Long-term quality of life after repeated ketamine infusions in anxious and nonanxious patients with depression
Yanmei LiangZerui YouXiaoyu ChenGuanxi LiuWeicheng LiChengyu WangXiaofeng LanZhanjie LuoSiming MaiFan ZhangYexian ZengYifang ChenYi‐Ying ChenYuping NingYanling Zhou
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Depression
ウサギを用いて,Ketamineの自律神経系への影響を検討するため腸管運動,血圧および心拍数を対象とする実験を行った.また,脳波トポグラフィを行い,Ketamineの脳波活動への影響を検討した.1)Ketamine投与により腸管の自発性運動は影響を受けなかった.2)脳幹網様体刺激による腸管運動の抑制効果はKetamine投与により減弱される傾向を示した.3)平均血圧および心拍数は,KetalnineO.3-5.0磁g/kg投与下では有意の変化を示さず,1Q . Omg/kg投与下にて,5%以下の危険率で有意の低下を示し,平均血圧が15.5%,心拍数が9.6%低下した.4)脳波トポグラフィの結果としては,Ketamine O.3-0.5mg/kgの投与下では,Delta帯域およびTheta帯域のパワー値および帯域構成比には変化が認められなかったが,Beta1帯域およびBeta2帯域のパワー値および帯域構成比には増加傾向がみられた.この結果,脳波上からもKetamineの少量投与(0.3-0.5mg/kg)下では,意識レベルはむしろ高まった状態にあることが明らかとなった.5)Ketami織eO.3-10.0mg/kgの投与下では,全周波数帯域においてパワー値には有意の増加が認められた.帯域構成比ではM一帯域,Beta1帯域およびBeta2帯域に増加傾向がみられた.
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106 patients undergoing abortion were anesthetized at random with 1 of 3 techniques; ketamine only (53 cases), thiopental followed by ketamine with nitrous oxide-oxygen maintenance (37 cases), or thiopental nitrous oxide-oxygen, d-tubocurarine (61 cases). The intravenous ketamine anesthesia was the easiest to administer for the staff, but 41.5% of the patients stated they would not want ketamine anesthesia again. Recovery room time for the no-ketamine group was shorter than in the 2-ketamine groups. Patients receiving Ketamine were most frequently nauseated. 24.5% of the ketamine-only patients reported unpleasant sensations on going to sleep.
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Ketamine, ketamine-xylazine, and ketamine-diazepam were evaluated clinically in 15 ferrets, and safe dosage was determined for each. All of the three regimens provided excellent immobilization. However, muscle rigidity and incomplete analgesia were noted in ketamine alone and in ketamine-diazepam respectively. It was concluded that 25 mg/kg ketamine and 2 mg/kg xylazine intramuscularly provided acceptable analgesia, muscle relaxation, duration and smooth recovery, although cardiac arrhythmias were a concern and require careful observation.
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A bstract Adult Antarctic fur seals (Arctocephalus gazella) were immobilized with Zoletil ® ( n = 172), ketamine ( n = 30), ketamine mixed with diazepam ( n = 23) and with ketamine mixed with xylazine ( n = 45). Response to all drugs was highly variable. There was a relationship between dose rate and level of immobilization in females given Zoletil ® . Males were slightly more sensitive to Zoletil ® than females but this could have been due to the greater body mass and lower mass‐specific metabolic rate of males. The dose required to achieve a level of immobilization declined with greater body mass for Zoletil ® and ketamine but not for ketamine‐diatepam. Ketamine and ketamine‐sedative mixtures commonly caused mild tremoring and occasionally caused convulsions. Neither reaction was seen with Zoletil ® . Mean doses were, Zoletil ® 1.5 mg/ kg, ketamine 6.9 mg/kg, ketamine‐diazepam 6.3 mg/kg ketamine and 6.3 μg/kg diazepam, and ketamine‐xylazine 7.3 mg/kg ketamine and 0.62 mg/ kg xylazine. Zoletil ® performs at least as well on Antarctic fur seals as ketamine but it may cause respiratory depression. The dose of ketamine required for Antarctic fur seals was greater than for most other species of seals.
