An Update on the Efficacy and Tolerability of Oral Ketamine for Major Depression: A Systematic Review and Meta-Analysis.

Adult Antidepressive Agents / adverse effects Depression Depressive Disorder, Major / drug therapy Female Humans Ketamine / adverse effects Male Middle Aged Mood Disorders / drug therapy
bipolar depression efficacy mood disorders oral ketamine unipolar depression

Journal

Psychopharmacology bulletin
ISSN: 2472-2448
Titre abrégé: Psychopharmacol Bull
Pays: United States
ID NLM: 0101123

Informations de publication

Date de publication:
14 09 2020
Historique:
entrez: 5 10 2020
pubmed: 6 10 2020
medline: 15 12 2021
Statut: ppublish

Résumé

Intravenous Ketamine has shown robust antidepressant efficacy although other routes of administration are currently needed. We conducted a systematic review and meta-analysis of studies evaluating the efficacy and tolerability of oral ketamine for depression. A comprehensive search of major electronic databases from inception to April 2020 was performed. Studies of oral ketamine for depression, from case series to randomized clinical trials, were eligible. Randomized controlled trials were included in a meta-analysis, focusing on response, remission, time to effect, and side effects. A total of 917 articles were identified with 890 studies screened, yielding a total of 10 studies included in our systematic review.Three randomized controlled trials (RCTs) (N = 161, mean age 37.9 ± 9.5 years, 58.6% females) were included in the meta-analysis. Pooled analysis suggested a significant antidepressant effect of oral ketamine (SMD: -0.75; 95% CI: -1.08, -0.43; p<0.0001; I This focused meta-analysis of oral ketamine suggests a marginal efficacy for major depressive disorder without increased risk of adverse events. Further larger sample studies are needed to confirm these preliminary findings, analyzing differential response/remission rates by affective disorder, optimal dosing strategies, and its long-term effects.

Sections du résumé

Background
Intravenous Ketamine has shown robust antidepressant efficacy although other routes of administration are currently needed. We conducted a systematic review and meta-analysis of studies evaluating the efficacy and tolerability of oral ketamine for depression.
Methods
A comprehensive search of major electronic databases from inception to April 2020 was performed. Studies of oral ketamine for depression, from case series to randomized clinical trials, were eligible. Randomized controlled trials were included in a meta-analysis, focusing on response, remission, time to effect, and side effects.
Results
A total of 917 articles were identified with 890 studies screened, yielding a total of 10 studies included in our systematic review.Three randomized controlled trials (RCTs) (N = 161, mean age 37.9 ± 9.5 years, 58.6% females) were included in the meta-analysis. Pooled analysis suggested a significant antidepressant effect of oral ketamine (SMD: -0.75; 95% CI: -1.08, -0.43; p<0.0001; I
Conclusion
This focused meta-analysis of oral ketamine suggests a marginal efficacy for major depressive disorder without increased risk of adverse events. Further larger sample studies are needed to confirm these preliminary findings, analyzing differential response/remission rates by affective disorder, optimal dosing strategies, and its long-term effects.

Identifiants

PMID: 33012876 PMC: PMC7511150
pubmed: 33012876
pmc: PMC7511150

Substances chimiques

Antidepressive Agents 0
Ketamine 690G0D6V8H

Types de publication

Journal Article Meta-Analysis Research Support, Non-U.S. Gov't Systematic Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

137-163

Informations de copyright

Copyright © 1964–2019 by MedWorks Media Inc, Los Angeles, CA All rights reserved. Printed in the United States.

Déclaration de conflit d'intérêts

Financial Disclosures Dr. Singh received research time support from Medibio. It is unrelated to the current study. Dr. Singh reports grant support from Mayo Clinic. Dr. Frye reports grant support from Assurex Health, Mayo Foundation, Medibio. Consultant (Mayo)—Actify Neurotherapies, Allergan, Intra-Cellular Therapies, Inc., Janssen, Myriad, Neuralstem Inc., Takeda, Teva Pharmaceuticals. He reports CME/Travel/Honoraria from the American Physician Institute, CME Outfitters, Global Academy for Medical Education. Dr. Vande Voort has received supplies and genotyping services from Assurex Health, Inc. for investigator-initiated studies. Other authors have none to declare. All authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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Auteurs

Nicolas A Nuñez (NA)

Nuñez, MD, MS, Pahwa, MD, Seshadri, MD, Kung, MD, Schak, MD, VandeVoort, MD, Frye, MD,Singh MD, MS, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA. Joseph, MBBS, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA, Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA. Prokop, MLS, Mayo Medical Libraries, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.

