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Subcutaneous Ketamine in Depression: A Systematic Review
Vitor Breseghello Cavenaghi1, Leandro Paulino da Costa1, Acioly Luiz Tavares Lacerda2
1Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.
Frontiers in Psychiatry
|June 14, 2021
Summary
Subcutaneous ketamine (SC ketamine) offers a rapid and effective antidepressant treatment for depression. This administration route is convenient, cost-effective, and shows promising efficacy and tolerability in patients.
Area of Science:
- Neuroscience
- Psychiatry
- Pharmacology
Background:
- Ketamine demonstrates rapid antidepressant effects.
- Subcutaneous (SC) administration is a cost-effective and convenient route for ketamine, particularly relevant for developing nations.
- This review synthesizes evidence on SC racemic ketamine and esketamine for depression treatment.
Approach:
- A systematic literature search was conducted across major databases (PubMed/MEDLINE, EMBASE, Web of Science) up to March 2021.
- Twelve studies (2 RCTs, 5 case reports, 5 retrospective studies) were included after applying stringent inclusion/exclusion criteria.
- Data synthesis focused on participant characteristics, dosage, efficacy, safety, and tolerability, with risk of bias assessed using the Cochrane tool.
Key Points:
- SC ketamine, including racemic ketamine and esketamine, was administered to unipolar and bipolar patients via single or multiple doses.
- Doses ranged from 0.1 to 0.5 mg/Kg for racemic ketamine and 0.5-1 mg/Kg for esketamine.
- Observed response/remission rates were high (50-100%), with rapid and robust antidepressant effects and transient side effects.
Conclusions:
- SC ketamine and esketamine represent a promising strategy for depression, demonstrating significant efficacy and good tolerability.
- Further research is warranted to explore the SC route's cost-effectiveness and compare it directly with intravenous (IV) and intranasal (IN) ketamine protocols.
