Ketamine administration in depressive disorders: a systematic review and meta-analysis

• Published in: Psychopharmacology 2014-09, Vol.231 (18), p.3663-3676
• Main Authors: Fond, Guillaume, Loundou, Anderson, Rabu, Corentin, Macgregor, Alexandra, Lançon, Christophe, Brittner, Marie, Micoulaud-Franchi, Jean-Arthur, Richieri, Raphaelle, Courtet, Philippe, Abbar, Mocrane, Roger, Matthieu, Leboyer, Marion, Boyer, Laurent
• Format: Article
• Language: English
• Subjects: Anesthetics, Dissociative - therapeutic use; Antidepressive Agents - therapeutic use; Biomedical and Life Sciences; Biomedicine; Bipolar disorder; Bipolar Disorder - drug therapy; Depression, Mental; Depressive Disorder, Major - drug therapy; Depressive Disorder, Treatment-Resistant - drug therapy; Depressive Disorder, Treatment-Resistant - therapy; Dosage and administration; Drug interactions; Drug therapy; Electroconvulsive Therapy; Humans; Identification and classification; Ketamine; Ketamine - therapeutic use; Mental depression; Neurosciences; Pharmacology/Toxicology; Psychiatry; Psychopharmacology; Review; Systematic review
• ISSN: 0033-3158; 1432-2072
• DOI: 10.1007/s00213-014-3664-5

Introduction Ketamine’s efficacy in depressive disorders has been established in several controlled trials. The aim of the present study was to determine whether or not ketamine administration significantly improves depressive symptomatology in depression and more specifically in major depressive disorder (MDD), bipolar depression, resistant depression (non-ECT studies), and as an anesthetic agent in electroconvulsive therapy (ECT) for resistant depression (ECT studies). Secondary outcomes were the duration of ketamine’s effect, the efficacy on suicidal ideations, the existence of a dose effect, and the safety/tolerance of the treatment. Methods Studies were included if they met the following criteria (without any language or date restriction): design: randomized controlled trials, intervention: ketamine administration, participants: diagnosis of depression, and evaluation of severity based on a validated scale. We calculated standardized mean differences (SMDs) with 95 % confidence intervals (CIs) for each study. We used fixed and random effects models. Heterogeneity was assessed using the I2 statistic. Results We included nine non-ECT studies in our quantitative analysis (192 patients with major depressive disorder and 34 patients with bipolar depression). Overall, depression scores were significantly decreased in the ketamine groups compared to those in the control groups (SMD = −0.99; 95 % CI −1.23, −0.75; p