Section - CAP Smart Takes

04. Dissociative Effects and Response to Ketamine in Youth With Treatment-Resistant Depression

Published on October 1, 2023 Certification expiration date: October 1, 2026

David R. Rosenberg, M.D.

Chair of the Department of Psychiatry & Behavioral Neuroscience - Wayne State University School of Medicine

Key Points

No association was found between ketamine's dissociative symptoms and treatment response in adolescents.
Adolescents receiving midazolam showed less depression improvement with higher depersonalization symptoms in 24 hours.
Tricyclic antidepressants are more effective in adults than in children and adolescents.

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Hi! David Rosenberg here for the Psychopharmacology Institute. In this CAP Smart Take, we examine the relationship between the dissociative effects of ketamine and treatment response in treatment-resistant adolescents with depression. Ketamine has generated significant excitement, particularly among adults with treatment-resistant and suicidal depression, due to its rapid antidepressant effect.

Lineham and colleagues studied 16 adolescents with treatment-resistant depression. In their 4-week trial, adolescents received an IV infusion of either ketamine 0.5 mg/kg over 40 minutes or midazolam 0.045 mg/kg over 40 minutes; the alternative agent was administered two weeks later. What were their findings?

No significant association between dissociative symptoms and improvement in depressive symptom severity or likelihood of ketamine response was observed in adolescents with treatment-resistant depression. This finding is notable as there have been conflicting results in adults. Some studies suggest that more dissociative symptoms experienced with ketamine infusion correlate with a greater and more sustained response

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05. Long-Acting Injectable Antipsychotics for Schizophrenia Spectrum Disorders in Youth

Learning Objectives:

Discuss the risks for reduced relapse for major depressive episodes in youth with continued antidepressant use vs placebo for 6-12 months.
Recognize the potential benefits and rare but severe side effects of antipsychotics in children with anorexia nervosa.
Recognize that there is no dose–response relationship in children and adolescents between sertraline exposure and cognitive, emotional, and behavioral outcomes as well as height.
Discuss the absence of an association between dissociative effects and depression improvement with ketamine or midazolam in treatment-resistant adolescents.
Discuss the potential efficacy of long-acting antipsychotics in adolescents with schizophrenia.

Original Release Date: October 1, 2023

Review and Re-release Date: March 1, 2024

Expiration Date: October 1, 2026

Expert: David Rosenberg, M.D.

Medical Editor: Melissa Mariano, M.D.

Relevant Financial Disclosures:

None of the faculty, planners, and reviewers for this educational activity have relevant financial relationships to disclose during the last 24 months with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

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This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of Medical Academy LLC and the Psychopharmacology Institute. Medical Academy is accredited by the ACCME to provide continuing medical education for physicians

Credit Designation Statement

Medical Academy designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.