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Dr. Andrew Rynne

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How to treat persistent depression symptoms in an elderly patient despite taking Ketamine?

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Dr. Salah Saad Shoman

Internal Medicine Specialist

Practicing since :2004

Answered : 1655 Questions

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Posted on Wed, 23 May 2018 in Medicines and Side Effects
Question: Just had 5 th Ketamine inf, 4 & 5 produced NO EFFECTS, EVEN THO DOC INCREASED DOSE BY 20% ON 5TH TRY. There was, I repeat no relaxation no comfort , nothing. He said he simply had not seen this before. Any ideas?

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Answered by Dr. Salah Saad Shoman 40 minutes later
Brief Answer:
NMDA receptor dysfunction

Detailed Answer:
Dear Ma'am, I have gone through your question and I understand your concerns but Ketamine exerts its effects by blocking NMDA receptors and stimulating AMPA receptors.. The NMDA receptors appear to be more affected than other glutamate receptors by the aging process, such that there is an overall decline in their number and functionality.. It is possible that those individuals with geriatric depression do not have sufficient NMDA receptors present for effective binding by ketamine, or that the NMDA are not functionally active to bind with kitamine resulting in failed therapy .. I hope you find this helpful..
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