INTRODUCTION: Depression is the most common psychiatric disorder that occurs following a Traumatic Brain Injury. To date, there are limited studies demonstrating the effectiveness of current treatments for this disorder and even less for those with repetitive injuries or rTBIs. Ketamine has been demonstrated to be effective in successfully treating depression and helping with damaged connectivity within the brain. It can be hypothesized that Ketamine may help with both of these areas that many TBI patients face after injury. This particular case report describes the successful treatment of a patient with a history of rTBIs who struggled with depression for the past several years. 

CASE PRESENTATION: Mr. M is as 51 year old single caucasian male who presented to the Actify Neurotherapies Treatment Center for treatment of his Major Depressive Disorder.  He had been depressed for five years but refused oral medication treatment due to fears over side effects. He presented with anergia, amotivation, feelings of sadness, anhedonia, impaired concentration and guilt/worthlessness with a QIDS score of 20 (Severe Depression) and GAD-7 of 18 (Severe Anxiety). Previous neuropsychological records revealed some cognitive impairment likely attributed to his multiple head injuries which included being hit over the head in an alley leading to amnesia for one month along with permanent anosmia. After completing a course of five Ketamine treatments, his symptoms either completely resolved or vastly improved as measured by the Levine Treatment Resistant Depression Scale (LRDTS). 

CONCLUSION: This case appears to be the first published report of a patient with multiple TBIs/rTBIs and Major depressive disorder successfully treated with intravenous ketamine. Overall, this illustrates the potential role that Ketamine may play in the treatment of psychiatric sequelae in individuals with a history of rTBIs. Ketamine has been demonstrated to increase BDNF and increase synaptogenesis which should encourage further research for brain injured individuals. Ketamine is also believed to potentially have neuroprotective effects as well which need to be further studied. Those with a history of one TBI are also at increased risk of having further rTBIs and therefore further increasing the chances of a depressive disorder. If one might be able to treat the individual before the repetitive event occurs, it may lead to quicker resolution of symptoms and may even decrease the chances of a subsequent event from occurring.  Further studies are necessary to validate and replicate the symptom resolution of the above case but indicates that this treatment may be a potential viable rapid treatment option for those struggling without relief in sight.

Intravenous Ketamine for Treatment of Major Depressive Disorder in a Patient with a History of Repetitive Traumatic Brain Injuries