Meta-analysis of short- and mid-term efficacy of ketamine in unipolar and bipolar depression
This meta-analysis (2015) of six randomised, double-blind, placebo-controlled trials (n=101) examined the short-and mid-term efficacy of ketamine (bipolar) to depression. Ketamine effectively reduced symptoms in unipolar depression for seven days, , whereas the maintenance of its efficacy in bipolar depression failed to reach significance after 4 days.
Authors
- Romeo, B.
- Choucha, W.
- Fossati, P.
Published
Abstract
Introduction
Among treatments currently assessed in major depression, ketamine, has been proposed of great interest, especially because of its very rapid action. However, the time-course of the antidepressive action of ketamine remained unclear. In the present meta-analysis, we provided a clear and objective view regarding the putative antidepressive effect of ketamine and its time-course.
Methods
We searched the MEDLINE and PsycINFO databases through December 2013, without limits on year of publication, using the key words ketamine and synonyms for mood disorder or episode. Six randomized, double-blind and placebo-controlled trials of ketamine in major depression (n=103 patients) were thus identified. Authors were contacted and they all provided original data necessary for this meta-analysis. Standardized mean differences (SMD) were calculated between the depression scores in ketamine and placebo groups at days 1, 2, 3-4, 7 and 14.
Results
Ketamine showed an overall antidepressive efficacy from day 1 to day 7. However, the maintenance of its efficacy over time failed to reach significance in bipolar depression after day 3-4. Significant SMDs were not explained by demographic or clinical characteristics of included samples.
Discussion
The present meta-analysis provides a high level of evidence that ketamine has a rapid antidepressive action during one week, especially in unipolar disorder.
Research Summary of 'Meta-analysis of short- and mid-term efficacy of ketamine in unipolar and bipolar depression'
Introduction
Major depression is common, disabling and often slow to respond to conventional monoaminergic antidepressants, prompting interest in treatments that act more rapidly. Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist that modulates the glutamatergic system, has been reported to produce marked antidepressant effects within hours of a single dose. However, the clinical literature is heterogeneous with small samples, mixed diagnoses (unipolar versus bipolar), differing outcome measures and variable follow-up times, so the time-course and reliability of ketamine’s antidepressant action remained unclear. Romeo and colleagues therefore carried out a meta-analysis to provide a quantitative, time-resolved estimate of ketamine’s efficacy in treatment‑resistant depression. The study aimed to compare ketamine with placebo on depression scores at prespecified time points (day 1, day 2, day 3–4, day 7 and day 14) and to explore whether demographic or clinical sample characteristics (age, sex, illness duration, episode duration, comorbidities, prior treatment) or route of administration influenced effect sizes. This work sought to address gaps in prior meta-analyses, particularly the lack of detailed time-course analyses based on continuous depression scores.
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Study Details
- Study Typemeta
- Journal
- Compounds
- Topics
- APA Citation
Romeo, B., Choucha, W., Fossati, P., & Rotge, J. (2015). Meta-analysis of short- and mid-term efficacy of ketamine in unipolar and bipolar depression. Psychiatry Research, 230(2), 682-688. https://doi.org/10.1016/j.psychres.2015.10.032
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