Side-effects associated with ketamine use in depression: a systematic review
This systematic review (2017) examined the reported side-effects of ketamine treatment for depression across 288 published reports and identified that headache, dizziness, dissociation, elevated blood pressure, and blurred vision were the most common in response to intravenous infusion. The most common acute psychiatric side-effect was anxiety, but there was no conclusive evidence about long-term side effects from the currently available studies.
Abstract
Introduction
This is the first systematic review of the safety of ketamine in the treatment of depression after single and repeated doses.
Methods
We searched MEDLINE, PubMed, PsycINFO, and Cochrane Databases and identified 288 articles, 60 of which met the inclusion criteria.
Results
After acute dosing, psychiatric, psychotomimetic, cardiovascular, neurological, and other side-effects were more frequently reported after ketamine treatment than after placebo in patients with depresssion. Our findings suggest a selective reporting bias with limited assessment of long-term use and safety and after repeated dosing, despite these being reported in other patient groups exposed to ketamine (eg, those with chronic pain) and in recreational users.
Discussion
We recommend large-scale clinical trials that include multiple doses of ketamine and long-term follow up to assess the safety of long-term regular use.
Research Summary of 'Side-effects associated with ketamine use in depression: a systematic review'
Introduction
Major depressive disorder is highly prevalent and existing monoaminergic antidepressants are effective in only about 50% of patients, with a protracted onset of action. In this context, ketamine has emerged as a promising rapidly acting antidepressant, but uncertainty remains about its safety profile. Short and colleagues note that most clinical trials to date have been small, short-term, frequently assessed a single dose only, and were not designed to detect rare, cumulative, or long-term harms. Evidence from other populations exposed to ketamine (for example, people with chronic pain or recreational users) has linked repeated use to urinary, hepatic, cognitive, and dependence-related harms, raising concern about the generalisability of short-term depression trial safety data. This paper therefore set out to systematically aggregate and evaluate reporting of side-effects associated with ketamine when used to treat depression. The primary objective was to identify and categorise adverse effects reported after single (acute) and repeated (cumulative and long-term) dosing in studies of adults with unipolar or bipolar depression, and to assess the extent and quality of side-effect surveillance in the published literature.
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Study Details
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Short, B., Fong, J., Galvez, V., Shelker, W., & Loo, C. K. (2018). Side-effects associated with ketamine use in depression: a systematic review. The Lancet Psychiatry, 5(1), 65-78. https://doi.org/10.1016/S2215-0366(17)30272-9
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