Ketamine Treatment for Depression in Patients With a History of Psychosis or Current Psychotic Symptoms: A Systematic Review.
J. Veraart, S. Smith-Apeldoorn, J. Spijker, J. Kamphuis, R. Schoevers
Journal of Clinical Psychiatry July 13, 2021 DOI: 10.4088/jcp.20r13459 via Semantic Scholar
Summary
Ketamine is known to have rapid antidepressant effects, but patients with psychotic features are usually excluded from treatment studies due to concerns that ketamine might worsen psychosis. This systematic review examined nine reports (pilot studies and case reports) involving 41 patients with a history of psychosis or current psychotic symptoms who received ketamine for depression or negative symptoms. The findings suggest that short-term ketamine treatment can be both safe and effective in this group, with side effects that were mild and self-limiting. The available evidence does not support the assumption that ketamine exacerbates psychotic symptoms in predisposed patients, although data are limited and further trials are needed.
Study at a glance
| Characteristics | Systematic review Peer reviewed |
|---|---|
| Sample size | 41 |
| Population | Patients with a history of psychosis or current psychotic symptoms receiving ketamine for depression or negative symptoms |
| Keywords | Medicine Psychology |
| Citations | 31 |
| Key finding | Short-term ketamine treatment for depression and negative symptoms in patients with a history of psychosis or current psychotic features can be safe and effective, with no evidence that it exacerbates psychotic symptoms. |
Abstract
Objective: Ketamine shows rapid and robust antidepressant effects in clinical studies. Psychotic features are an exclusion criterion in most ketamine treatment studies based on the assumption that psychosis will increase with ketamine administration. As patients with treatment-resistant depression (TRD) often have psychotic features, and treatment-resistant depressive symptoms are also common in patients with schizophrenia, the aim of this systematic review is to determine whether this assumption holds true. Data Sources: The literature was searched for data on ketamine treatment for depression or negative symptomatology in patients with a history of psychosis or current psychotic symptoms (PubMed/MEDLINE) from inception to March 2020 without date or language restrictions. The following terms were used: ketamine and psychosis, psychotic or schizo*. A filter for human studies was applied. Study Selection: A total of 482 articles were identified; 473 articles were excluded because they did not report on the effect of ketamine treatment in patients with a history of psychosis or current psychotic symptoms. Data Extraction: The remaining 9 articles were reviewed. Results: Nine reports of pilot studies and case reports with a total of 41 patients have been published. These studies suggest that short-term ketamine treatment for depression and even negative symptoms in patients with a history of psychosis or current psychotic features can be both safe and effective, as side effects were mild and self-limiting. Conclusions: The currently available literature does not support the assumption that ketamine will exacerbate psychotic symptoms in predisposed patients. Data, however, are limited, and further trials are needed in this patient group.