Efficacy and safety of perioperative application of ketamine on postoperative depression: A meta-analysis of randomized controlled studies
Jie Guo, Di Qiu, Han-Wen Gu, Xing-Ming Wang, Kenji Hashimoto, Guang-Fen Zhang, Jian-Jun Yang
Molecular Psychiatry January 20, 2023 DOI: 10.1038/s41380-023-01945-z (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Meta-analysis Randomized Peer reviewed |
|---|---|
| Sample size | 3,159 |
| Population | Patients undergoing surgery |
| Intervention | Ketamine |
| Topics | Depression Esketamine Ketamine |
| Citations | 46 |
| Key findings | Perioperative ketamine reduces postoperative depression scores and pain scores on day one but increases the risk of nausea, vomiting, headache, hallucination, and dizziness. |
Abstract
Ketamine, a commonly used general anesthetic, can produce rapid and sustained antidepressant effect. However, the efficacy and safety of the perioperative application of ketamine on postoperative depression remains uncertain. We performed a meta-analysis to determine the effect of perioperative intravenous administration of ketamine on postoperative depression. Randomized controlled trials comparing ketamine with placebo in patients were included. Primary outcome was postoperative depression scores. Secondary outcomes included postoperative visual analog scale (VAS) scores for pain and adverse effects associated with ketamine. Fifteen studies with 1697 patients receiving ketamine and 1462 controls were enrolled. Compared with the controls, the ketamine group showed a reduction in postoperative depression scores, by a standardized mean difference (SMD) of −0.97, 95% confidence interval [CI, −1.27, −0.66], P < 0.001, I^2 = 72% on postoperative day (POD) 1; SMD−0.65, 95% CI [−1.12, −0.17], P < 0.001, I^2 = 94% on POD 3; SMD−0.30, 95% CI [−0.45, −0.14], P < 0.001, I^2 = 0% on P OD 7; and SMD−0.25, 95% CI [−0.38, −0.11], P < 0.001, I^2 = 59% over the long term. Ketamine reduced VAS pain scores on POD 1 (SMD−0.93, 95% CI [−1.58, −0.29], P = 0.005, I^2 = 97%), but no significant difference was found between the two groups on PODs 3 and 7 or over the long term. However, ketamine administration distinctly increased the risk of adverse effects, including nausea and vomiting (risk ratio [RR] 1.40, 95% CI [1.12, 1.75], P = 0.003, I^2 = 30%), headache (RR 2.47, 95% CI [1.41, 4.32], P = 0.002, I^2 = 19%), hallucination (RR 15.35, 95% CI [6.^24, 37.34], P < 0.001, I^2 = 89%), and dizziness (RR 3.48, 95% CI [2.68, 4.50], P < 0.001, I^2 = 89%) compared with the controls. In conclusion, perioperative application of ketamine reduces postoperative depression and pain scores with increased risk of adverse effects.
Comparable studies
Other systematic reviews and meta-analyses on ketamine for depression, most cited first.
Citations in the library
Cited by 19
- Randomized trial of ketamine masked by surgical anesthesia in patients with depression Nature Mental Health October 19, 2023
- Ketamine and its two enantiomers in anesthesiology and psychiatry: A historical review and future directions Journal of Anesthesia and Translational Medicine July 11, 2024
- Randomized Trial of Ketamine Masked by Surgical Anesthesia in Depressed Patients medRxiv Preprint Server April 28, 2023
- Repurposing General Anesthetic Drugs to Treat Depression: A New Frontier for Anesthesiologists in Neuropsychiatric Care. Anesthesiology August 1, 2024
- Effect of esketamine on postoperative depression in women with breast cancer and preoperative depressive symptoms: The EASE randomized trial. Journal of clinical anesthesia April 1, 2025
and 14 more in the library
Cites 24
- A Randomized Trial of an N-methyl-D-aspartate Antagonist in Treatment-Resistant Major Depression Archives of General Psychiatry August 1, 2006
- The effect of a single dose of intravenous ketamine on suicidal ideation: a systematic review and individual participant data meta-analysis American Journal of Psychiatry October 3, 2017
- R-ketamine: a rapid-onset and sustained antidepressant without psychotomimetic side effects Translational Psychiatry September 1, 2015
- Side-effects associated with ketamine use in depression: a systematic review. The Lancet Psychiatry 2018
- A Double-Blind, Randomized, Placebo-Controlled, Dose-Frequency Study of Intravenous Ketamine in Patients With Treatment-Resistant Depression American Journal of Psychiatry April 8, 2016
and 19 more in the library