Resident Physician, Henry Ford Allegiance Health, Jackson, MI, USA.
University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, USA.
Psychiatr Q. 2020 Dec;91(4):1147-1192. doi: 10.1007/s11126-020-09830-6.
Major Depressive Disorder (MDD) is a common psychiatric disorder with major implications for healthcare system and socioeconomic burden. For chronic and treatment-resistant depression, Ketamine has emerged as a possible treatment option. This systematic review explores the evidence for the effectiveness and tolerability of Ketamine in patients with MDD. This systematic review was conducted following the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist. Eight electronic databases were searched by using search terms: (ketamine) AND (trial OR RCT OR clinical-trial) AND (depressive OR depression OR "depressive-disorder"). After a rigorous screening process against the predetermined eligibility criteria, 35 randomized controlled trials (RCTs) were included. Quality assessment of included studies was done by using the Cochrane risk-of-bias tool for RCTs. Thirty-five RCTs are included in this review article with majority of studies from United States, Iran, and China. Intravenous (IV) Ketamine was effective in 70% (21/30) of the included studies whereas oral and Intranasal (IN) Ketamine were effective in two and three studies, respectively. The majority of studies (6/8) using Ketamine as anesthetic agent during electroconvulsive therapy (ECT) failed to show an improvement compared to the participants receiving ECT and placebo. The most common reported side effects were nausea, vomiting, dizziness, diplopia, drowsiness, dysphoria, hallucinations, and confusion. Ketamine is an effective treatment option for patients with MDD with undesirable effects when administered via oral, IV and IN routes. Ketamine agumentation of ECT requires further exploration in well-designed studies with adequate sample size. The short-lived antidepressant effect of Ketamine is a potential limitation, therefore, further studies administering multiple infusions for acute treatment and maintenance are necessary.
重度抑郁症（MDD）是一种常见的精神疾病，对医疗保健系统和社会经济负担有重大影响。对于慢性和治疗抵抗性抑郁症，氯胺酮已成为一种可能的治疗选择。本系统评价探讨了氯胺酮治疗 MDD 患者的有效性和耐受性的证据。本系统评价按照系统评价和荟萃分析的首选报告项目（PRISMA）清单指南进行。使用搜索词在八个电子数据库中进行搜索：（氯胺酮）和（试验或 RCT 或临床试验）和（抑郁或抑郁症或“抑郁障碍”）。经过严格的筛选过程，符合预定的纳入标准，共纳入 35 项随机对照试验（RCT）。使用 Cochrane RCT 偏倚风险工具对纳入研究进行质量评估。本综述文章纳入了 35 项 RCT，其中大多数研究来自美国、伊朗和中国。静脉内（IV）氯胺酮在 70%（21/30）的纳入研究中有效，而口服和鼻内（IN）氯胺酮在两项和三项研究中有效。在使用氯胺酮作为电惊厥治疗（ECT）麻醉剂的大多数研究（6/8）中，与接受 ECT 和安慰剂的参与者相比，未能显示出改善。最常见的报告副作用是恶心、呕吐、头晕、复视、嗜睡、烦躁、幻觉和意识混乱。氯胺酮是 MDD 患者的有效治疗选择，但通过口服、IV 和 IN 途径给药时会产生不良影响。需要在设计良好、样本量足够的研究中进一步探索氯胺酮增强 ECT 的效果。氯胺酮的抗抑郁作用持续时间短是一个潜在的限制，因此，需要进一步研究对急性治疗和维持期进行多次输注。
