Administration of ketamine for unipolar and bipolar depression
This review (2017) examined clinical trials that investigated the antidepressant efficacy of ketamine for unipolar (MDD) and bipolar depression (BD). Results indicate that intravenous and intranasal ketamine produces strong reductions of depressive symptoms within a short period and with response rates up to 88%, however, depressive relapse occurs in up to 90% of patients within 2 weeks after treatment.
Authors
- Siegfried Kasper
Published
Abstract
Objective
Clinical trials demonstrated that ketamine exhibits rapid antidepressant efficacy when administered in subanaesthetic dosages. We reviewed currently available literature investigating efficacy, response rates and safety profile.
Methods
Twelve studies investigating unipolar, seven on bipolar depression were included after search in medline, scopus and web of science.
Results
Randomized, placebo-controlled or open-label trials reported antidepressant response rates after 24 h on primary outcome measures at 61%. The average reduction of Hamilton Depression Rating Scale (HAM-D) was 10.9 points, Beck Depression Inventory (BDI) 15.7 points and Montgomery-Asberg Depression Rating Scale (MADRS) 20.8 points. Ketamine was always superior to placebo. Most common side effects were dizziness, blurred vision, restlessness, nausea/vomiting and headache, which were all reversible. Relapse rates ranged between 60% and 92%. To provide best practice-based information to patients, a consent-form for application and modification in local language is included.
Conclusions
Ketamine constitutes a novel, rapid and efficacious treatment option for patients suffering from treatment resistant depression and exhibits rapid and significant anti-suicidal effects. New administration routes might serve as alternative to intravenous regimes for potential usage in outpatient settings. However, long-term side effects are not known and short duration of antidepressant response need ways to prolong ketamine’s efficacy.
Research Summary of 'Administration of ketamine for unipolar and bipolar depression'
Introduction
Treatment-resistant depression (TRD), commonly defined as failure to respond to more than two antidepressant trials, affects an estimated 10–30% of people with major depressive disorder and carries high risks of suicide, relapse and socioeconomic burden. Ketamine, an NMDA-receptor antagonist first introduced as an anaesthetic, attracted interest after animal and serendipitous clinical observations suggested rapid antidepressant effects; subsequent small clinical trials have reported robust, short-lived reductions in depressive symptoms. Despite ketamine's long history in anaesthesia and known pharmacology, uncertainties remain about optimal dosing and administration, duration of benefit, long-term safety, interaction with other medications and how to translate trial protocols into routine clinical practice. Kraus and colleagues set out to review clinical trials of ketamine in unipolar and bipolar depression to summarise efficacy, response and remission rates, and the safety profile, and to offer practical information for clinicians. The review sought studies using standardised depression outcome measures and aimed to focus on clinically relevant end points, primarily 24-h post-treatment effects; a patient consent form for clinical application was developed as supplementary material to aid implementation in practice.
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Study Details
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Kraus, C., Rabl, U., Vanicek, T., Carlberg, L., Popovic, A., Spies, M., Bartova, L., Gryglewski, G., Papageorgiou, K., Lanzenberger, R., Willeit, M., Winkler, D., Rybakowski, J. K., & Kasper, S. (2017). Administration of ketamine for unipolar and bipolar depression. International Journal of Psychiatry in Clinical Practice, 21(1), 2-12. https://doi.org/10.1080/13651501.2016.1254802
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La Torre, J. T., Mahammadli, M., Greenway, K. T. et al. · BMC Psychiatry (2022)
Bahji, A., Zarate, C. A., Vazquez, G. H. · International Journal of Neuropsychopharmacology (2021)
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Feifel, D., Malcolm, B., Boggie, D. et al. · Journal of Affective Disorders (2017)
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