Ketamine treatment for anhedonia in unipolar and bipolar depression: a systematic review.
European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology – September 01, 2024
Source: PubMed
Summary
Rapid relief from the inability to feel pleasure (anhedonia) may be possible with ketamine therapy. This groundbreaking treatment shows promise for both major depressive disorder and bipolar depression patients. Studies reveal that a single dose can quickly restore the brain's ability to experience joy and reward, with effects lasting several days to weeks. Esketamine nasal spray and IV ketamine both demonstrated significant improvements in mood and emotional responsiveness.
Abstract
Ketamine, an N-methyl-D-aspartate receptor antagonist, is a racemic mixture of esketamine and arketamine used to treat unipolar and bipolar depression. Preliminary reports indicate that it may be beneficial for depressed patients reporting symptoms of anhedonia. In this systematic review we aim to assess and analyze the existing body of evidence regarding the therapeutic effects of ketamine on the domain of anhedonia. Electronic databases (PubMed, APA Psycinfo and Web of Science) were searched from inception to November 2023. Protocol was registered in PROSPERO under the identifier CRD42023476603. A total of twenty-two studies, including four randomized-controlled trials and eighteen open-label trials were included. All studies reported alleviation of anhedonia symptoms following ketamine or esketamine administration, regardless of the number of infusions. Several important limitations were included, first and foremost low number of placebo-controlled randomized-controlled trials. This review indicates a potential anti-anhedonic effect of ketamine in patients with depression. Several trials used neuroimaging techniques which confirm ketamine's effect on functional connectivity correlating with the improvement in anhedonia. Despite considerable variations in methodology and the specific brain regions investigated, these studies collectively point towards ketamine's neuroplastic effects in mitigating anhedonia.