Ketamine and depression: a narrative review.

Area of Science:

• Neuroscience
• Psychiatry
• Pharmacology

Background:

• Depression is a leading global cause of disability.
• Treatment resistance affects one-third of patients with depression.
• Ketamine, an N-methyl-D-aspartate receptor antagonist, has demonstrated antidepressant properties.

Purpose of the Study:

• To review the efficacy and safety of ketamine for major depressive disorder and bipolar disorder.
• To synthesize evidence from Cochrane reviews, meta-analyses, and randomized controlled trials (RCTs).

Main Methods:

• Conducted an exhaustive electronic literature search.
• Included Cochrane reviews, meta-analyses, and RCTs of ketamine for depressive disorders.
• Analyzed data on ketamine's antidepressant effects, duration, and safety profiles.

Main Results:

• Ketamine demonstrated a rapid antidepressant effect, peaking within 24 hours, lasting 1-2 weeks.
• No significant improvement in depressive symptoms was observed at the end of electroconvulsive therapy sessions.
• Safety and tolerability were generally good at low, single doses, but data on repeated higher doses are limited.

Conclusions:

• Ketamine shows promise for rapid symptom relief in depression, particularly with suicidal ideation.
• The overall level of evidence for ketamine's efficacy in depression remains low.
• More high-quality RCTs are essential to fully explore ketamine's efficacy and safety, especially with repeated administration.