An Update on the Efficacy and Tolerability of Oral Ketamine for Major Depression: A Systematic Review and Meta-Analysis.

Q3 Medicine
Psychopharmacology bulletin Pub Date : 2020-09-14
Nicolas A Nuñez, Boney Joseph, Mehak Pahwa, Ashok Seshadri, Larry J Prokop, Simon Kung, Kathryn M Schak, Jennifer L Vande Voort, Mark A Frye, Balwinder Singh
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引用次数: 0

Abstract

Background: Intravenous Ketamine has shown robust antidepressant efficacy although other routes of administration are currently needed. We conducted a systematic review and meta-analysis of studies evaluating the efficacy and tolerability of oral ketamine for depression.

Methods: A comprehensive search of major electronic databases from inception to April 2020 was performed. Studies of oral ketamine for depression, from case series to randomized clinical trials, were eligible. Randomized controlled trials were included in a meta-analysis, focusing on response, remission, time to effect, and side effects.

Results: A total of 917 articles were identified with 890 studies screened, yielding a total of 10 studies included in our systematic review.Three randomized controlled trials (RCTs) (N = 161, mean age 37.9 ± 9.5 years, 58.6% females) were included in the meta-analysis. Pooled analysis suggested a significant antidepressant effect of oral ketamine (SMD: -0.75; 95% CI: -1.08, -0.43; p<0.0001; I2 = 0%) although remission rates (RR:2.77; 95% CI:0.96, 8.00; p = 0.06) and response rates (RR:2.58; 95% CI:0.94,7.08; p = 0.07) were marginal compared to placebo at the endpoint. Oral ketamine antidepressant effects seemed to take effect at the 2nd week (SMD: -0.71; 95% CI: -1.08, -0.35; p = 0.001; I2 = 0%). There were no significant differences in the overall side-effects between oral ketamine and the placebo group (RR 1.28, 95% CI: 0.89-1.83; p = 0.19).

Conclusion: This focused meta-analysis of oral ketamine suggests a marginal efficacy for major depressive disorder without increased risk of adverse events. Further larger sample studies are needed to confirm these preliminary findings, analyzing differential response/remission rates by affective disorder, optimal dosing strategies, and its long-term effects.

口服氯胺酮治疗重度抑郁症疗效和耐受性的最新进展:一项系统综述和荟萃分析。
背景:静脉注射氯胺酮已显示出强大的抗抑郁疗效,尽管目前需要其他给药途径。我们对评估口服氯胺酮治疗抑郁症的疗效和耐受性的研究进行了系统回顾和荟萃分析。方法:全面检索成立至2020年4月的主要电子数据库。口服氯胺酮治疗抑郁症的研究,从病例系列到随机临床试验,都是合格的。随机对照试验被纳入荟萃分析,重点关注反应、缓解、到效时间和副作用。结果:共有917篇文章被确定,890项研究被筛选,总共有10项研究被纳入我们的系统综述。meta分析纳入3项随机对照试验(rct) (N = 161,平均年龄37.9±9.5岁,女性58.6%)。综合分析表明,口服氯胺酮的抗抑郁作用显著(SMD: -0.75;95% ci: -1.08, -0.43;p2 = 0%),但缓解率(RR:2.77;95% ci:0.96, 8.00;p = 0.06)和应答率(RR:2.58;95%置信区间:0.94,7.08;P = 0.07)在终点与安慰剂相比是边缘的。口服氯胺酮抗抑郁药物似乎在第2周起作用(SMD: -0.71;95% ci: -1.08, -0.35;P = 0.001;I2 = 0%)。口服氯胺酮组与安慰剂组的总体副作用无显著差异(RR 1.28, 95% CI: 0.89-1.83;P = 0.19)。结论:这项针对口服氯胺酮的荟萃分析表明,在不增加不良事件风险的情况下,口服氯胺酮对重度抑郁症有边际疗效。需要进一步的大样本研究来证实这些初步发现,分析情感障碍的不同反应/缓解率,最佳给药策略及其长期影响。
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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来源期刊
Psychopharmacology bulletin
Psychopharmacology bulletin PHARMACOLOGY & PHARMACY-PSYCHIATRY
CiteScore
2.70
自引率
0.00%
发文量
32
期刊介绍: Information not localized
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