The effectiveness of ketamine in medication of treatment-resistant depression - review
DOI:
https://doi.org/10.12775/QS.2024.16.52628Keywords
ketamine, depression, treatment-resistant depression, TRD, suicideAbstract
In spite of the variety of antidepressant drugs available for treating depressive disorder, treatment resistant depression (TRD) is still prevalent among the population.
Despite being used mainly in anesthesia, and mostly phased out by more modern anesthetics, ketamine shows potential when it comes to depressive disorder treatment.
We've set out to investigate the the relevant body of work to determine the efficacy of ketamine usage in patients with TRD.
Research shows that usage of ketamine used in patients with TRD leads to mood elevation, better cognitive functions, sleep and appetite. Moreover, ketamine is shown to decrease suicidal thoughts and shows potential in acute actions in emergency situations, especially with its faster effects when compared to traditional antidepressants. Some research show significant reduction in suicidal thoughts after just one infusion of ketamine.
Clinicians have developed intranasal, subcutaneous, intramuscular and oral ways of administering ketamine, which, though less bioavailable, when compered to intravenous use, are much more convenient and less expensive for the patients. All those ways of administering the drug have their upsides and downsides, and theres still debate on which is best.
Ketamine shows promise in patients with TRD. Some studies show that up to 70% of people with TRD response to ketamine, which might show efficacy of ketamine usage in those patients
State of knowledge:
Despite extensive research in the field of depression treatment, there's considerable lack of comprehensive reviews of efficacy of ketamine usage in cases where traditional ways of treating depression have failed. In the face of increasing number cases of treatment resistant depression worldwide, this paper aims to gather research papers regarding this topic and synthesize it into comprehensive review.
References
Nowacka A, Borczyk M. Ketamine applications beyond anesthesia - A literature review. Eur J Pharmacol. 2019;860:172547. doi:10.1016/j.ejphar.2019.172547
Gałuszko-Węgielnik M, Wiglusz MS, Słupski J, et al. Efficacy of Ketamine in bipolar depression: focus on anhedonia. Psychiatr Danub. 2019;31(Suppl 3):554-560.
Hustveit, O., Maurset, A. and Øye, I. (1995), Interaction of the Chiral Forms of Ketamine with Opioid, Phencyclidine, σ and Muscarinic Receptors. Pharmacology & Toxicology, 77: 355-359. https://doi.org/10.1111/j.1600-0773.1995.tb01041.x
Williams NR, Heifets BD, Bentzley BS, et al. Attenuation of antidepressant and antisuicidal effects of ketamine by opioid receptor antagonism. Mol Psychiatry. 2019;24(12):1779-1786. doi:10.1038/s41380-019-0503-4
Belmaker RH, Agam G. Major depressive disorder. N Engl J Med. 2008;358(1):55-68. doi:10.1056/NEJMra073096
McIntyre RS, Rosenblat JD, Nemeroff CB, et al. Synthesizing the Evidence for Ketamine and Esketamine in Treatment-Resistant Depression: An International Expert Opinion on the Available Evidence and Implementation. Am J Psychiatry. 2021;178(5):383-399. doi:10.1176/appi.ajp.2020.20081251
López-Díaz Á, Fernández-González JL, Luján-Jiménez JE, Galiano-Rus S, Gutiérrez-Rojas L. Use of repeated intravenous ketamine therapy in treatment-resistant bipolar depression with suicidal behaviour: a case report from Spain. Ther Adv Psychopharmacol. 2017;7(4):137-140. doi:10.1177/2045125316675578
Bahji A, Vazquez GH, Zarate CA Jr. Comparative efficacy of racemic ketamine and esketamine for depression: A systematic review and meta-analysis [published correction appears in J Affect Disord. 2021 Feb 15;281:1001. doi: 10.1016/j.jad.2020.11.103]. J Affect Disord. 2021;278:542-555. doi:10.1016/j.jad.2020.09.071
Zhao X, Venkata SL, Moaddel R, et al. Simultaneous population pharmacokinetic modelling of ketamine and three major metabolites in patients with treatment-resistant bipolar depression. Br J Clin Pharmacol. 2012;74(2):304-314. doi:10.1111/j.1365-2125.2012.04198.x
Singh JB, Fedgchin M, Daly EJ, et al. A Double-Blind, Randomized, Placebo-Controlled, Dose-Frequency Study of Intravenous Ketamine in Patients With Treatment-Resistant Depression. Am J Psychiatry. 2016;173(8):816-826. doi:10.1176/appi.ajp.2016.1601003s
Fava M, Freeman MP, Flynn M, et al. Double-blind, placebo-controlled, dose-ranging trial of intravenous ketamine as adjunctive therapy in treatment-resistant depression (TRD) [published correction appears in Mol Psychiatry. 2020 Jul;25(7):1604. doi: 10.1038/s41380-018-0311-2]. Mol Psychiatry. 2020;25(7):1592-1603. doi:10.1038/s41380-018-0256-5
Szarmach J, Cubała WJ, Włodarczyk A, Wiglusz MS. Short-term ketamine administration in treatment-resistant depression: focus on cardiovascular safety. Psychiatr Danub. 2019;31(Suppl 3):585-590.
