Administration of ketamine for unipolar and bipolar depression. (2nd January 2017)

• Record Type: Journal Article
• Authors: Kraus, Christoph; Rabl, Ulrich; Vanicek, Thomas; Carlberg, Laura; Popovic, Ana; Spies, Marie; Bartova, Lucie; Gryglewski, Gregor; Papageorgiou, Konstantinos; Lanzenberger, Rupert; Willeit, Matthäus; Winkler, Dietmar; Rybakowski, Janusz K.; Kasper, Siegfried
• Is Part Of: International journal of psychiatry in clinical practice. Volume 21:Number 1(2017)
• Page Start: 2
• Page End: 12
• Publication Date: 2017-01-02
• Subjects: Ketamine -- depression -- rapid antidepressant -- glutamate -- NMDA-receptor; Mental illness -- Periodicals; Older people -- Mental health -- Periodicals; Psychiatry -- Periodicals; 616.89005
• DOI: 10.1080/13651501.2016.1254802
• Languages: English
• ISSNs: 1365-1501

Abstract

Abstract: Objective: Clinical trials demonstrated that ketamine exhibits rapid antidepressant efficacy when administered in subanaesthetic dosages. We reviewed currently available literature investigating efficacy, response rates and safety profile. Methods: Twelve studies investigating unipolar, seven on bipolar depression were included after search in medline, scopus and web of science. Results: Randomized, placebo-controlled or open-label trials reported antidepressant response rates after 24 h on primary outcome measures at 61%. The average reduction of Hamilton Depression Rating Scale (HAM-D) was 10.9 points, Beck Depression Inventory (BDI) 15.7 points and Montgomery-Asberg Depression Rating Scale (MADRS) 20.8 points. Ketamine was always superior to placebo. Most common side effects were dizziness, blurred vision, restlessness, nausea/vomiting and headache, which were all reversible. Relapse rates ranged between 60% and 92%. To provide best practice-based information to patients, a consent-form for application and modification in local language is included. Conclusions: Ketamine constitutes a novel, rapid and efficacious treatment option for patients suffering from treatment resistant depression and exhibits rapid and significant anti-suicidal effects. New administration routes might serve as alternative to intravenous regimes for potential usage in outpatient settings. However, long-term side effects are not known and short duration of antidepressant response need ways to prolong ketamine's efficacy.