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
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.