Comparative efficacy of racemic ketamine and esketamine for depression: a systematic review and meta-analysis
Anees Bahji, Gustavo Vazquez, Carlos A. Zarate
Journal of Affective Disorders September 23, 2020 DOI: 10.1016/j.jad.2020.09.071 (opens in new tab)
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Study at a glance
AI-extracted from the abstract| Characteristics | Systematic review and meta-analysis Randomized Peer reviewed |
|---|---|
| Sample size | 1,877 |
| Population | Adults with unipolar or bipolar major depression |
| Interventions | Racemic ketamine Esketamine |
| Topics | Depression Esketamine Ketamine |
| Citations | 404 |
| Key findings | Racemic ketamine showed greater response and remission rates and lower dropouts compared with esketamine for treating depression. |
Abstract
Background: Ketamine appears to have a therapeutic role in certain mental disorders, most notably depression. However, the comparative performance of different formulations of ketamine is less clear.
Objectives: This study aimed to assess the comparative efficacy and tolerability of racemic and esketamine for the treatment of unipolar and bipolar major depression.
Design: Systematic review and meta-analysis. Data sources: We searched PubMed, MEDLINE, Embase, PsycINFO, the Cochrane Central Register of Controlled Clinical Trials, and the Cochrane Database of Systematic Reviews for relevant studies published since database inception and December 17, 2019. Study eligibility criteria: We considered randomized controlled trials examining racemic or esketamine for the treatment of unipolar or bipolar major depression.
Outcomes: Primary outcomes were response and remission from depression, change in depression severity, suicidality, retention in treatment, drop-outs, and drop-outs due to adverse events. Analysis: Evidence from randomized controlled trials was synthesized as rate ratios (RRs) for treatment response, disorder remission, adverse events, and withdrawals and as standardized mean differences (SMDs) for change in symptoms, via random-effects meta-analyses.
Findings: 24 trials representing 1877 participants were pooled. Racemic ketamine relative to esketamine demonstrated greater overall response (RR = 3.01 vs. RR = 1.38) and remission rates (RR = 3.70 vs. RR = 1.47), as well as lower dropouts (RR = 0.76 vs. RR = 1.37).
Conclusions: Intravenous ketamine appears to be more efficacious than intranasal esketamine for the treatment of depression.
In the evidence
This study is part of the evidence base for 2 syntheses in the library. Here is how each one recorded it.
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Racemic ketamine showed greater response and remission rates and lower dropouts than esketamine, though both were effective.
Synthesized
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Racemic ketamine showed greater response and remission rates and lower dropouts compared with esketamine for treating depression.
Synthesized
Comparable studies
Other systematic reviews and meta-analyses on esketamine for depression, most cited first.