , Daniel Schlieper  1 , Patrick van Caster  1   2 , Matthias J Lutterbeck  1 , Jacqueline Schwartz  3 , Joachim Cordes  4 , Ina Grau  5 , Peter Kienbaum  6 , Martin Neukirchen  1   6
Affiliations

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

Eduard Falk et al. BMC Palliat Care. .

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.

Keywords: Anxiety; Depression; Esketamine; Ketamine; Palliative care; Psychological distress; S-ketamine; Total pain.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Changes in the STADI global values of the S-ketamine group from T1 to T2. STADI values were assessed on several days a week and therefore not available 2 to 3 days after S-ketamine application. The circles at the beginning and end of each line are measured data points, while the connecting lines are shown to identify each individual
Fig. 2
Fig. 2
Group means ± SD for STADI anxiety (a) and depression (b) values at T1 and T2. * p: statistical significance p < 0.05 of mean differences
See this image and copyright information in PMC

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