Li Jiafeng, Ma Ling, Sun Huan, Li Meng, Cao Yuan, Peng Yang, Xu Jiajun
Mental Health Center, West China Hospital of Sichuan University, Chengdu, China.
Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany.
Eur Arch Psychiatry Clin Neurosci. 2024 Oct 9. doi: 10.1007/s00406-024-01920-x.
The current systematic review and meta-analysis examined the effect of racemic ketamine or esketamine on suicidal ideation in individuals with uni- or bipolar depression. We searched the MEDLINE, Embase, Central, PsycINFO, and Web of Science databases to identify randomized controlled trials that examined the effect of racemic ketamine or esketamine monotherapy on suicidal ideation (SI) in individuals with uni- or bipolar depression. The two monotherapies were compared; the primary outcome was the rate of remission of SI, and the secondary outcome was the SI score. The risk ratio was used as an effect size measure for binary variables, while the standardized mean difference was used as an effect size measure for continuous variables. Our meta-analysis included 13 randomized controlled trials involving 1,1109 individuals with uni- or bipolar depression. Patients receiving racemic ketamine monotherapy had a significantly higher acute SI remission rate than those receiving placebo or midazolam (RR = 2.06, 95% CI 1.47 to 2.91, P < 0.0001). Racemic ketamine also led to significantly lower SI scores than placebo or midazolam (SMD = -0.36, 95% CI -0.71 to -0.01, P = 0.04). The evidence for the treatment of SI with esketamine was inconsistent. The pooled effect sizes for long-term anti-SI effects did not reveal significant differences between therapies. Our study indicated the efficacy of racemic ketamine monotherapy for rapidly and transiently reducing SI in individuals with uni- or bipolar depression, but the efficacy of racemic ketamine monotherapy against long-term suicidal ideation remains unclear. There is not -sufficient evidence to support the anti-suicidal effects of esketamine monotherapy.Protocol registration: Prospero registration number: CRD42023434380.
本系统评价和荟萃分析研究了消旋氯胺酮或艾氯胺酮对单相或双相抑郁症患者自杀观念的影响。我们检索了MEDLINE、Embase、Central、PsycINFO和Web of Science数据库，以确定研究消旋氯胺酮或艾氯胺酮单一疗法对单相或双相抑郁症患者自杀观念（SI）影响的随机对照试验。对这两种单一疗法进行了比较；主要结局是SI缓解率，次要结局是SI评分。风险比用作二元变量的效应量指标，而标准化均值差用作连续变量的效应量指标。我们的荟萃分析纳入了13项随机对照试验，涉及11109名单相或双相抑郁症患者。接受消旋氯胺酮单一疗法的患者急性SI缓解率显著高于接受安慰剂或咪达唑仑的患者（RR = 2.06，95%CI 1.47至2.91，P < 0.0001）。消旋氯胺酮也导致SI评分显著低于安慰剂或咪达唑仑（SMD = -0.36，95%CI -0.71至-0.01，P = 0.04）。使用艾氯胺酮治疗SI的证据不一致。长期抗SI效应的合并效应量未显示各疗法之间存在显著差异。我们的研究表明，消旋氯胺酮单一疗法对快速、短暂降低单相或双相抑郁症患者的SI有效，但消旋氯胺酮单一疗法对长期自杀观念的疗效仍不清楚。没有足够的证据支持艾氯胺酮单一疗法的抗自杀作用。方案注册：Prospero注册号：CRD42023434380。