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Objective To observe the influence of propofol-ketamine combined intravenous anesthesia and ketamine intravenous anesthesia on breath and circulation functions and the postoperative recovery for children undergoing mini-middle-operations. Methods Thirty children undergoing mini-middle-operation were randomly divided into two groups: the propofol-ketamine group (15 cases), continuous infusion of propofol [4~6 mg/(kg·h) ] and ketamine [2~3 mg/(kg·h)]during the operation; the ketamine group (15 cases), intermittent intravenous injection of ketamine [1~2 mg/kg] during the operation. Results During the operation the function of circulation in the propofol-ketamine group was more steady than that in the ketamine group. The incidences of involuntary movement and nystagmus were less in the propofol-ketamine group than the ketamine group. The amount of ketamine was less and the time for recovery was shorter in the propofol-ketamine group than the ketamine group (P0.05). Conclusion Compared with intravenous ketamine anesthesia, propofol-ketamine combined anesthesia is more steady and faster to awake after operation and therefore more suitable to children's operation.
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麻酔薬(R,S) -ketamine は,治療抵抗性うつ病患者に単回投与で即効性の抗うつ効 果, および希死念慮・自殺願望の低下を示す。(S) -ketamine は(R) -ketamine より NMDA 受容体への親和性が強いことから,米国ヤンセン社は新規抗うつ薬として(S)- ketamine を選んだ。2019 年3 月,米国FDA はヤンセン社の(S) -ketamine 点鼻薬を治療 抵抗性うつ病の追加治療薬として承認したが,(S) -ketamine 点鼻薬に関する問題点も指 摘されている。一方,筆者らはもう1 つの光学異性体(R) -ketamine の方が(S) -ketamine より抗うつ効果が強く,副作用が少ないことを報告した。また最近ブラジルの研究 者は,(R) -ketamine が治療抵抗性うつ病患者に単回投与で即効性の抗うつ効果を示すこ とを報告した。本稿において,(R,S) -ketamine の抗うつ作用におけるNMDA 受容体の役 割と光学異性体の最新知見について考察する。 臨床精神薬理 23:787-792, 2020 Key words ::(R)−ketamine (or arketamine), (S)−ketamine (or esketamine), NMDA receptor
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Purpose: The purpose of this article is to investigate how age-related macular degeneration (AMD) is associated with anxiety and depression. Methods: An online repository of deidentified patient data was queried to identify and retrospectively analyze patients with AMD, depression, or anxiety via ICD-9 and ICD-10 codes. Odds ratios were calculated between AMD and anxiety and depression, respectively. Results: Of the 51 019 patients analyzed in this study, 11 681 (22.9%) had depression, 8727 (17.1%) had anxiety, and 2752 (5.4%) had AMD. The prevalence of anxiety among AMD patients was 18.2%, and the prevalence of depression among AMD patients was 25.0%. The odds of a patient with AMD carrying a diagnosis of anxiety are 1.3 (95% CI 1.2, 1.5) times higher than a patient without AMD, and the odds of carrying a diagnosis of depression are also 1.3 (95% CI 1.1, 1.4) times more likely. Conclusions: Patients with AMD have increased odds of suffering from comorbid anxiety and depression. Ophthalmologists should consider mental health screens and appropriate referrals as new diagnoses of AMD are made or as the disease progresses.
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Objective To investigate the incidence of type 2 diabetic inpatients' anxiety and depression,and discuss the treatment effect of health education.Methods We investigated the anxiety and depression of type 2 diabetic inpatients between January 2009 and May 2012,gave health education to the anxious and depressed patients,and reevaluation was carried out when the patients were discharged from the hospital.Results The result showed that 22.45% of the type 2 diabetic inpatients had anxiety,and 11.37% of them had depression.After the health education,the number of anxious patients was markedly reduced(P 0.05),especially in patients with mild and moderate anxiety,but it had no distinct improvement in severely anxious patients.To all the depressed patients,health education had bad curative effect,especially in those with moderate and serious depression.Conclusion Anxiety and depression have high incidence in type 2 diabetic inpatients,and health education is an effective treatment for patients with mild and moderate anxiety.
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Comment: The Editor has had several patients whose reaction to ketamine corroborates the present report. One who had been anesthetized 3 times prior to a 3 hour operation using ketamine, when asked about her reaction to ketamine, replied: “Oh, everybody should have that nice anesthetic!” Chlorpromazine, 25 mg. per 70 kg., given i.v. at least 5 minutes before the ketamine, obviates most of the emergence phenomena. Moreover, about 0.6 mg. of ketamine per pound is then adequate. The hypertension is much less than with ketamine alone. Sleeping time is prolonged, however. When cardiovascular stability and spontaneous respiration are crucial factors in the safety of the patient, the positive value of ketamine far outweighs any emergence excitement.
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Review question: What is the effectiveness of bright light therapy (BLT) on depressive symptoms in older adults with non-seasonal depression? Review objective: The review objective is to determine the current evidence related to the effectiveness of BLT on depressive symptoms in older adults with non-seasonal depression.
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