Arabzadeh S, Hakkikazazi E, Shahmansouri N, et al. Does oral administration of ketamine accelerate response to treatment in major depressive disorder? Results of a double-blind controlled trial. J Affect Disord. 2018;235:236-241. doi:10.1016/j.jad.2018.02.056
George D, Gálvez V, Martin D, et al. Pilot Randomized Controlled Trial of Titrated Subcutaneous Ketamine in Older Patients with Treatment-Resistant Depression. Am J Geriatr Psychiatry. 2017;25(11):1199-1209. doi:10.1016/j.jagp.2017.06.007
Chilukuri H, Reddy NP, Pathapati RM, Manu AN, Jollu S, Shaik AB. Acute antidepressant effects of intramuscular versus intravenous ketamine. Indian J Psychol Med. 2014 Jan;36(1):71-6. doi: 10.4103/0253-7176.127258. Erratum in: Indian J Psychol Med. 2015 Jul-Sep;37(3):379. doi: 10.4103/0253-7176.162911. PMID: 24701015; PMCID: PMC3959024.
Mihaljević S, Pavlović M, Reiner K, Ćaćić M. Therapeutic Mechanisms of Ketamine. Psychiatr Danub. 2020;32(3-4):325-333. doi:10.24869/psyd.2020.325
Pereira S, Brennan E, Patel A, Moran M, Wallier J, Liebowitz MR. Managing dissociative symptoms following the use of esketamine nasal spray: a case report. Int Clin Psychopharmacol. 2021;36(1):54-57. doi:10.1097/YIC.0000000000000327
Short B, Fong J, Galvez V, Shelker W, Loo CK. Side-effects associated with ketamine use in depression: a systematic review. Lancet Psychiatry. 2018;5(1):65-78. doi:10.1016/S2215-0366(17)30272-9
Lapidus KA, Levitch CF, Perez AM, et al. A randomized controlled trial of intranasal ketamine in major depressive disorder. Biol Psychiatry. 2014;76(12):970-976. doi:10.1016/j.biopsych.2014.03.026
Szulc A, Gałecki P. Psychiatria. Edra Urban & Partner; 2018.
Swainson J, McGirr A, Blier P, et al. The Canadian Network for Mood and Anxiety Treatments (CANMAT) Task Force Recommendations for the Use of Racemic Ketamine in Adults with Major Depressive Disorder: Recommandations Du Groupe De Travail Du Réseau Canadien Pour Les Traitements De L'humeur Et De L'anxiété (Canmat) Concernant L'utilisation De La Kétamine Racémique Chez Les Adultes Souffrant De Trouble Dépressif Majeur [published correction appears in Can J Psychiatry. 2021 Dec;66(12):1102. doi: 10.1177/07067437211035276]. Can J Psychiatry. 2021;66(2):113-125. doi:10.1177/0706743720970860
Xu Y, Hackett M, Carter G, et al. Effects of Low-Dose and Very Low-Dose Ketamine among Patients with Major Depression: a Systematic Review and Meta-Analysis. Int J Neuropsychopharmacol. 2016;19(4):pyv124. Published 2016 Apr 20. doi:10.1093/ijnp/pyv124
Wan LB, Levitch CF, Perez AM, et al. Ketamine safety and tolerability in clinical trials for treatment-resistant depression. J Clin Psychiatry. 2015;76(3):247-252. doi:10.4088/JCP.13m08852
Zimmermann KS, Richardson R, Baker KD. Esketamine as a treatment for paediatric depression: questions of safety and efficacy. Lancet Psychiatry. 2020;7(10):827-829. doi:10.1016/S2215-0366(19)30521-8
Albott CS, Lim KO, Forbes MK, et al. Efficacy, Safety, and Durability of Repeated Ketamine Infusions for Comorbid Posttraumatic Stress Disorder and Treatment-Resistant Depression. J Clin Psychiatry. 2018;79(3):17m11634. doi:10.4088/JCP.17m11634
Kryst J, Kawalec P, Pilc A. Efficacy and safety of intranasal esketamine for the treatment of major depressive disorder. Expert Opin Pharmacother. 2020;21(1):9-20. doi:10.1080/14656566.2019.1683161
Price RB, Iosifescu DV, Murrough JW, et al. Effects of ketamine on explicit and implicit suicidal cognition: a randomized controlled trial in treatment-resistant depression. Depress Anxiety. 2014;31(4):335-343. doi:10.1002/da.22253
Price RB, Iosifescu DV, Murrough JW, et al. Effects of ketamine on explicit and implicit suicidal cognition: a randomized controlled trial in treatment-resistant depression. Depress Anxiety. 2014;31(4):335-343. doi:10.1002/da.22253
Wilkinson ST, Ballard ED, Bloch MH, et al. The Effect of a Single Dose of Intravenous Ketamine on Suicidal Ideation: A Systematic Review and Individual Participant Data Meta-Analysis. Am J Psychiatry. 2018;175(2):150-158. doi:10.1176/appi.ajp.2017.17040472
Daly EJ, Singh JB, Fedgchin M, et al. Efficacy and Safety of Intranasal Esketamine Adjunctive to Oral Antidepressant Therapy in Treatment-Resistant Depression: A Randomized Clinical Trial. JAMA Psychiatry. 2018;75(2):139-148. doi:10.1001/jamapsychiatry.2017.3739
Phillips JL, Norris S, Talbot J, et al. Single, Repeated, and Maintenance Ketamine Infusions for Treatment-Resistant Depression: A Randomized Controlled Trial. Am J Psychiatry. 2019;176(5):401-409. doi:10.1176/appi.ajp.2018.18070834
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