Appetite measures as correlates of clinical response in mood disorders treated with ketamine: systematic review

Summary

Ketamine treatment may improve depressive symptoms related to appetite in patients with treatment-resistant mood disorders, although the effects can vary. Out of five studies reviewed involving 678 participants, two reported significant improvements in appetite, one showed no change, another indicated a worsening of appetite, and one noted minimal effects on increased appetite. This suggests that appetite could be an important factor in assessing the antidepressant effects of treatments.

Study at a glance

Abstract

Mood disorders, including major depressive disorder (MDD) and bipolar disorder (BP), significantly impact global health, with MDD affecting over 300 million people and BP affecting approximately 2% of the world's population. Ketamine, originally an anesthetic, has emerged as a promising treatment for patients with treatment-resistant depression (TRD), due to its unique pharmacological properties, such as N-methyl-D-aspartate (NMDA) receptor antagonism and anti-inflammatory effects. The potential of ketamine in treating depression has sparked debate regarding its effects on appetite. This paper aims to conduct a systematic review focusing on the complex interplay between ketamine treatment and appetite. A total of 78 references were identified from electronic databases: PubMed, Web of Science, APA PsycINFO, and EBSCOhost, with 5 meeting the inclusion criteria for this review, encompassing 678 participants. Appetite was assessed using both clinician-rated and self-reported scales. Two studies reported significant improvement in reduced appetite following ketamine or esketamine treatment; one reported no significant change; one found a paradoxical worsening of reduced appetite; and one noted minimal effect on increased appetite and atypical symptoms. The data presented suggest that in patients with treatment-resistant mood disorders, ketamine may contribute to the improvement of depressive symptoms, including those related to appetite, or may exhibit neutral effects on food consumption desire. Appetite measurement may be a valuable indicator of the antidepressant effect, facilitating signal detection for substances beyond traditional monoaminergic antidepressants. Despite limited data, establishing a confirmed link between appetite and antidepressants could aid in treatment planning, particularly for patients with metabolic disorders or those at risk of malnutrition, potentially improving adherence and outcomes in treatment-resistant mood disorders. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024510640, identifier CRD42024588790.

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