Oral Ketamine in the Treatment of Depression and Anxiety in Patients With Cancer

Inclusion Criteria: * Patients with cancer * Outpatient status at the time of study entry * 18 years of age or older * Life expectancy of at least 1 month * Regular access to a telephone (for safety reasons) * Reliable transportation to follow-up visits * Caregiver observation available for 24 hours after the dose * Histologically-proven malignancy * Depression score of \>11 on the Hospital Anxiety and Depression Scale (HADS) * Provision of informed consent * Able to complete the patient questionnaires alone or with assistance * Able to speak and read English * May receive other psycho-active medications while on the study i.e. opiates, except as defined within the exclusion criteria * May receive psychotherapy from an outside provider at the beginning and/or during the course of the study Exclusion Criteria: * Obvious cognitive dysfunction or Mini Mental Status Exam score \<20 * Antidepressants started or dose changed within 8 weeks of the beginning of the study or during the study * Benzodiazepines prescribed for psychiatric indications that have been started or dose change within 2 weeks of the beginning of study enrollment * Suicidal ideation or a suicide attempt within the last year * Patients with current or past psychosis not from delirium * Females who are pregnant or nursing * Unable to take oral medications * Primary or metastatic brain malignancy * Gastrointestinal tract obstruction * Prior adverse reaction to or other contraindication to ketamine * Substance abuse or dependence, as defined by Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria, within the last 90 days