Subcutaneous Ketamine in Depression: A Systematic Review
V. B. Cavenaghi, Leandro Paulino da Costa, Acioly L T Lacerda, E. S. Hirata, E. Miguel, Renerio Fraguas
Frontiers in Psychiatry May 28, 2021 DOI: 10.3389/fpsyt.2021.513068 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Systematic review Randomized Peer reviewed |
|---|---|
| Population | Patients with unipolar or bipolar depression |
| Dose | 0.1-0.5 mg/kg racemic ketamine; 0.5-1 mg/kg esketamine |
| Topics | Depression Esketamine Ketamine |
| Citations | 41 |
| Key findings | Subcutaneous racemic ketamine and esketamine produce a rapid and robust antidepressant effect with response and remission rates from 50 to 100% and transitory side effects. |
Abstract
Background: Ketamine has been shown to produce a rapid and robust antidepressant effect. Though numerous routes of administration have been studied, subcutaneous (SC) has proven to be a convenient and cost-effective route making its use particularly relevant in developing countries. Here we provide a systematic review covering the use of SC racemic ketamine and esketamine in depression, including its efficacy, safety and tolerability.
Methods: A systematic literature search was carried out, from inception through March, 2021, using PubMed/MEDLINE, EMBASE and Web of Science, with no limits of language. After identifying 159 potentially relevant articles, 12 articles were selected after applying our inclusion/exclusion criteria. These comprised two randomized clinical trials, five case-reports and five retrospective studies. Given the small number of studies found and their heterogeneous nature, a meta-analysis was not considered appropriate. Here we provide a synthesis of these data including participant characteristics, dose range, efficacy, safety/ tolerability. Risk of bias was accessed using the Cochrane risk of bias tool.
Results: SC Ketamine was administered to unipolar and bipolar patients a single or multiple doses, weekly or twice-weekly, a dose-titration approach was made in major studies, dose ranged from 0.1 to 0.5 mg/Kg of racemic ketamine and 0.5–1 mg/Kg of esketamine. Across all studies, SC ketamine showed a rapid and robust antidepressant effect, with response/ remission rates from 50 to 100% following both single or multiple doses, with transitory side effects.
Conclusion: SC racemic ketamine and esketamine in depression is a promising strategy showing beneficial efficacy and tolerability. Future studies exploring the SC route, its cost-effectiveness, and a direct comparison with IV and intranasal (IN) protocols are warranted. Systematic Review
Registration: CRD42019137434