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04:29
Vagus Nerve Stimulation As an Adjunctive Neurostimulation Tool in Treatment-resistant Depression
Published on: January 7, 2019
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Symptom Reduction and Deprescribing in a Patient With Treatment-Resistant Depression Using Sublingual Ketamine
1School of Nursing, Duke University, Durham, USA.
Cureus
|August 5, 2025
Summary
Low-dose sublingual ketamine effectively treated a patient with treatment-resistant depression (TRD) and comorbid anxiety disorders. This approach facilitated the discontinuation of multiple psychotropic medications without adverse effects.
Area of Science:
- Psychiatry
- Pharmacology
- Neuroscience
Background:
- Treatment-resistant depression (TRD) presents a significant clinical challenge, often necessitating polypharmacy.
- Comorbid anxiety and trauma-related disorders complicate TRD management.
- Traditional pharmacologic strategies may yield limited efficacy in complex cases.
Observation:
- A 37-year-old male with major depressive disorder (MDD), post-traumatic stress disorder (PTSD), and social anxiety disorder showed poor response to escitalopram, quetiapine, trazodone, and gabapentin.
- The patient was treated with low-dose sublingual ketamine troches.
- Clinically significant improvements in depression and anxiety symptoms were observed.
Findings:
- Sublingual ketamine administration led to meaningful reductions in depression and anxiety symptom severity.
- The patient successfully tapered off four previously prescribed psychotropic medications.
- No adverse effects were reported during the ketamine treatment course.
Implications:
- Sublingual ketamine shows potential as an effective treatment for complex TRD with comorbidities.
- Ketamine therapy may support deprescribing efforts, simplifying medication regimens.
- This case underscores the utility of novel pharmacologic approaches in managing refractory psychiatric conditions.
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