Oral ketamine for the treatment of pain and treatment-resistant depression
Robert A. Schoevers, Tharcila V. Chaves, Sonya M. Balukova, Marije Aan Het Rot, Rudie Kortekaas
The British Journal of Psychiatry February 1, 2016 Peer reviewed DOI: 10.1192/bjp.bp.115.165498 via OpenAlex
Summary
Oral ketamine appears to be well tolerated for treatment-resistant depression, with dosing regimens suggesting it may be acceptable in terms of side effects. However, the overall quality of studies on its antidepressant effects is low, and doses for depression are generally lower than those used for pain management. There is a need for more rigorous randomized controlled trials to evaluate both short- and long-term outcomes and side effects.
Study at a glance
| Design | review |
|---|---|
| Population | patients with treatment-resistant depression and chronic pain |
| Key finding | The methodological strength of studies investigating the antidepressant effects of ketamine was considered low, regardless of the route of administration. |
Abstract
BACKGROUND: Recent studies with intravenous (i.v.) application of ketamine show remarkable but short-term success in patients with MDD. Studies in patients with chronic pain have used different ketamine applications for longer time periods. This experience may be relevant for psychiatric indications. AIMS: To review the literature about the dosing regimen, duration, effects and side-effects of oral, intravenous, intranasal and subcutaneous routes of administration of ketamine for treatment-resistant depression and pain. METHOD: Searches in PubMed with the terms 'oral ketamine', 'depression', 'chronic pain', 'neuropathic pain', 'intravenous ketamine', 'intranasal ketamine' and 'subcutaneous ketamine' yielded 88 articles. We reviewed all papers for information about dosing regimen, number of individuals who received ketamine, number of ketamine days per study, results and side-effects, as well as study quality. RESULTS: Overall, the methodological strength of studies investigating the antidepressant effects of ketamine was considered low, regardless of the route of administration. The doses for depression were in the lower range compared with studies that investigated analgesic use. Studies on pain suggested that oral ketamine may be acceptable for treatment-resistant depression in terms of tolerability and side-effects. CONCLUSIONS: Oral ketamine, given for longer time periods in the described doses, appears to be well tolerated, but few studies have systematically examined the longer-term negative consequences. The short- and longer-term depression outcomes as well as side-effects need to be studied with rigorous randomised controlled trials.