Oral ketamine for the treatment of pain and treatment-resistant depression
Robert A Schoevers, Tharcila V. Chaves, Sonya M. Balukova, Marije Aan Het Rot, Rudie Kortekaas
The British Journal of Psychiatry February 1, 2016 DOI: 10.1192/bjp.bp.115.165498 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Systematic review Randomized Peer reviewed |
|---|---|
| Intervention | Ketamine |
| Topics | Anxiety Ketamine Depression Esketamine |
| Keywords | Tolerability Dosing Analgesic Depression economics Anesthesia Chronic pain Regimen Antidepressant Adverse effect |
| Citations | 80 |
| Key findings | The methodological strength of studies on ketamine's antidepressant effects is low regardless of route, and oral ketamine may be acceptable for treatment-resistant depression in terms of tolerability and side-effects, but longer-term consequences remain understudied. |
Abstract
Background: Recent studies with intravenous (i.v.) application of ketamine show remarkable but short-term success in patients with MDD. Studies in patients with chronic pain have used different ketamine applications for longer time periods. This experience may be relevant for psychiatric indications.
Aims: To review the literature about the dosing regimen, duration, effects and side-effects of oral, intravenous, intranasal and subcutaneous routes of administration of ketamine for treatment-resistant depression and pain.
Method: Searches in PubMed with the terms 'oral ketamine', 'depression', 'chronic pain', 'neuropathic pain', 'intravenous ketamine', 'intranasal ketamine' and 'subcutaneous ketamine' yielded 88 articles. We reviewed all papers for information about dosing regimen, number of individuals who received ketamine, number of ketamine days per study, results and side-effects, as well as study quality.
Results: Overall, the methodological strength of studies investigating the antidepressant effects of ketamine was considered low, regardless of the route of administration. The doses for depression were in the lower range compared with studies that investigated analgesic use. Studies on pain suggested that oral ketamine may be acceptable for treatment-resistant depression in terms of tolerability and side-effects.
Conclusions: Oral ketamine, given for longer time periods in the described doses, appears to be well tolerated, but few studies have systematically examined the longer-term negative consequences. The short- and longer-term depression outcomes as well as side-effects need to be studied with rigorous randomised controlled trials.