The antidepressant effect and safety of non-intranasal esketamine: A systematic review

S. Smith-Apeldoorn, Maurice Vischjager, J. Veraart, J. Kamphuis, M. aan het Rot, R. Schoevers
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引用次数: 6

Abstract

Background: The introduction of esketamine into the field of psychiatry comes on the heels of excitement from studies on racemic ketamine. While the intranasal route has been the most studied to date, other modes of administration of esketamine may also be of interest in the management of depression. Aims: To systematically review the literature on non-intranasal esketamine for depression in terms of its antidepressant effect and safety. Methods: We searched PubMed, Embase, the Cochrane Library, and Google Scholar from inception up to February 2021. Search terms included a combination of Medical Subject Headings and text words indicative of esketamine and depression. We selected both controlled and uncontrolled studies examining non-intranasal esketamine for the treatment of depression. Results: We identified four randomized controlled trials (RCTs) on intravenous esketamine and 15 open-label studies on intravenous (n = 80), subcutaneous (n = 73), and oral (n = 5) esketamine. We found intravenous, subcutaneous, and possibly oral administration of esketamine to be effective in reducing depressive symptoms in most patients with major depressive disorder, bipolar depression, and (severe) treatment-resistant depression. Clinical response to repeated administration of esketamine persisted over the course of treatment. Esketamine was well tolerated by most patients, but open-label data indicate marked psychotomimetic symptoms in exceptional cases. The overall quality of the controlled studies was considered high, the overall quality of the uncontrolled studies low to moderate. Conclusions: Intravenous, subcutaneous, and possibly oral esketamine may offer an effective and safe addition to the depression treatment armamentarium. However, as most included studies lacked a control group and had small sample sizes, the quality of our results is limited. Different types and formulations of ketamine remain to be compared directly.
非鼻用艾氯胺酮的抗抑郁效果和安全性:一项系统综述
背景:艾氯胺酮进入精神病学领域是在对外消旋氯胺酮的研究令人兴奋之后。虽然鼻内途径是迄今为止研究最多的,但艾氯胺酮的其他管理模式也可能对抑郁症的管理感兴趣。目的:系统回顾非鼻用艾氯胺酮治疗抑郁症的疗效和安全性。方法:我们检索了PubMed、Embase、Cochrane Library和Google Scholar,检索时间从成立到2021年2月。搜索词包括医学主题标题和表明艾氯胺酮和抑郁症的文本词的组合。我们选择了对照和非对照研究,检查非鼻用艾氯胺酮治疗抑郁症。结果:我们确定了4项静脉注射艾氯胺酮的随机对照试验(rct)和15项静脉注射(n = 80)、皮下注射(n = 73)和口服(n = 5)艾氯胺酮的开放标签研究。我们发现静脉注射、皮下注射和可能的口服艾氯胺酮可有效减轻大多数重度抑郁症、双相抑郁症和(严重)治疗难治性抑郁症患者的抑郁症状。反复给予艾氯胺酮的临床反应在整个治疗过程中持续存在。大多数患者对艾氯胺酮耐受性良好,但开放标签数据显示,在特殊情况下,有明显的拟精神症状。对照研究的总体质量为高,非对照研究的总体质量为低至中等。结论:静脉注射、皮下注射和可能的口服艾氯胺酮可能是一种有效和安全的抑郁症治疗手段。然而,由于大多数纳入的研究缺乏对照组且样本量小,我们的结果质量有限。氯胺酮的不同类型和配方仍有待直接比较。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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