Ketamine and Nitroprusside for Depression

Exclusion Criteria

• •Lifetime history of psychotic features, diagnosis of schizophrenia or any other psychotic disorder, or diagnosis of bipolar disorder;
• •Lifetime histories of autism, mental retardation, pervasive developmental disorders, or Tourette's syndrome;
• •Current diagnosis of obsessive compulsive disorder (OCD) or eating disorder (bulimia nervosa or anorexia nervosa);
• •Subjects with DSM-V drug or alcohol abuse/dependence within the preceding 2 years;
• •Patients with schizotypal or antisocial personality disorder, or any clinically significant axis II disorder that would, in the investigator's judgment, preclude safe study participation;
• •Patients judged clinically to be at serious and imminent suicidal or homicidal risk;
• •Women who are either pregnant or nursing;
• •Any serious, unstable medical illnesses including hepatic, renal impairment, gastroenterologic, respiratory, cardiovascular, endocrinologic, neurologic, immunologic, or hematologic disease;
• •History of congestive heart failure or established coronary artery disease;
• •History of cerebrovascular insufficiency
• •History of intrapulmonary arteriovenous shunts, co-arctation of the aorta or other conditions where cardiac outflow tract is obstructed;
• •Vitamin B12 deficiency;
• •Clinically significant abnormal findings of laboratory parameters, physical examination, or ECG;
• •Renal impairment, as reflected by a BUN \> 20 mg/dL and/or creatinin clearance of \>1.3 mg/dL;
• •Thyroid impairment, as reflected by a thyroid-stimulating hormone (TSH) \> 4.2 mU/L;
• •Hepatic injury, as reflected by AST or ALT greater than twice the upper limit of the reference range (AST: \>80; ALT \>110)
• •Patients who have a positive urine toxicology for illicit substances at screening and within 24 hours of the infusion;
• •Treatment with an irreversible MAOI within 2 weeks prior to randomization or fluoxetine within 4 weeks prior to randomization;
• •Treatment with other antidepressants (classified as SSRIs, SNRIs, Atypical Antidepressants, MAOIs, TCAs) within one week of randomization.
• •Previous recreational use of phencyclidine (PCP) or KET;
• •Hypertension with systolic BP \>160 mm Hg or diastolic BP \>90 mm Hg at screening, systolic BP \> 165 mm Hg or diastolic BP \> 95 mm Hg immediately prior to treatment with study drug or hypotension with systolic BP \< 90 or diastolic \< 60 at screening or immediately prior to treatment with study drug; heart rate \>110 or \<60 at either of these time points;
• •Treatment with sildenafil (Viagra), tadalafil (Cialis), Avanafil (Stendra), Vardenafil (Levitra) or other drugs in the same category of phosphodiesterase-5 enzyme inhibitors within 2 weeks of infusion.