Coyle Caoimhe M, Laws Keith R
School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK.
Hum Psychopharmacol. 2015 May;30(3):152-63. doi: 10.1002/hup.2475. Epub 2015 Apr 7.
The current meta-analysis examines the effects of ketamine infusion on depressive symptoms over time in major depressive disorder (MDD) and bipolar disorder (BD).
Following a systematic review of the literature, data were extracted from 21 studies (n = 437 receiving ketamine) and analysed at four post-infusion time points (4 h, 24 h, 7 days and 12-14 days). The moderating effects of several factors were assessed including: repeat/single infusion, diagnosis, open-label/participant-blind infusion, pre-post/placebo-controlled design and the sex of patients.
Effect sizes were significantly larger for repeat than single infusion at 4 h, 24 h and 7 days. For single infusion studies, effect sizes were large and significant at 4 h, 24 h and 7 days. The percentage of males was a predictor of antidepressant response at 7 days. Effect sizes for open-label and participant-blind infusions were not significantly different at any time point.
Single ketamine infusions elicit a significant antidepressant effect from 4 h to 7 days; the small number of studies at 12-14 days post infusion failed to reach significance. Results suggest a discrepancy in peak response time depending upon primary diagnosis - 24 h for MDD and 7 days for BD. The majority of published studies have used pre-post comparison; further placebo-controlled studies would help to clarify the effect of ketamine over time.
本次荟萃分析研究了氯胺酮输注对重度抑郁症（MDD）和双相情感障碍（BD）患者抑郁症状随时间的影响。
在对文献进行系统回顾后，从21项研究（n = 437接受氯胺酮治疗）中提取数据，并在输注后的四个时间点（4小时、24小时、7天和12 - 14天）进行分析。评估了几个因素的调节作用，包括：重复/单次输注、诊断、开放标签/参与者盲法输注、前后对照/安慰剂对照设计以及患者性别。
在4小时、24小时和7天时，重复输注的效应量显著大于单次输注。对于单次输注研究，效应量在4小时、24小时和7天时较大且显著。男性比例是7天时抗抑郁反应的一个预测因素。开放标签和参与者盲法输注的效应量在任何时间点均无显著差异。
单次氯胺酮输注在4小时至7天内产生显著的抗抑郁作用；输注后12 - 14天的研究数量较少，未达到显著水平。结果表明，根据主要诊断不同，峰值反应时间存在差异——MDD为24小时，BD为7天。大多数已发表的研究采用了前后对照；进一步的安慰剂对照研究将有助于阐明氯胺酮随时间的效应。
