Icahn School of Medicine at Mount Sinai, Babcock Building, 5 West, 1111 Amsterdam Avenue, New York, NY, 10025, USA.
Eur Child Adolesc Psychiatry. 2021 Oct;30(10):1485-1501. doi: 10.1007/s00787-020-01542-3. Epub 2020 May 8.
Suicide is the second leading cause of death in the United States among individuals aged 10-24, and severe youth depression is often refractory to the current standards of care. Many studies have demonstrated the efficacy of ketamine in reducing depressive symptoms in adults with treatment-resistant mood disorders, though few studies utilizing ketamine in youth populations exist. This systematic review examines the current state of evidence for ketamine use in children with treatment-resistant mood disorders. We conducted a search utilizing two electronic databases for English-language studies investigating the therapeutic effects and side effect profile of ketamine in youth ≤ 19 years of age with a diagnosis of a treatment-resistant mood disorder. Analysis included subjects with treatment-resistant depression with and without psychotic features and with bipolar disorder. Primary outcome measures included the following scales: Montgomery-Asberg Depression Rating Scale, Children's Depression Rating Scale, Children's Depression Rating Scale Revised, Child Bipolar Questionnaire, Overt Aggression Scale, Yale-Brown Obsessive-Compulsive Scale, and Scale for Suicidal Ideation. Four published studies were identified that investigated therapeutic ketamine use in youth for the primary purpose of treating a treatment-resistant psychiatric disorder. Three additional studies that did not meet eligibility criteria were identified and discussed. Ketamine was shown in youth to generally improve depressive symptoms, decrease acute suicidality, and reduce mood lability, though a number of subjects remained resistant to its treatment. These findings substantiate the need for further longitudinal studies investigating ketamine's long-term safety, its efficacy, and abuse potential in the youth.
在美国，自杀是 10-24 岁人群的第二大死因，而严重的青少年抑郁往往对当前的治疗标准具有抗性。许多研究已经证明氯胺酮在减轻成人治疗抵抗性情绪障碍患者的抑郁症状方面的有效性，尽管利用氯胺酮治疗青少年的研究很少。本系统综述考察了氯胺酮在治疗抵抗性情绪障碍的儿童中的使用现状。我们利用两个电子数据库进行了搜索，以查找英语研究，调查了诊断为治疗抵抗性情绪障碍的≤19 岁青少年中氯胺酮的治疗效果和副作用特征。分析包括伴有和不伴有精神病特征的治疗抵抗性抑郁症以及双相情感障碍患者。主要结局测量包括以下量表：蒙哥马利-阿斯伯格抑郁评定量表、儿童抑郁评定量表、儿童抑郁评定量表修订版、儿童双相问卷、明显攻击量表、耶鲁-布朗强迫量表和自杀意念量表。确定了 4 项已发表的研究，这些研究主要调查了治疗性氯胺酮在青少年中的使用，目的是治疗治疗抵抗性精神障碍。还确定并讨论了另外 3 项不符合入选标准的研究。研究表明，氯胺酮通常可以改善青少年的抑郁症状，降低急性自杀意念，并降低情绪波动性，但仍有许多患者对其治疗具有抗性。这些发现证实了需要进一步进行纵向研究，以调查氯胺酮在青少年中的长期安全性、疗效和滥用潜力。
