Real-world effectiveness of ketamine in treatment-resistant depression: A systematic review & meta-analysis.
Yazen Alnefeesi, D. Chen-Li, Ella Krane, Muhammad Youshay Jawad, Nelson B Rodrigues, Felicia Ceban, Joshua D. Di Vincenzo, Shakila Meshkat, R. Ho, H. Gill, K. Teopiz, Bing Cao, Yena Lee, R. Mcintyre, J. Rosenblat
Journal of Psychiatric Research May 1, 2022 DOI: 10.1016/j.jpsychires.2022.04.037 via Semantic Scholar
Summary
Ketamine shows substantial real-world antidepressant effects in treatment-resistant depression, with about 45% of patients responding and 30% achieving remission, based on a systematic review and meta-analysis of 79 studies involving 2665 patients. The effect varies considerably among individuals; more treatment-resistant cases remit less often, but response rates do not differ. The therapeutic benefit does not significantly decline with repeated treatments, indicating that even the most treatment-resistant patients may benefit and that mid-to-long term treatment is effective for many.
Study at a glance
| Characteristics | Systematic review and meta-analysis Randomized Peer reviewed |
|---|---|
| Sample size | 2,665 |
| Population | Patients with treatment-resistant depression |
| Keywords | Medicine Psychology |
| Citations | 177 |
| Key finding | Ketamine produces a substantial antidepressant effect in real-world treatment-resistant depression, with 45% responding and 30% remitting, and the effect does not diminish with repeated treatments. |
Abstract
Ketamine is a promising therapeutic option in treatment-resistant depression (TRD). The acute efficacy of ketamine in TRD has been demonstrated in replicated randomised-controlled trials (RCTs), but the generalizability of RCT data to real-world practice is limited. To this end, we conducted a systematic review (Search date: 25/12/2021; 1482 records identified) and meta-analysis of studies evaluating the real-world clinical effectiveness of ketamine in TRD patients. Four overlapping syntheses (Total n = 2665 patients; k = 79 studies) and 32 meta-regressions (Total n = 2050; k = 37) were conducted. All results suggest that the mean antidepressant effect is substantial (mean ± 95% CI, % responded = 45 ± 10%; p< 0.0001, % remitted = 30 ± 5.9%; p< 0.0001, Hedges g of symptomatological improvement = 1.44 ± 0.609; p < 0.0001), but the effect varies considerably among patients. The more treatment-resistant cases were found to remit less often (p < 0.01), but no such effect on response was evident (p > 0.05). Meta-regressions also confirmed that the therapeutic effect does not significantly decline with repeated treatments (p > 0.05). These results demonstrate that even the most treatment-resistant patients may benefit from ketamine, and that mid-to-long term treatment is effective in many patients.