Introduction
Affecting nearly twenty percent of United States citizens, Major Depressive Disorder represents just one of a myriad of mental illnesses that could benefit from the exploration of promising new treatments, one of which being ketamine therapy. Many medications for mental illness have been adopted in regular practice in the last century, but research suggests that ketamine therapy may have better outcomes than its predecessors. Although standard antidepressants and antipsychotics are common for treating mental illnesses, existing research suggests that ketamine therapy can have faster and more efficient outcomes for patients diagnosed with post-traumatic stress and major depressive disorders (Womble, 2013). Ketamine contains elements that increase binding potential with N-methyl-D-aspartate-receptors, which have been shown to share a direct link with mental illness when binding is impaired or reduced. When administered in therapeutic doses, ketamine therapy is effective and efficient in producing desired outcomes related to mental illness management, with results being seen in several hours versus days to weeks with traditional treatments (Dowben, Grant & Keltner, 2012). The purpose of this paper is to recommend that the findings related to ketamine therapy trials result in healthier and more therapeutic outcomes for individuals with mental illness than standard antidepressant regiments alone.
Literature Review
Some clinical trials have been established to test alternative therapeutics with pronounced and lasting effects among patients with treatment-resistant bipolar depression. In 2006, a study was conducted at the National Institute of Mental Health (NIMH) Mood Disorders Research Unit in Bethesda, Maryland, to determine the efficacy of N-methyl-D-aspartate-receptor antagonist in producing rapid antidepressant effects (Diazgranados et al., 2010). In particular, the researchers utilized ketamine, a noncompetitive N-methyl-D-aspartate-receptor that shows promising results in reducing depressive symptoms and suicide ideation among patients.
Study Design, Population, and Findings
The longitudinal, single-center, double-blind, randomized, cross over study comprised of eighteen participants between eighteen to sixty-five years-old, who were recruited from local inpatient psychiatric units, referrals from local and national physicians, and the Internet (Diazgranados et al., 2010). During the research period, randomly selected patients were administered with a combination of lithium and Ketamine, while others remained under placebo control. Results from the study revealed a significant improvement in depressive symptoms, forty minutes after ketamine infusion (Diazgranados et al., 2010). On the other hand, placebo patients showed little progress. These findings demonstrate that ketamine has better therapeutic outcomes compared to standard antidepressants.
Similar research on the therapeutic effects of ketamine on mental illness was conducted among patients with treatment-resistance major depressive disorder (MDD). The open-label inpatient study comprised of thirty-three individuals who were eighteen to sixty-five year old, with a history of major depressive disorder (DiazGranados et al., 2010). Unlike earlier research, which utilized a combination of two antidepressants, the scholars used ketamine as the sole medication. The strategy enabled the researchers to determine whether the outcomes were a result of ketamine infusion. Similar to previous clinical trials, the researchers randomly administered either placebo or riluzole to a portion of the participants six hours after ketamine administration (DiazGranados et al., 2010). Findings from the study revealed positive changes in patient outcomes after the N-methyl-D-aspartate-receptor antagonist was infused. Subjects with high suicide ideation, above the scale of three, as measured using the Scale of Suicide Ideation (SSI), showed significant improvement within two hundred and thirty minutes of medication (DiazGranados et al., 2010). Reduction of suicidal thoughts, stress, and tension among the study participants are a clear indication of the efficacy of ketamine as a treatment for mental illness.
Strengths of the Literature
The above literature efficiently builds on the existing body of knowledge regarding the therapeutic effects of ketamine on mental illness. Notably, the two studies incorporate methodologies that facilitate the collection of accurate data and the formulation of precise conclusions. For instance, the first trial was conducted among hospitalized subjects (DiazGranados et al., 2010). The setting made it easier for scholars to obtain information about patients’ history and treatment before launching a clinical intervention. In addition, the cross over study design created ease in monitoring the lasting effects of ketamine over an extended period. One of their findings was a decline in depressive symptoms from forty minutes to three days after infusion (DiazGranados et al., 2010). These prolonged effects of treatment may not have been identified under a cross-sectional study.
