Abstract
In the past two decades, subanaesthetic doses of ketamine have been demonstrated to have rapid and sustained antidepressant effects, and accumulating research has demonstrated ketamine's therapeutic effects for a range of psychiatric conditions. In light of these findings surrounding ketamine's psychotherapeutic potential, we systematically review the extant evidence on ketamine's effects in treating mental health disorders. The systematic review protocol was registered in PROSPERO (identifier CRD42019130636). Human studies investigating the therapeutic effects of ketamine in the treatment of mental health disorders were included. Because of the extensive research in depression, bipolar disorder and suicidal ideation, only systematic reviews and meta-analyses were included. We searched Medline and PsycINFO on 21 October 2020. Risk-of-bias analysis was assessed with the Cochrane Risk of Bias tools and A Measurement Tool to Assess Systematic Reviews (AMSTAR) Checklist. We included 83 published reports in the final review: 33 systematic reviews, 29 randomised controlled trials, two randomised trials without placebo, three non-randomised trials with controls, six open-label trials and ten retrospective reviews. The results were presented via narrative synthesis. Systematic reviews and meta-analyses provide support for robust, rapid and transient antidepressant and anti-suicidal effects of ketamine. Evidence for other indications is less robust, but suggests similarly positive and short-lived effects. The conclusions should be interpreted with caution because of the high risk of bias of included studies. Optimal dosing, modes of administration and the most effective forms of adjunctive psychotherapeutic support should be examined further.
Highlights
In the past two decades, subanaesthetic doses of ketamine have been demonstrated to have rapid and sustained antidepressant effects, and accumulating research has demonstrated ketamine’s therapeutic effects for a range of psychiatric conditions
The results were grouped according to patient population (MDD, bipolar disorder, suicidal ideation, generalised and social anxiety disorders, post-traumatic stress disorder, obsessive–compulsive disorders, substance use disorders and eating disorders) and by setting
We identified 24 systematic reviews of the antidepressant effect of ketamine in the treatment of unipolar depression and/or major depressive disorder (MDD), 12 of which conducted meta-analyses
Summary
In the past two decades, subanaesthetic doses of ketamine have been demonstrated to have rapid and sustained antidepressant effects, and accumulating research has demonstrated ketamine’s therapeutic effects for a range of psychiatric conditions. Since ketamine was developed in 1964, largely as a replacement for phencyclidine, it has been used primarily in veterinary and paediatric anaesthesia, but interest in recent years has burgeoned in psychiatry after reports of its rapid-acting antidepressant effects.[1] The potential for ketamine to be used in the treatment of psychiatric disorders was first noted in the 1970s,2 and has been the focus of formal investigation since the 1990s, with investigative and off-label use in the context of mental health increasing across North America and Europe since that time. This work is timely as off-label prescribing of ketamine for a large number of psychiatric disorders other than depression continues,[5] but there have been no comprehensive syntheses of the state of the evidence so far
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
