Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Department of Mood Disorders, PsyQ Haaglanden, Parnassia Psychiatric Institute, The Hague, The Netherlands.
J Psychopharmacol. 2022 May;36(5):531-544. doi: 10.1177/02698811221084055. Epub 2022 May 12.
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.
To systematically review the literature on non-intranasal esketamine for depression in terms of its antidepressant effect and safety.
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.
We identified four randomized controlled trials (RCTs) on intravenous esketamine and 15 open-label studies on intravenous ( = 80), subcutaneous ( = 73), and oral ( = 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.
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.
氯胺酮在精神病学领域的应用是在对消旋氯胺酮研究的兴奋之后出现的。虽然鼻内给药途径是迄今为止研究最多的，但氯胺酮的其他给药方式在抑郁症的治疗中也可能引起关注。
系统综述非鼻内氯胺酮治疗抑郁症的文献，评估其抗抑郁作用和安全性。
我们检索了 PubMed、Embase、Cochrane 图书馆和 Google Scholar，检索时间截至 2021 年 2 月。检索词包括氯胺酮和抑郁症的主题词和文本词的组合。我们选择了评估非鼻内氯胺酮治疗抑郁症的对照和非对照研究。
我们确定了 4 项关于静脉内氯胺酮的随机对照试验（RCT）和 15 项关于静脉内（ = 80）、皮下（ = 73）和口服（ = 5）氯胺酮的开放标签研究。我们发现，静脉内、皮下和口服氯胺酮给药在大多数伴有重性抑郁障碍、双相抑郁和（严重）治疗抵抗性抑郁的患者中，有效减轻抑郁症状。重复给予氯胺酮后，临床反应在治疗过程中持续存在。大多数患者对氯胺酮的耐受性良好，但开放标签数据表明，在极少数情况下会出现明显的精神病样症状。对照研究的整体质量被认为较高，非对照研究的整体质量为低到中度。
静脉内、皮下和口服氯胺酮可能为抑郁症的治疗手段提供有效且安全的选择。然而，由于大多数纳入的研究缺乏对照组且样本量较小，我们的研究结果质量有限。不同类型和配方的氯胺酮仍有待直接比较。
