A systematic review of ketamine for the treatment of depression among older adults

• Published in: The American journal of geriatric psychiatry 2021-04, Vol.29 (4), p.S93-S96
• Main Authors: Farheen, Syeda Arshiya, Gupta, Aarti, Dhar, Romika, Patadia, Palak, Funaro, Melissa, Bhattacharya, Gargi, Tampi, Rajesh
• Format: Article
• Language: English
• ISSN: 1064-7481; 1545-7214
• DOI: 10.1016/j.jagp.2021.01.089

Depression is the second most prevalent mental health disorder among older adults after anxiety disorders. It effects 7% of the general older population globally 5.6% of US older adults. Suicide rates also increase between ages of 60-90 in both men and women around the world. A large body of literature shows increased association of late life depression with increased morbidity and mortality in this age group. Evidence for depression as a risk factor for physical and cognitive decline that results in lower quality of life and function among older adults underlines the importance of early recognition and prompt treatment of this serious condition. The most common modalities currently used for treatment of late life depression include pharmacotherapy, psychotherapy and electroconvulsive therapy (ECT). Pharmacotherapy mostly consists of antidepressants targeting the monoaminergic system. Ketamine has recently emerged as a novel, rapid acting option for treatment resistant depression in adults. Ketamine is a N-methyl-D-aspartate (NMDA) receptor antagonist, which has been used primarily as an anesthetic since the 1960s. In 1990s preclinical studies demonstrated the role of NMDA receptor antagonists in treatment of depression, which was later confirmed in a pilot clinical study. Berman et al administered subanaesthetic doses of Ketamine (0.5mg/kg) vs. placebo to 7 study participants which resulted in robust decreases in Hamilton Depression Rating Scale scores within 4 hours of the infusion in all participants. The effect was sustained for 3 days followed by diminution of the scores and relapse of symptoms. This rapid onset anti-depressant effect of ketamine compared to conventional antidepressants attracted considerable interest and these findings have since been reliably replicated in multiple different studies, using different protocols and routes of administration of ketamine. This systematic review evaluates randomized controlled trials completed in the older adult population with depression to appraise the efficacy and tolerability of ketamine specifically in this population. The authors followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) On November 09, 2019 the authors conducted a comprehensive search of multiple databases: PubMed (through November 09, 2019), MEDLINE (Ovid ALL 1946 to November 08, 2019), Embase (Ovid 1974 to 2019 November 08), PsycINFO (Ovid 1806 to October Week 4 2019), Web of Science Core Collection