TY - JOUR
T1 - Maintenance ketamine treatment for depression
T2 - a systematic review of efficacy, safety, and tolerability
AU - Smith-Apeldoorn, Sanne Y.
AU - Veraart, Jolien KE
AU - Spijker, Jan
AU - Kamphuis, Jeanine
AU - Schoevers, Robert A.
N1 - Funding Information:
JKEV received a speaker's fee from Janssen Pharmaceuticals, outside the submitted work. RAS received research funding for two randomised clinical trials with generic oral esketamine from the Netherlands Organisation for Health Research and Development and the National Health Care Institute, a speaker's fee and investigator initiated research grant from Janssen Pharmaceuticals, and consultancy fees from GH Research, Beckley PsyTech, and QPS, outside the submitted work. The other authors declared no competing interests.
Publisher Copyright:
© 2022 Elsevier Ltd
PY - 2022/11
Y1 - 2022/11
N2 - Ketamine has rapid yet often transient antidepressant effects in patients with treatment-resistant depression. Different strategies have been proposed to prolong these effects. Maintenance ketamine treatment appears promising, but little is known about its efficacy, safety, and tolerability in depression. We searched Pubmed, Embase, and the Cochrane Library and identified three randomised controlled trials, eight open-label trials, and 30 case series and reports on maintenance ketamine treatment. We found intravenous, intranasal, oral, and possibly intramuscular and subcutaneous maintenance ketamine treatment to be effective in sustaining antidepressant effect in treatment-resistant depression. Tachyphylaxis, cognitive impairment, addiction, and serious renal and urinary problems seem uncommon. Despite the methodological limitations, we conclude that from a clinical view, maintenance ketamine treatment seems to be of therapeutic potential. We recommend both controlled and naturalistic studies with long-term follow-up and sufficient power to determine the position of maintenance ketamine treatment within routine clinical practice.
AB - Ketamine has rapid yet often transient antidepressant effects in patients with treatment-resistant depression. Different strategies have been proposed to prolong these effects. Maintenance ketamine treatment appears promising, but little is known about its efficacy, safety, and tolerability in depression. We searched Pubmed, Embase, and the Cochrane Library and identified three randomised controlled trials, eight open-label trials, and 30 case series and reports on maintenance ketamine treatment. We found intravenous, intranasal, oral, and possibly intramuscular and subcutaneous maintenance ketamine treatment to be effective in sustaining antidepressant effect in treatment-resistant depression. Tachyphylaxis, cognitive impairment, addiction, and serious renal and urinary problems seem uncommon. Despite the methodological limitations, we conclude that from a clinical view, maintenance ketamine treatment seems to be of therapeutic potential. We recommend both controlled and naturalistic studies with long-term follow-up and sufficient power to determine the position of maintenance ketamine treatment within routine clinical practice.
U2 - 10.1016/S2215-0366(22)00317-0
DO - 10.1016/S2215-0366(22)00317-0
M3 - Review article
C2 - 36244360
AN - SCOPUS:85139735999
SN - 2215-0366
VL - 9
SP - 907
EP - 921
JO - The Lancet Psychiatry
JF - The Lancet Psychiatry
IS - 11
ER -