Ketamine use in pediatric depression: A systematic review

Introduction

Major depressive disorder (MDD) is a common and burdensome condition in children and adolescents, with lifetime prevalence estimates reported as about 3.2% in children aged 3–17 and 13.3% in adolescents aged 12–17 in the extracted text. Early-onset depression is associated with impaired social and academic functioning, physical illness, risky behaviours and contributes substantially to lost productivity and disability in youth. Standard first-line care combines psychotherapy and pharmacotherapy (for example selective serotonin reuptake inhibitors), but response rates to conventional antidepressant monotherapy in paediatric populations remain limited and there is an unmet need for faster-acting or more effective options for treatment-resistant cases. Meshkat and colleagues situate ketamine—a non-competitive NMDA receptor antagonist that modulates glutamatergic signalling—as a candidate rapid-acting antidepressant whose efficacy and safety are established in adults but remain poorly characterised in people under 18. The authors therefore conducted a systematic review to identify, appraise and summarise clinical studies that examined ketamine administration for the primary treatment of depression in children and adolescents, with the goal of describing effectiveness, safety and gaps in the evidence base. They note that no prior systematic review focused specifically on ketamine for paediatric depression had been published.