The Efficacy of Ketamine in the Palliative Care Setting: A Comprehensive Review of the Literature

Introduction

Goldman and colleagues place this review in the context of substantial unmet need for rapid-acting treatments of psychological and physical symptoms in palliative care. The background emphasises that depression is common and difficult to diagnose in patients with life‑threatening illness, that standard monoaminergic antidepressants often take four to six weeks to work (a timeframe commonly longer than patients’ remaining life expectancy), and that psychostimulants used for faster relief have limitations such as tolerance and a range of side effects. Ketamine, an NMDA receptor antagonist, has attracted interest because it modulates the glutamatergic system and can produce antidepressant effects within minutes to hours, with single-dose effects reported to last up to about two weeks outside palliative settings. Ketamine’s analgesic properties and potential to reduce opioid requirements are also noted as clinically relevant for palliative populations where uncontrolled pain is frequent. This review therefore set out to examine the evidence specifically for ketamine’s efficacy as an antidepressant and as an analgesic in palliative care patients. The authors aimed to collate clinical trials, case reports and randomized controlled trials addressing these two outcomes, describe patterns relating to dose and route of administration, and identify gaps needing further research so that clinicians and investigators can better understand when ketamine might be useful in palliative contexts.