Authors: Jason Chang, DNP, ARNP-C
Affiliations: AVYIA
Corresponding Author/Contact: jason.chang@avyia.com
Abstract
M&M, a 49-year-old female with a longstanding history of depression and anxiety since adolescence, underwent a personalized microdosing ketamine regimen after failing conventional antidepressant therapies. Adjustments in dosing led to improvements in her depressive symptoms, suicidal ideation, and overall mood. Patient feedback included observations of “fewer thoughts of suicide” and moments described as “true happiness” by her and her husband. This case report outlines her treatment course and outcomes.
Keywords
Depression, anxiety, suicidal ideation, microdosing ketamine, personalized titration, patient experience
Introduction
Treatment-resistant depression and anxiety pose significant challenges, especially when conventional therapies yield limited benefits. This case report examines M&M’s response to a personalized ketamine microdosing protocol that led to improved mood and reduced suicidal ideation, offering insights into an alternative therapeutic approach.
Case Presentation
Patient Information:
- Demographics: 49-year-old female (M&M)
- History: Chronic depression, anxiety, and suicidal ideation dating back to age 14, with a history of anorexia nervosa and bulimia nervosa (currently in remission).
Clinical Findings:
- Symptoms: Persistent depressive moods, intrusive suicidal thoughts (described by the patient as “just thoughts”), and anxiety that’s poorly responsive to prior medications.
- Patient Narrative: M&M’s initial interest in ketamine was spurred by a friend’s positive experience with the treatment.
- Medication History: Previous trials with Effexor and Cymbalta were ineffective and accompanied by undesirable side effects. She has also trialed using Gabapentin, THC, and psilocybin microdosing with limited benefits.
Diagnostic Assessment
- Evaluation: Comprehensive psychiatric assessment confirmed treatment-resistant depression.
- Review: Evaluation of medication history and side effects guided the decision for a personalized ketamine titration.
Therapeutic Intervention
Following a thorough intake assessment, M&M was started on a personalized microdosing ketamine regimen with gradual dose titration.
- Adjustment: Initially, she hesitated to increase the dose due to sedative effects, but after fine-tuning her dosing schedule, she began noticing early improvements.
- Adjunctive Treatments: A new SSRI was added, and she continued regular psychotherapy.
Follow-up and Outcomes
Within days of the adjusted regimen, M&M noted:
- An improvement in depressive symptoms, with “fewer thoughts of suicide” and a reduction in intrusive thoughts.
- Both she and her husband observed her smiling more and experiencing “moments of true happiness.”
- Her overall clinical picture steadily improved as dosing adjustments and supportive therapies continued.
Discussion
M&M’s case illustrates that personalized dosing of ketamine, when combined with standard psychiatric care, can provide significant benefits in treatment-resistant mood disorders. Her experience underscores the importance of individualizing treatment to minimize side effects while maximizing therapeutic outcomes. This case study suggests that while SSRIs may be the first line treatment of mood disorders, ketamine should be considered shortly after the initial medication(s) fail to improve the patient’s mood.
Conclusion
The positive clinical outcomes observed in M&M’s case, supported by her own quotes on reduced suicidal ideation and enhanced happiness, demonstrate the potential for ketamine microdosing as a valuable adjunct in managing chronic depression and anxiety. Continued monitoring and further research are recommended.
Patient Consent and Ethical Considerations
Informed consent was obtained from M&M for publication, with all identifiers removed to ensure confidentiality.
References
References available upon request.
