Case notes

Severe depression

Neuro Medical Clinic, Mall Road, Saddar, Rawalpindi · Dr. Umar Zafar Ali, Neurologist & Medical Specialist

A young lady with severe depression , aggression and suicidal ideation.

Had treatment with many psychiatrists for last 4-5 years. Combination of various antidepressants and ECT done with no relief.

Brought in with low mood ,refusal to undergo treatment from psychiatrist and suicidal thoughts.

Left with few choices, ketamine was tried.

Ketamine is NMDA receptor agonist. It has rapid antidepressant effect which last for several weeks. For this low dosage is used and it can be given orally. A 50 – 100 mg single oral dose at night usually gives a good result.

Patient was advised single dose with a repeat dose at 04 weeks. Patient showed a remarkable recovery.

At present she is on regular SSRI therapy, with no suicidal ideation and willing to change her life for better.

Doing it properly

Little and often beats one long session. Keep to the stated frequency for at least two weeks before judging whether it is helping, and stop any movement that causes sharp pain rather than working through it.

Come in if

Symptoms are worsening, waking you at night, spreading to a new limb, or unchanged after four weeks. Walk in during clinic hours — Monday to Saturday, 11:00 am to 06:00 pm — and bring this guide and any reports with you.

A question about your own case is better answered by the doctor than by a guide. Message the clinic with your name and file number.

General education, not a prescription. Seek urgent care for sudden weakness, slurred speech, a first-ever fit, a face that has drooped, or the worst headache of your life.