The Experts below are selected from a list of 1536 Experts worldwide ranked by ideXlab platform
Rudolf Stohler - One of the best experts on this subject based on the ideXlab platform.
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repeated intravenous ketamine therapy in a patient with treatment resistant major depression
World Journal of Biological Psychiatry, 2009Co-Authors: Michael Liebrenz, Rudolf Stohler, Alain BorgeatAbstract:BACKGROUND: The intravenous administration of ketamine, an N-methyl-D-aspartate receptor antagonist, results in a great improvement of depression symptoms, but it is not clear for how long. This single-case trial was conducted to explore the duration of improvement and the effects of a second administration on the clinical outcome. METHODS: In an open label trial, a 55-year-old male patient with treatment-resistant major depression and a co-occurring alcohol and Benzodiazepine Dependence received two intravenous infusions of 0.5 mg/kg ketamine over the course of 6 weeks. Depression severity was assessed by means of a weekly clinical interview, the 21-item Hamilton Depression Rating Scale (HDRS), and the 21-item Beck Depression Inventory (BDI). RESULTS: The first ketamine infusion lead to a pronounced improvement of symptoms, peaking on the second day post infusion (HDRS -56.6%, BDI -65.4%). Positive effects started fading by day 7, reaching baseline by day 35. The second infusion was less efficacious: HDRS and BDI were reduced by 43 and 35%, respectively, and returned to baseline by day 7. CONCLUSION: In this patient with a co-occurring substance use disorder, repeated administrations of ketamine produced positive results. Since the second application has been less efficacious, doses and schedule of administrations need to be further investigated.
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intravenous ketamine therapy in a patient with a treatment resistant major depression
Swiss Medical Weekly, 2007Co-Authors: Michael Liebrenz, Alain Borgeat, Ria Leisinger, Rudolf StohlerAbstract:BACKGROUND: Recently, reports from North America have indicated that the intravenous infusion of ketamine hydrochloride (an N-methyl-d-aspartate receptor antagonist) results in a sudden and robust improvement of depression symptoms. OBJECTIVE: To corroborate antidepressant effectiveness of IV ketamine in a patient with a co-occurring substance use disorder for the first time in a European clinical setting. DESIGN: Open label trial Methods: A 55-year-old male subject with a treatment-resistant major depression and a co-occurring alcohol and Benzodiazepine Dependence received an intravenous infusion of 0.5 mg/kg ketamine over a period of 50 minutes. Effects were assessed by means of a clinical interview, the 21-item Hamilton Depression Rating scale (HDRS), and the 21-item Beck Depression Inventory (BDI) at baseline, 1 hour, 1 day, 2 days, and 7 days after intervention. RESULTS: Following the administration of ketamine the subject experienced a significant improvement of his symptoms peaking on the 2nd day post infusion (HDRS from 36 to 16; -56.6%, BDI from 26 to 9; -65.4%). The subject first reported improvements 25 min. into the infusion and continued to describe positive effects throughout the subsequent 7 days. CONCLUSION: Ketamine not only seems to have strong antidepressant effects but also to act very swiftly. These actions were unaffected by an alcohol or benzodiazpine Dependence.
Fabio Lugoboni - One of the best experts on this subject based on the ideXlab platform.
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slow subcutaneous infusion of flumazenil for the treatment of long term high dose Benzodiazepine users a review of 214 cases
Journal of Psychopharmacology, 2016Co-Authors: Marco Faccini, Roberto Leone, Sibilla Opri, Rebecca Casari, Chiara Resentera, Laura Morbioli, Anita Conforti, Fabio LugoboniAbstract:Despite the first reports concerning Benzodiazepine Dependence being published in the early 1960s literature, the risk of Benzodiazepine addiction is still greatly debated. The severe discomfort and life threatening complications usually experienced by long-term Benzodiazepine users who suddenly interrupt Benzodiazepine intake have led to the development of several detoxification protocols. A successful strategy used by our Addiction Unit is abrupt Benzodiazepine cessation by administering flumazenil slow subcutaneous infusion (FLU-SSI) with an elastomeric pump. Although some studies proved the efficacy of flumazenil infusion more than 20 years ago, only a few centres in the world offer this method to their patients. This paper reports the data related to 214 subjects addicted to high doses of Benzodiazepine and treated with the FLU-SSI method between 2012 and 2014. This technique is less invasive and requires less nursing intervention than intravenous infusion. Our data support FLU-SSI as a possible effi...
