Efficacy of ketamine in the rapid treatment of major depressive disorder: a meta-analysis of randomized, double-blind, placebo-controlled studies

Abstract

BackgroundAn increasing number of studies are reporting that ketamine could be treated as a novel antidepressant for major depressive disorder (MDD). Therefore, we performed this meta-analysis to comprehensively and systematically assess the efficacy of ketamine for treating patients with MDD.MethodRandomized, double-blind, placebo-controlled studies on ketamine versus placebo for treating MDD were searched up to April 2016 in medical databases (PubMed, CCTR, Web of Science, Embase, CBM-disc, and CNKI). Three treatment time points (24 and 72 h, and day 7) were chosen. Response and remission rates were the main outcomes. The random effects model was used. An intention-to-treat analysis was conducted.ResultsNine high-quality studies that included 368 patients were selected to compare the efficacy of ketamine to placebo. The therapeutic effects of ketamine at 24 and 72 h, and day 7 were found to be significantly better than placebo. Response and remission rates in the ketamine group at 24 and 72 h, and day 7 were 52.2% and 20.6%; 47.9% and 23.8%; and 39.8% and 26.2%, respectively. No significant heterogeneity existed, and the Egger’s test showed no publication bias.ConclusionThese results indicated that ketamine could yield a good efficacy in the rapid treatment of MDD. Future large-scale clinical studies are needed to confirm our results and investigate the mid- and long-term efficacy of ketamine in treating MDD.

Inflammation in psychiatric disorders: what comes first?

“…Importantly, blocking NMDA glutamate receptors (with ketamine) or inhibiting IDO activity protects mice from experimentally induced depression‐like behavior . Based on these preclinical findings, ketamine has proven to have rapid antidepressant effects in humans . Drugs that block IDO may also be useful for patients with depression and high inflammatory markers.…”

Keeping up with the clinical advances: depression

“…Furthermore, results at all time points were highly significant (p < 0.00001). 28 Of clinical relevance is the time to response to ketamine wherein, following a single infusion, antidepressant effects can be observed within 4 hours. 29 Notably, the use of ketamine for MDD has been associated with psychotomimetic effects post-infusion and may have the potential for abuse.…”

New medications for treatment-resistant depression: a brief review of recent developments

“…8,9 Today, after an additional decade of research, the rapid and robust antidepressant effects of ketamine have been extensively replicated. 10,11 It is now clear that 0.4-0.6 mg/kg of ketamine, typically infused over approximately 30-60 minutes, can exert a dramatic antidepressant effect in 40%-60% of depressed patients.…”

“…Unlike all of the conventional medical therapies for depression, the antidepressant effects of a ketamine infusion are often evident within the first 24 hours and typically persist for up to 7 days, ie, long after the potentially intoxicating effects of the drug have passed. 10,11 The rapidity of ketamine's antidepressant effects thus offers special promise for use in psychiatric inpatient settings, where each day of care costs more than $1000. The effects of ketamine infusions on the suicidal ideations appear to be as rapidand of comparable magnitude-as its effects on mood and core depressive symptoms.…”