Maintenance ketamine treatment for depression: a systematic review of efficacy, safety, and tolerability.
Sanne Y Smith-Apeldoorn, Jolien K E Veraart, Jan Spijker, Jeanine Kamphuis, Robert A Schoevers
The Lancet Psychiatry November 1, 2022 DOI: 10.1016/s2215-0366(22)00317-0 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Systematic review Randomized Open-label Case report Peer reviewed |
|---|---|
| Topics | Depression Esketamine Ketamine |
| Citations | 163 |
| Key findings | Maintenance ketamine treatment appears effective in sustaining antidepressant effects in treatment-resistant depression, with uncommon serious side effects. |
Abstract
Ketamine has rapid yet often transient antidepressant effects in patients with treatment-resistant depression. Different strategies have been proposed to prolong these effects. Maintenance ketamine treatment appears promising, but little is known about its efficacy, safety, and tolerability in depression. We searched Pubmed, Embase, and the Cochrane Library and identified three randomised controlled trials, eight open-label trials, and 30 case series and reports on maintenance ketamine treatment. We found intravenous, intranasal, oral, and possibly intramuscular and subcutaneous maintenance ketamine treatment to be effective in sustaining antidepressant effect in treatment-resistant depression. Tachyphylaxis, cognitive impairment, addiction, and serious renal and urinary problems seem uncommon. Despite the methodological limitations, we conclude that from a clinical view, maintenance ketamine treatment seems to be of therapeutic potential. We recommend both controlled and naturalistic studies with long-term follow-up and sufficient power to determine the position of maintenance ketamine treatment within routine clinical practice.
Comparable studies
Other systematic reviews and meta-analyses on ketamine for depression, most cited first.
Citations in the library
Cited by 88
- Perioperative Adjunctive Esketamine for Postpartum Depression Among Women Undergoing Elective Cesarean Delivery JAMA Network Open March 6, 2024
- Glutamatergic Modulators for Major Depression from Theory to Clinical Use. CNS Drugs November 1, 2024
- Ketamine, an Old–New Drug: Uses and Abuses Pharmaceuticals December 21, 2023
- The Montreal model: an integrative biomedical-psychedelic approach to ketamine for severe treatment-resistant depression Frontiers in Psychiatry September 19, 2023
- Number needed to treat (NNT) for ketamine and esketamine in adults with treatment-resistant depression: A systematic review and meta-analysis. Journal of Affective Disorders July 1, 2024
and 83 more in the library
Cites 31
- Efficacy of Esketamine Nasal Spray Plus Oral Antidepressant Treatment for Relapse Prevention in Patients With Treatment-Resistant Depression JAMA Psychiatry June 5, 2019
- Efficacy and Safety of Intranasal Esketamine Adjunctive to Oral Antidepressant Therapy in Treatment-Resistant Depression JAMA Psychiatry December 27, 2017
- Ketamine use: a review Addiction July 21, 2011
- Side-effects associated with ketamine use in depression: a systematic review. The Lancet Psychiatry 2018
- Single, Repeated, and Maintenance Ketamine Infusions for Treatment-Resistant Depression: A Randomized Controlled Trial. American Journal of Psychiatry March 29, 2019
and 26 more in the library