Oral Ketamine for Depression: A Systematic Review

Area of Science:

• Psychiatry and Pharmacology
• Neuroscience
• Clinical Research

Background:

• Intravenous (IV) ketamine offers rapid antidepressant effects but faces accessibility challenges.
• Oral ketamine presents a more accessible alternative for depression treatment.
• Systematic review to evaluate oral ketamine's potential in treating depression.

Purpose of the Study:

• To systematically review the efficacy, safety, tolerability, and dosage of oral ketamine for bipolar and unipolar depression.
• To assess the speed of antidepressant effects and antisuicide potential of oral ketamine.
• To identify the optimal dosing range and administration frequency for oral ketamine.

Main Methods:

• Systematic literature search of MEDLINE/PubMed, EMBASE, and Google Scholar up to July 2018.
• Inclusion of all clinical studies evaluating oral ketamine for depression.
• Qualitative analysis of 13 identified articles (2 RCTs, 1 open-label, 5 chart reviews, 5 case reports).

Main Results:

• Randomized controlled trials (RCTs) showed antidepressant efficacy and good tolerability, with effects emerging after 2-6 weeks.
• Retrospective studies suggested rapid antidepressant and antisuicide effects, but these were not confirmed in RCTs.
• Variable dosages (0.5-7.0 mg/kg) were used; most studies employed 1-2 mg/kg every 1-3 days. No significant adverse effects were reported.

Conclusions:

• Oral ketamine demonstrates antidepressant effects and good tolerability, though slower than IV administration.
• Antisuicide effects and efficacy in treatment-resistant depression require further investigation.
• Well-designed randomized controlled trials are necessary to validate these findings.