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Ketamine for depression: where do we go from here?

Marije Aan Het Rot1, Carlos A Zarate, Dennis S Charney

  • 1Department of Psychology and School of Behavioral and Cognitive Neuroscience, University of Groningen, The Netherlands. m.aan.het.rot@rug.nl

Biological Psychiatry
|June 19, 2012
PubMed
Summary
This summary is machine-generated.

Ketamine shows rapid antidepressant effects for major depressive episodes, including treatment-resistant cases. Further research is supported, but ketamine is not recommended outside hospital settings due to limited data and potential risks.

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Area of Science:

  • Neuroscience
  • Psychiatry
  • Pharmacology

Background:

  • Ketamine, a dissociative anesthetic, demonstrates rapid antidepressant effects.
  • Its utility is explored for major depressive episodes, including bipolar disorder and treatment-resistant depression.
  • Existing reports raise questions about patient selection, efficacy, and duration of ketamine's antidepressant effects.

Purpose of the Study:

  • To systematically review published data on ketamine's antidepressant effects.
  • To identify and analyze completed, ongoing, and planned studies on ketamine for depression.
  • To address key questions regarding ketamine response, administration, and duration.

Main Methods:

  • Systematic review of PubMed.gov and ClinicalTrials.gov.
  • Inclusion of case studies, open-label investigations, and controlled trials.
  • Analysis of data from 163 patients, primarily with treatment-resistant depression.

Main Results:

  • Response rates varied: 25%-85% at 24 hours and 14%-70% at 72 hours post-infusion.
  • Controlled trials used within-subject, crossover designs with inactive placebo.
  • Adverse effects were generally mild, including transient changes in vital signs.

Conclusions:

  • Risk-benefit analyses support further research into ketamine for severe mood disorders.
  • Paucity of randomized controlled trials and lack of active placebo limit current recommendations.
  • Ketamine administration is not advised outside of a hospital setting due to potential risks and limited long-term outcome data.