The Use of Prophylactic Ketamine to Mitigate Postoperative Depressive Symptoms: A Systematic Review.

A systematic review of nine randomized controlled trials examined whether a single intravenous dose of ketamine (0.1 mg/kg to 1 mg/kg) given during or shortly after surgery can prevent depressive symptoms in adults undergoing surgery. Seven of the trials found that ketamine significantly reduced postoperative depression scores compared to a control, while two trials found no significant change. Depressive symptoms affect 10% to 60% of surgical patients and are linked to higher rates of complications and death. The review suggests prophylactic ketamine may help build resilience against postoperative depression, but more research is needed on safety, timing, and use across different surgical types.

Study at a glance

Abstract

Depression is predicted to be the leading burden of disease worldwide by 2030 with a prevalence of 10% to 60% in the surgical population. Depressive symptoms in the perioperative population are associated with a myriad of grave complications, including higher morbidity and mortality. This systematic review aims to determine whether a single dose of intravenous ketamine can be used prophylactically as a routine resilience-enhancing agent in all high-risk adult patients undergoing surgery to mitigate depressive symptoms postoperatively by appraising evidence of existing literature. An evidence-based systematic review. The databases PubMed, CINAHL, and Scopus were searched, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Search and Medical Subject Headings (MeSH) terms used: "ketamine," "surgical procedures," "surgical," "surgery," "depression," and "depressive disorder." In 9 randomized controlled trials (RCTs), bolus ketamine doses of 0.1 mg/kg to 1 mg/kg were administered intraoperatively or in the postanesthesia care unit. The primary outcome was the subjective feelings of depression as evaluated by different validated depression screening tools and seven RCTs observed statistically significant findings between the control and intervention (ketamine) groups with postoperative depression scores. Two RCTs did not find a significant change in depression scores. Research on the use of prophylactic ketamine as an antidepressant in the perioperative population offers insight into changing routine practices and can shape how mental health is viewed in hospitals. Further research is warranted on the safety profile of ketamine, and risk stratification with careful consideration of baseline depressive symptoms, timing, and its use across a wider variety of surgical subspecialties.