The second clinical-trial also implemented ideal study designs. Although the scholars utilized an open-label strategy, sufficient information was collected at the beginning of the study. For example, a Structured Clinical Interview for Diagnosis, Diagnostic and Statistical Manual of Mental Disorders (SCID) was used to determine the eligibility of the participants, which included zero-diagnosis “of alcohol or substance abuse or dependence ninety days prior to the study” (DiazGranados et al., 2010, p. 4). Besides, medical examinations such as routine blood labs, electrocardiogram, and urine toxicology were conducted to assess the patients’ state of health (DiazGranados et al., 2010). The procedure facilitated the selection of ideal participants for the clinical trial, whose outcomes would generate a concise conclusion on the efficacy of ketamine use among mental health patients.
Questions Unanswered in the Literature
Although the selected literature is associated with several strengths, it fails to answer some clinical questions. The other research, on N-methyl-D-aspartate-receptor antagonist use in patients with treatment-resistance major depressive disorder, lacks a comprehensive assessment of the adverse outcomes of ketamine infusion. Studies show a close link between ketamine use and some concerning effects, such as induction of psychotic and dissociative symptoms (Dowben, Grant & Keltner, 2013). The outcome can be evaluated through observation of patients’ behavior after drug administration and using special equipment to measure progressive vital signs. This strategy was used in a medical case involving a twenty-six-year-old male combat veteran diagnosed with post-traumatic stress disorder and chronic depressive disorder. Vital signs, including blood pressure and heart rate, were measured before and after clinical intervention to assess potential untoward effects (Womble, 2013). The omission of these possible dissociative signs may have a negative implication on nursing practice, especially among caregivers with limited knowledge on the effects of ketamine.
Additionally, although the studies prove positive results associated with short term effects of the drug, they fail to express response to longer-term effects. Some scholarly work associate long-term ketamine use with spatial memory impairment. This is especially the case among patients who abuse the medication. The selected articles fail to highlight these adverse outcomes, which may have occurred among participants involved in the longitudinal study. Future research should assess this aspect, to help caregivers understand potential side effects and areas for improvement with the medication used.
Weaknesses of the Literature
Both studies utilized a small sample size. In one clinical-trial, eighteen subjects were included, while the other setting engaged thirty-three participants. Development of a sample population was based on the number of patients that met the study criteria. In clinical studies, it is essential to have an ample population to identify variations in the research outcomes, which may not be realized in a smaller group. Although the chosen literature provides substantial evidence that supports the effectiveness of ketamine use over other standard antidepressants, the results may not be generalizable over a large population.
Recommendations
Existing limitations in the selected literature necessitate improvements in the manner in which studies are conducted on therapeutic effects of ketamine on mental illness. Nursing researchers should adopt a multi-faceted approach in evaluating outcomes associated with the infusion of medication. It is crucial for scholars to acknowledge potential post-infusion side effects and to record them during the study. Notably, there would be need for researchers to highlight both short and long term effects of ketamine use among participants. The practice may enable clinical providers to make informed decisions on the safety of ketamine use among patients.
Researchers should also observe safety measures when administering ketamine among patients. First, it would be essential to infuse the correct dosage. Clinicians are required to administer 0.5mg/kg of ketamine hydrochloride (DiazGranados et al., 2010). It would also be essential to understand that the medication is an anesthetic. Therefore, it may cause temporary dizziness among subjects. Some of the measures that can be taken to prevent anesthetic-related falls include assisting patients to walk around and monitoring their vision, gait, and alertness after drug administration (Dowben et al., 2013). These precautions may help enhance a patient’s well-being and reduce costs associated with hospital falls.
References
Diazgranados, N., Ibrahim, L., Brutsche, N., Ameli, R., Henter, I … & Zarate, C. (2010). Rapid resolution of suicidal ideation after a single infusion of an N-methyl-D-aspartate antagonist in patients with treatment-resistant major depressive disorder. The Journal of Clinical Psychiatry, 71(12), 1605-1611.
Diazgranados, N., Ibrahim, L., Brutsche, N., Newberg, A., Kronstein, P … & Zarate, C. (2010). A randomized add-on-trial of an N-methyl-D-aspartate Antagonist in treatment-resistant bipolar depression. Archives of General Psychiatry, 67(8), 793-802.
Dowben, J., Grant, J. & Keltner, N. (2013). Biological perspectives. Perspectives in Psychiatric Care, 49(1), 2-4.
Howland, R. H. (2013). Ketamine for the treatment of depression. Journal of Psychosocial Nursing and Mental Health Services, 51(1), 11-14. doi:10.3928/02793695-20121219-01
Womble, A. (2013). Effects of ketamine on major depressive disorder in a patient with posttraumatic stress disorder. AANA Journal, 81(2), 118-119.
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