Evaluation of initial Ketamine/Milnacipran co-prescription in palliative depression

Primary objective

To show an improvement in the depressive syndrome for patients followed in palliative care by ketamine in combination with milnacipran: greater reduction in MADRS score in the ketamine group compared with the control group (placebo).

Secondary objectives and hypotheses generated

• Specify antidepressant response modalities:
  • Number of responding patients
  • Number of patients in remission
  • Quantify depressive symptoms by self-assessment
• Evaluate improvement in global functioning and quality of life;
• Evaluate reduction in suicidal intentions and requests for euthanasia secondary to depressive syndrome;
• Expected benefit for the patient: rapid resolution of depressive symptoms by the addition of ketamine, before the effect of a conventional antidepressant prescribed alone;
• Expected benefit in terms of knowledge of the effect and conditions of implementation of this treatment in palliative care;
• Risk related to the injection and tolerance of treatments, which remain treatments of usual use in palliative care in other indications.