Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada.
Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada; Braxia Health, Braxia Scientific Corp, Mississauga, ON, Canada.
Psychiatry Res. 2022 Nov;317:114911. doi: 10.1016/j.psychres.2022.114911. Epub 2022 Oct 15.
Pediatric depression is a common psychiatric disorder that is associated with significant morbidity and mortality. Ketamine is a non-competitive N-methyl-D-aspartate (NMDA) receptor antagonist with demonstrated antidepressant effects in the adult population, however, the efficacy and safety of ketamine for the treatment of pediatric depression remains poorly understood. Electronic databases were searched from inception to June 2022 to identify relevant articles. Six articles involving 46 participants with a mean age of 15.7 years were included in this systematic review. Out of six articles, three were case reports, one was a randomized clinical trial (RCT) and two were open-label trials. All studies used 0.5 mg/kg intravenous ketamine except for one, which used 2-7 micrograms/kg. Ketamine was significantly associated with reduced depressive symptoms without severe adverse events. Taken together, the results of these studies demonstrated the potential role of ketamine for treating pediatric depression. Several important limitations were identified, most notably the small sample sizes of the component studies, and that all studies administered intravenous ketamine. Further studies with larger sample sizes and different administration modalities are needed to better determine the efficacy and safety of ketamine in pediatric depression.
儿童抑郁症是一种常见的精神障碍，与显著的发病率和死亡率有关。氯胺酮是一种非竞争性 N-甲基-D-天冬氨酸（NMDA）受体拮抗剂，已证明在成年人群中有抗抑郁作用，然而，氯胺酮治疗儿童抑郁症的疗效和安全性仍知之甚少。电子数据库从建立到 2022 年 6 月进行了检索，以确定相关文章。本系统评价纳入了 6 篇文章，共涉及 46 名参与者，平均年龄为 15.7 岁。在 6 篇文章中，有 3 篇是病例报告，1 篇是随机临床试验（RCT），2 篇是开放标签试验。除了一篇文章使用 2-7 微克/公斤的剂量外，所有研究均使用 0.5 毫克/公斤静脉注射氯胺酮。氯胺酮与抑郁症状减轻显著相关，没有严重的不良事件。综上所述，这些研究的结果表明氯胺酮在治疗儿童抑郁症方面具有潜在作用。但也确定了几个重要的局限性，最值得注意的是各组成研究的样本量较小，且所有研究均给予静脉注射氯胺酮。需要进一步进行更大样本量和不同给药方式的研究，以更好地确定氯胺酮在儿童抑郁症中的疗效和安全性。
