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Ketamine subcutaneous continuous infusion for depressive symptoms at home: A case report beyond pain use

Published online by Cambridge University Press:  06 May 2024

Carolina Simões Open the ORCID record for Carolina Simões [Opens in a new window] ,
Miguel Julião Open the ORCID record for Miguel Julião [Opens in a new window] ,
Patrícia Calaveiras Open the ORCID record for Patrícia Calaveiras [Opens in a new window] ,
Paula Câmara  and
Teresa Santos
Carolina Simões
Affiliation:
Department of Palliative Medicine, Equipa Comunitária de Suporte em Cuidados Paliativos de Sintra, ULS Amadora/Sintra, Sintra, Portugal
Miguel Julião*
Affiliation:
Department of Palliative Medicine, Equipa Comunitária de Suporte em Cuidados Paliativos de Sintra, ULS Amadora/Sintra, Sintra, Portugal
Patrícia Calaveiras
Affiliation:
Department of Palliative Medicine, Equipa Comunitária de Suporte em Cuidados Paliativos de Sintra, ULS Amadora/Sintra, Sintra, Portugal
Paula Câmara
Affiliation:
Department of Palliative Medicine, Equipa Comunitária de Suporte em Cuidados Paliativos de Sintra, ULS Amadora/Sintra, Sintra, Portugal
Teresa Santos
Affiliation:
Department of Palliative Medicine, Unidade de Cuidados na Comunidade de Vila Franca de Xira, ULS Estuário do Tejo, Vila Franca de Xira, Portugal
*
Corresponding author: Miguel Julião; Email: migueljuliao@gmail.com
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Abstract

Objectives

Ketamine has been widely used in refractory pain as an opioid adjuvant. Evidence suggests that ketamine can also have an essential role in easing depressive symptoms. Its rapid onset of action makes it a valuable choice in palliative care.

Methods

We present a case of a 70-year-old man with stage IV renal carcinoma and bone metastasis. The main symptoms included neuropathic pain, depression, and a persistent and severe desire for death.

Results

We started continuous subcutaneous infusion with morphine 30 mg and ketamine 100 mg/day. The dose of ketamine was incremented to the maximum of 250 mg/day. During the 28-day treatment, we observed an overall improvement in neuropathic pain, depressive symptoms, and other end-of-life psychological aspects of distress. Only minor psychological side effects were identified, which were controlled by using midazolam in the continuous subcutaneous infusion.

Significance of results

Some studies have already demonstrated the benefits of ketamine use in alleviating depression, using parental infusion or oral formulas, which are administered in hospice care. Our report enhances the benefit of the subcutaneous route for palliative patients cared for at home.

Keywords

Paindepressive symptomsketaminesubcutaneous continuous infusionhome-based palliative care
Type
Case Report
Information
Palliative & Supportive Care , First View , pp. 1 - 5
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Copyright
© The Author(s), 2024. Published by Cambridge University Press.

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