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high dose Benzodiazepine Dependence description of 29 patients treated with flumazenil infusion and stabilised with clonazepam
Psychiatry Research-neuroimaging, 2012Co-Authors: Gianluca Quaglio, Cristian Pattaro, Gilberto Gerra, Sophie Mathewson, Paul Verbanck, Don Des C Jarlais, Fabio LugoboniAbstract:The withdrawal syndrome from Benzodiazepine (BZD) can be severe and in some cases may impede cessation of the use of the drug. We present here a case series of Benzodiazepine detoxification by flumazenil infusion, stabilised with clonazepam. Patients were treated with flumazenil 1.35 mg/day for a median of 7 days. Self-reported physical withdrawal symptoms were recorded daily. In addition to flumazenil, antidepressants were given before treatment commenced and clonazepam was administered nightly with both being continued after discharge. Twenty-nine patients were treated. No patients dropped out from the treatment programme. Nine patients (31%) required a temporary reduction/cessation of the infusion. The linear trend in the reduction of the daily withdrawal scores in the overall study population was significant. The linear trends were also significant in the group of patients for whom a temporary reduction/suspension of the flumazenil was required. Six months after treatment, 15 patients (53%) were abstinent from clonazepam and other BZDs. For five (21%) the BZD Dependence were reinstated. More than two-thirds of the subjects tolerated the procedure well and about half had a good long term response. Slow flumazenil infusion appears to merit consideration as a possible future treatment. Suggestions for future research are examined.
Michael Liebrenz - One of the best experts on this subject based on the ideXlab platform.
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attitudes towards a maintenance agonist treatment approach in high dose Benzodiazepine dependent patients a qualitative study
Harm Reduction Journal, 2016Co-Authors: Michael Liebrenz, Marcel Andre Schneider, Anna Buadze, Marietherese Gehring, Anish Dube, Carlo CaflischAbstract:High-dose Benzodiazepine Dependence constitutes a major clinical concern. Although withdrawal treatment is recommended, it is unsuccessful for a significant proportion of affected patients. More recently, a Benzodiazepine maintenance approach has been suggested as an alternative for patients’ failing discontinuation treatment. While there is some data supporting its effectiveness, patients’ perceptions of such an intervention have not been investigated. An exploratory qualitative study was conducted among a sample of 41 high-dose Benzodiazepine (BZD)-dependent patients, with long-term use defined as doses equivalent to more than 40 mg diazepam per day and/or otherwise problematic use, such as mixing substances, dose escalation, recreational use, or obtainment by illegal means. A qualitative content analysis approach was used to evaluate findings. Participants generally favored a treatment discontinuation approach with abstinence from BZD as its ultimate aim, despite repeated failed attempts at withdrawal. A maintenance treatment approach with continued prescription of a slow-onset, long-acting agonist was viewed ambivalently, with responses ranging from positive and welcoming to rejection. Three overlapping themes of maintenance treatment were identified: “Only if I can try to discontinue…and please don’t call it that,” “More stability and less criminal activity…and that is why I would try it,” and “No cure, no brain and no flash…and thus, just for everybody else!” Some patients experienced slow-onset, long-acting BZDs as having stabilized their symptoms and viewed these BZDs as having helped avoid uncontrolled withdrawal and abstain from criminal activity. We therefore encourage clinicians to consider treatment alternatives if discontinuation strategies fail.
