The Role of Ketamine in Treatment-Resistant Depression: A Systematic Review

Summary & key facts

Researchers looked through published studies to see how well ketamine works for people whose depression did not get better with usual treatments. They combined 24 studies that included 416 people. Most studies found that ketamine caused fast improvement in depressive symptoms, sometimes within hours, and it also reduced suicidal thoughts in these groups. However, most studies did not check how long the benefit lasts, and ketamine can cause unusual mind or perception changes that make using it harder to manage.

Key facts:

• The authors reviewed 24 studies that together included 416 people with treatment-resistant depression, which means their depression did not improve with standard treatments.
• Most studies showed that ketamine produced rapid antidepressant effects, with some patients reporting improvement within hours after a dose.
• Several studies reported that ketamine reduced suicidal thoughts in people with treatment-resistant depression.
• The review found that the long-term benefits of ketamine were not well studied; most research only looked at short-term effects.
• Ketamine can cause psychotomimetic effects, which means it can produce odd changes in perception or thinking similar to hallucinations, and this may complicate its use.
• The authors concluded that ketamine is an interesting and potentially useful option for people with hard-to-treat depression, but they said more research is needed to understand how well it works over time and how best to give it.

Abstract

BACKGROUND: At least 10-20% of the patients suffering from depression meet criteria for treatment-resistant depression (TRD). In the last decades, an important role of glutamate in mood modulation has been hypothesized and ketamine, a non noncompetitive antagonist of the N-methyl-D-aspartate (NMDA) receptors, has been demonstrated to be effective in both MDD and TRD. However, concerns emerged about the optimal dosage, and frequency of administration of this treatment. METHODS: aiming to systematically review the current literature focusing on the main pharmacological properties and impact of ketamine in TRD, a detailed literature search in PubMed/Medline and ScienceDirect databases was conducted. Twenty-four manuscripts including a total of 416 patients fulfilled inclusion criteria. RESULTS: Most studies demonstrated that the NMDA antagonist ketamine has rapid antidepressant effects in TRD patients, confirming the active role of glutamate in the pathophysiology of this complex condition. Ketamine has been demonstrated to be rapidly effective and was associated with a significant clinical improvement in depressive symptoms within hours after administration. Also, ketamine was also found to be effective in reducing suicidality in TRD samples. LIMITATIONS: The long-term efficacy of ketamine has not been investigated by most studies. The psychotomimetic properties may complicate the application of this pharmacological agent. CONCLUSIONS: Ketamine may be considered a valid and intriguing antidepressant option for the treatment of TRD. Further studies are needed to evaluate its long-term antidepressant efficacy in patients with TRD.

Topics

Neurotransmitter Receptor Influence on Behavior Treatment of Major Depression Tryptophan and brain disorders

Categories

Health Sciences Medicine Pharmacology

Tags

Anesthesia Animal models of depression Antagonist Antidepressant Anxiety Depression (economics) Economics Glutamate receptor Internal medicine Ketamine Macroeconomics Major depressive disorder Medicine Mood NMDA receptor Pharmacology Psychiatry Psychotomimetic Receptor Treatment-resistant depression

Substances

Ketamine

Conditions & symptoms

Anxiety Depression Lack of energy or motivation Sadness or low mood