Intravenous ketamine infusions in patients with depression and Epilepsy: Case series

Background

Mood disorders affect approximately one-third of individuals with epilepsy, posing an increased risk of suicide. There is an unquestionable need for more effective antidepressant treatment in this group of patients. This study explores the safety and tolerability of low-dose intravenous ketamine in six patients with comorbid depression and epilepsy. This report is limited to the post-hoc observation of six patients only. Thus, no causative conclusions are warranted, and prospective, large sample studies are needed to demonstrate the effect of ketamine on seizures, depression, and side effect profile along with the systematic outcome measures assessment.

Methods

Six patients diagnosed with major depressive disorder (MDD) or bipolar disorder I (BP-I) and concurrent epilepsy received a series of eight intravenous ketamine infusions alongside their standard antidepressant, mood stabilizer, and antiseizure medications.

Results

The observed side effects were mild and transient, with no exacerbation of epilepsy noted. No serious adverse events occurred. Four patients experienced a significant reduction in Montgomery–Åsberg Depression Rating Scale (MADRS) scores, two achieving full remission. Three patients reported a subjective decrease in seizure activity during the twelve-month follow-up.

Conclusions

Short-term intravenous ketamine treatment demonstrated favorable safety and tolerability profile with clinical efficacy in six patients with depression and epilepsy.