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Attitudes towards a maintenance (-agonist) treatment approach in high-dose Benzodiazepine-dependent patients: a qualitative study
Harm Reduction Journal, 2016Co-Authors: Michael Liebrenz, Anna Buadze, Marietherese Gehring, Anish Dube, Marcel Schneider, Carlo CaflischAbstract:Background High-dose Benzodiazepine Dependence constitutes a major clinical concern. Although withdrawal treatment is recommended, it is unsuccessful for a significant proportion of affected patients. More recently, a Benzodiazepine maintenance approach has been suggested as an alternative for patients’ failing discontinuation treatment. While there is some data supporting its effectiveness, patients’ perceptions of such an intervention have not been investigated. Methods An exploratory qualitative study was conducted among a sample of 41 high-dose Benzodiazepine (BZD)-dependent patients, with long-term use defined as doses equivalent to more than 40 mg diazepam per day and/or otherwise problematic use, such as mixing substances, dose escalation, recreational use, or obtainment by illegal means. A qualitative content analysis approach was used to evaluate findings. Results Participants generally favored a treatment discontinuation approach with abstinence from BZD as its ultimate aim, despite repeated failed attempts at withdrawal. A maintenance treatment approach with continued prescription of a slow-onset, long-acting agonist was viewed ambivalently, with responses ranging from positive and welcoming to rejection. Three overlapping themes of maintenance treatment were identified: “Only if I can try to discontinue…and please don’t call it that,” “More stability and less criminal activity…and that is why I would try it,” and “No cure, no brain and no flash…and thus, just for everybody else!” Conclusions Some patients experienced slow-onset, long-acting BZDs as having stabilized their symptoms and viewed these BZDs as having helped avoid uncontrolled withdrawal and abstain from criminal activity. We therefore encourage clinicians to consider treatment alternatives if discontinuation strategies fail.
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repeated intravenous ketamine therapy in a patient with treatment resistant major depression
World Journal of Biological Psychiatry, 2009Co-Authors: Michael Liebrenz, Rudolf Stohler, Alain BorgeatAbstract:BACKGROUND: The intravenous administration of ketamine, an N-methyl-D-aspartate receptor antagonist, results in a great improvement of depression symptoms, but it is not clear for how long. This single-case trial was conducted to explore the duration of improvement and the effects of a second administration on the clinical outcome. METHODS: In an open label trial, a 55-year-old male patient with treatment-resistant major depression and a co-occurring alcohol and Benzodiazepine Dependence received two intravenous infusions of 0.5 mg/kg ketamine over the course of 6 weeks. Depression severity was assessed by means of a weekly clinical interview, the 21-item Hamilton Depression Rating Scale (HDRS), and the 21-item Beck Depression Inventory (BDI). RESULTS: The first ketamine infusion lead to a pronounced improvement of symptoms, peaking on the second day post infusion (HDRS -56.6%, BDI -65.4%). Positive effects started fading by day 7, reaching baseline by day 35. The second infusion was less efficacious: HDRS and BDI were reduced by 43 and 35%, respectively, and returned to baseline by day 7. CONCLUSION: In this patient with a co-occurring substance use disorder, repeated administrations of ketamine produced positive results. Since the second application has been less efficacious, doses and schedule of administrations need to be further investigated.
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intravenous ketamine therapy in a patient with a treatment resistant major depression
Swiss Medical Weekly, 2007Co-Authors: Michael Liebrenz, Alain Borgeat, Ria Leisinger, Rudolf StohlerAbstract:BACKGROUND: Recently, reports from North America have indicated that the intravenous infusion of ketamine hydrochloride (an N-methyl-d-aspartate receptor antagonist) results in a sudden and robust improvement of depression symptoms. OBJECTIVE: To corroborate antidepressant effectiveness of IV ketamine in a patient with a co-occurring substance use disorder for the first time in a European clinical setting. DESIGN: Open label trial Methods: A 55-year-old male subject with a treatment-resistant major depression and a co-occurring alcohol and Benzodiazepine Dependence received an intravenous infusion of 0.5 mg/kg ketamine over a period of 50 minutes. Effects were assessed by means of a clinical interview, the 21-item Hamilton Depression Rating scale (HDRS), and the 21-item Beck Depression Inventory (BDI) at baseline, 1 hour, 1 day, 2 days, and 7 days after intervention. RESULTS: Following the administration of ketamine the subject experienced a significant improvement of his symptoms peaking on the 2nd day post infusion (HDRS from 36 to 16; -56.6%, BDI from 26 to 9; -65.4%). The subject first reported improvements 25 min. into the infusion and continued to describe positive effects throughout the subsequent 7 days. CONCLUSION: Ketamine not only seems to have strong antidepressant effects but also to act very swiftly. These actions were unaffected by an alcohol or benzodiazpine Dependence.
Alain Borgeat - One of the best experts on this subject based on the ideXlab platform.
