Ketamine for the treatment of mental health and substance use disorders: comprehensive systematic review
Zach Walsh, Özden Merve Mollaahmetoğlu, Joseph M. Rootman, Shannon Golsof, Johanna Louise Keeler, Beth Marsh, David Nutt, Celia J. A. Morgan
BJPsych Open December 23, 2021 DOI: 10.1192/bjo.2021.1061 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Systematic review Randomized Open-label Peer reviewed |
|---|---|
| Intervention | Ketamine |
| Topics | Depression Ketamine Addiction Esketamine |
| Keywords | Systematic review Psycinfo Suicidal ideation Medline Meta-analysis Mental health Checklist Publication bias Randomized controlled trial Clinical psychology |
| Citations | 180 |
| Key findings | Systematic reviews and meta-analyses support robust, rapid, and transient antidepressant and anti-suicidal effects of ketamine. |
Abstract
Background: In the past two decades, subanaesthetic doses of ketamine have been demonstrated to have rapid and sustained antidepressant effects, and accumulating research has demonstrated ketamine's therapeutic effects for a range of psychiatric conditions.
Aims: In light of these findings surrounding ketamine's psychotherapeutic potential, we systematically review the extant evidence on ketamine's effects in treating mental health disorders.
Method: The systematic review protocol was registered in PROSPERO (identifier CRD42019130636). Human studies investigating the therapeutic effects of ketamine in the treatment of mental health disorders were included. Because of the extensive research in depression, bipolar disorder and suicidal ideation, only systematic reviews and meta-analyses were included. We searched Medline and PsycINFO on 21 October 2020. Risk-of-bias analysis was assessed with the Cochrane Risk of Bias tools and A Measurement Tool to Assess Systematic Reviews (AMSTAR) Checklist.
Results: We included 83 published reports in the final review: 33 systematic reviews, 29 randomised controlled trials, two randomised trials without placebo, three non-randomised trials with controls, six open-label trials and ten retrospective reviews. The results were presented via narrative synthesis.
Conclusions: Systematic reviews and meta-analyses provide support for robust, rapid and transient antidepressant and anti-suicidal effects of ketamine. Evidence for other indications is less robust, but suggests similarly positive and short-lived effects. The conclusions should be interpreted with caution because of the high risk of bias of included studies. Optimal dosing, modes of administration and the most effective forms of adjunctive psychotherapeutic support should be examined further.