Ketamine-induced altered states of consciousness: a systematic review of implications for therapeutic outcomes in psychiatric practices.
Kaike Thiê da Costa Gonçalves, Vagner Deuel O de Tavares, Maria Luiza de Morais Barros, Aldielyson Jorge Cavalcante de Brito, Patrícia Cavalcanti-Ribeiro, Fernanda Palhano-Fontes, Marcelo Falchi-Carvalho, Emerson Arcoverde, Rafael Guimarães Dos Santos, Jaime E C Hallak, Draulio Barros de Araujo, Nicole Leite Galvão-Coelho
European archives of psychiatry and clinical neuroscience October 28, 2024 DOI: 10.1007/s00406-024-01925-6 via PubMed
Summary
AI-generated from the abstractA systematic review of 29 studies examined whether the psychoactive effects of ketamine are linked to its therapeutic benefits for psychiatric disorders. About half of the studies (51.72%) found a positive relationship between ketamine-induced altered states of consciousness and clinical outcomes, while 44.83% found no link, and one study found a negative association. For mood disorders like major depressive disorder and bipolar disorder, 48% of studies showed a positive relationship and 48% showed none. All three studies on substance use disorder reported a positive correlation. The authors conclude the relationship remains uncertain due to high variability across studies.
Study at a glance
| Characteristics | Systematic review Peer reviewed |
|---|---|
| Sample size | 29 |
| Population | Patients with mood disorders (major depressive disorder, bipolar disorder), substance use disorder, and social anxiety disorder |
| Intervention | subcutaneous |
| Topics | Anxiety Depression Esketamine Ketamine |
| Keywords | Bipolar disorder Dissociation Mystical experiences |
| Citations | 5 |
| Key finding | Approximately half of the reviewed studies found a positive association between ketamine's psychoactive effects and therapeutic outcomes, but the relationship remains indeterminate due to high heterogeneity. |
Abstract
This systematic review aims to elucidate the nexus between ketamine's psychoactive properties and its efficacy in treating a broad spectrum of psychiatric disorders. We searched three databases and used citation tracking to include 29 studies. Predominantly, mood disorders, including bipolar disorder (BD) and major depressive disorder (MDD) (MDD + BD: + n = 25 studies), a large part of them involve treatment-resistant patients (n = 14 studies), substance use disorder (SUD, n = 3 studies), and social anxiety disorder (SAD, n = 1 study). From all included studies (n = 29), 15 (51.72%) of them identified a positive relation between ketamine-induced altered states of consciousness and clinical outcomes, while 13 studies (44.83%) showed no linkage between them, and one study (3.45%) delineated a negative association. Focusing solely on intravenous (IV) ketamine infusions (n = 25), 14 studies (56%) reported a positive modulation of ketamine's psychoactive effects and therapeutic benefits, whereas 10 studies (40%) confirmed no relationship, and one study (4%) showed a negative association. The single study (33.34%) involving subcutaneous ketamine and all three studies (66.6%) intranasal administration did not demonstrate a significant interaction between ketamine's psychoactive effects and therapeutic response. All three SUD studies reported a positive correlation between ketamine's psychoactive effects and therapeutic response. In contrast, the single SAD study did not find a relationship between these parameters. For studies involving mood disorders (n = 25), 12 studies (48%) reported a positive relationship between psychoactive effects and therapeutic response. Others 12 studies (48%) identified a null relationship, and one study (4%) found a significant negative association. Although we have found a larger association than previous studies between ketamine's psychoactive properties and its efficacy in treating a broad spectrum of psychiatric disorders, its topic remains indeterminate, mainly due to the high heterogeneity.