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repeated intravenous ketamine therapy in a patient with treatment resistant major depression
World Journal of Biological Psychiatry, 2009Co-Authors: Michael Liebrenz, Rudolf Stohler, Alain BorgeatAbstract:BACKGROUND: The intravenous administration of ketamine, an N-methyl-D-aspartate receptor antagonist, results in a great improvement of depression symptoms, but it is not clear for how long. This single-case trial was conducted to explore the duration of improvement and the effects of a second administration on the clinical outcome. METHODS: In an open label trial, a 55-year-old male patient with treatment-resistant major depression and a co-occurring alcohol and Benzodiazepine Dependence received two intravenous infusions of 0.5 mg/kg ketamine over the course of 6 weeks. Depression severity was assessed by means of a weekly clinical interview, the 21-item Hamilton Depression Rating Scale (HDRS), and the 21-item Beck Depression Inventory (BDI). RESULTS: The first ketamine infusion lead to a pronounced improvement of symptoms, peaking on the second day post infusion (HDRS -56.6%, BDI -65.4%). Positive effects started fading by day 7, reaching baseline by day 35. The second infusion was less efficacious: HDRS and BDI were reduced by 43 and 35%, respectively, and returned to baseline by day 7. CONCLUSION: In this patient with a co-occurring substance use disorder, repeated administrations of ketamine produced positive results. Since the second application has been less efficacious, doses and schedule of administrations need to be further investigated.
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intravenous ketamine therapy in a patient with a treatment resistant major depression
Swiss Medical Weekly, 2007Co-Authors: Michael Liebrenz, Alain Borgeat, Ria Leisinger, Rudolf StohlerAbstract:BACKGROUND: Recently, reports from North America have indicated that the intravenous infusion of ketamine hydrochloride (an N-methyl-d-aspartate receptor antagonist) results in a sudden and robust improvement of depression symptoms. OBJECTIVE: To corroborate antidepressant effectiveness of IV ketamine in a patient with a co-occurring substance use disorder for the first time in a European clinical setting. DESIGN: Open label trial Methods: A 55-year-old male subject with a treatment-resistant major depression and a co-occurring alcohol and Benzodiazepine Dependence received an intravenous infusion of 0.5 mg/kg ketamine over a period of 50 minutes. Effects were assessed by means of a clinical interview, the 21-item Hamilton Depression Rating scale (HDRS), and the 21-item Beck Depression Inventory (BDI) at baseline, 1 hour, 1 day, 2 days, and 7 days after intervention. RESULTS: Following the administration of ketamine the subject experienced a significant improvement of his symptoms peaking on the 2nd day post infusion (HDRS from 36 to 16; -56.6%, BDI from 26 to 9; -65.4%). The subject first reported improvements 25 min. into the infusion and continued to describe positive effects throughout the subsequent 7 days. CONCLUSION: Ketamine not only seems to have strong antidepressant effects but also to act very swiftly. These actions were unaffected by an alcohol or benzodiazpine Dependence.
Ria Leisinger - One of the best experts on this subject based on the ideXlab platform.
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intravenous ketamine therapy in a patient with a treatment resistant major depression
Swiss Medical Weekly, 2007Co-Authors: Michael Liebrenz, Alain Borgeat, Ria Leisinger, Rudolf StohlerAbstract:BACKGROUND: Recently, reports from North America have indicated that the intravenous infusion of ketamine hydrochloride (an N-methyl-d-aspartate receptor antagonist) results in a sudden and robust improvement of depression symptoms. OBJECTIVE: To corroborate antidepressant effectiveness of IV ketamine in a patient with a co-occurring substance use disorder for the first time in a European clinical setting. DESIGN: Open label trial Methods: A 55-year-old male subject with a treatment-resistant major depression and a co-occurring alcohol and Benzodiazepine Dependence received an intravenous infusion of 0.5 mg/kg ketamine over a period of 50 minutes. Effects were assessed by means of a clinical interview, the 21-item Hamilton Depression Rating scale (HDRS), and the 21-item Beck Depression Inventory (BDI) at baseline, 1 hour, 1 day, 2 days, and 7 days after intervention. RESULTS: Following the administration of ketamine the subject experienced a significant improvement of his symptoms peaking on the 2nd day post infusion (HDRS from 36 to 16; -56.6%, BDI from 26 to 9; -65.4%). The subject first reported improvements 25 min. into the infusion and continued to describe positive effects throughout the subsequent 7 days. CONCLUSION: Ketamine not only seems to have strong antidepressant effects but also to act very swiftly. These actions were unaffected by an alcohol or benzodiazpine Dependence.