Subanesthetic ketamine infusion reducing symptoms of depression in a patient with end-stage heart failure enrolled in hospice care: A case report

Authors

Tejaspreet Kaur, Advocate Aurora HealthFollow
Kavita Sharma, Advocate Aurora HealthFollow
Leanne Groban, Advocate Aurora HealthFollow

Recommended Citation

Kaur T, Sharma K, Groban L. Subanesthetic Ketamine Infusion Reducing Symptoms of Depression in a Patient With End-Stage Heart Failure Enrolled in Hospice Care: A Case Report. J Palliat Med. 2023;26(10):1435-1438. doi:10.1089/jpm.2022.0430

Affiliations

Zilber Family Hospice

Abstract

Background: The development of major depressive disorder in patients at end of life often goes undiagnosed, as it is difficult to distinguish from preparatory grief and/or hypoactive delirium in this unique patient population. If this preliminary barrier of appropriate diagnosis is overcome, it can be quite difficult to properly select and adjust pharmacological therapy. Many well-established antidepressants take four to five weeks for maximal effectiveness (which may be far too long of a titration period for patients at end of life), have various contraindications to patients' comorbid chronic conditions (particularly patients with cardiovascular disease), or may simply be ineffective. Case: We present a case report of severe treatment-resistant depression in an end-stage heart failure patient enrolled in hospice care. Discussion: We discuss the potential use of a single low-dose intravenous racemic ketamine infusion to reduce end-of-life suffering related to depression, despite the theoretical contraindication of ketamine use in such patients, in part, due to its sympathomimetic secondary effect.

Type

Article

PubMed ID

37327367