Boney Joseph (B)

Nuñez, MD, MS, Pahwa, MD, Seshadri, MD, Kung, MD, Schak, MD, VandeVoort, MD, Frye, MD,Singh MD, MS, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA. Joseph, MBBS, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA, Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA. Prokop, MLS, Mayo Medical Libraries, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.

Mehak Pahwa (M)

Nuñez, MD, MS, Pahwa, MD, Seshadri, MD, Kung, MD, Schak, MD, VandeVoort, MD, Frye, MD,Singh MD, MS, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA. Joseph, MBBS, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA, Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA. Prokop, MLS, Mayo Medical Libraries, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.

Ashok Seshadri (A)

Nuñez, MD, MS, Pahwa, MD, Seshadri, MD, Kung, MD, Schak, MD, VandeVoort, MD, Frye, MD,Singh MD, MS, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA. Joseph, MBBS, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA, Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA. Prokop, MLS, Mayo Medical Libraries, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.

Larry J Prokop (LJ)

Nuñez, MD, MS, Pahwa, MD, Seshadri, MD, Kung, MD, Schak, MD, VandeVoort, MD, Frye, MD,Singh MD, MS, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA. Joseph, MBBS, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA, Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA. Prokop, MLS, Mayo Medical Libraries, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.

Simon Kung (S)

Nuñez, MD, MS, Pahwa, MD, Seshadri, MD, Kung, MD, Schak, MD, VandeVoort, MD, Frye, MD,Singh MD, MS, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA. Joseph, MBBS, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA, Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA. Prokop, MLS, Mayo Medical Libraries, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.

Kathryn M Schak (KM)

Nuñez, MD, MS, Pahwa, MD, Seshadri, MD, Kung, MD, Schak, MD, VandeVoort, MD, Frye, MD,Singh MD, MS, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA. Joseph, MBBS, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA, Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA. Prokop, MLS, Mayo Medical Libraries, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.

Jennifer L Vande Voort (JL)

Nuñez, MD, MS, Pahwa, MD, Seshadri, MD, Kung, MD, Schak, MD, VandeVoort, MD, Frye, MD,Singh MD, MS, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA. Joseph, MBBS, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA, Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA. Prokop, MLS, Mayo Medical Libraries, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.

Mark A Frye (MA)

Nuñez, MD, MS, Pahwa, MD, Seshadri, MD, Kung, MD, Schak, MD, VandeVoort, MD, Frye, MD,Singh MD, MS, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA. Joseph, MBBS, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA, Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA. Prokop, MLS, Mayo Medical Libraries, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.

Balwinder Singh (B)

Nuñez, MD, MS, Pahwa, MD, Seshadri, MD, Kung, MD, Schak, MD, VandeVoort, MD, Frye, MD,Singh MD, MS, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA. Joseph, MBBS, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA, Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA. Prokop, MLS, Mayo Medical Libraries, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › An Update on the Efficacy and Tolerability of...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Agents du système nerveux central › Psychoanaleptiques › Antidépresseurs › An Update on the Efficacy and Tolerability of...
questionsmedicales.fr › Comportement et mécanismes comportementaux › Émotions › Dépression › An Update on the Efficacy and Tolerability of...
questionsmedicales.fr › Troubles mentaux › Troubles de l'humeur › Trouble dépressif › Trouble dépressif majeur › An Update on the Efficacy and Tolerability of...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › An Update on the Efficacy and Tolerability of...
questionsmedicales.fr › Composés chimiques organiques › Hydrocarbures › Hydrocarbures cycliques › Hydrocarbures alicycliques › Cyclohexanes › Kétamine › An Update on the Efficacy and Tolerability of...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › An Update on the Efficacy and Tolerability of...
questionsmedicales.fr › Troubles mentaux › Troubles de l'humeur › An Update on the Efficacy and Tolerability of...