Efficacy and safety of ketamine for unipolar refractory depression: an overview of systematic reviews
DOI:
https://doi.org/10.30968/rbfhss.2024.154.1122Abstract
Purpose: To analyze the evidence of efficacy and safety of the use of intravenous ketamine for adults with refractory unipolar major depression. Methods: This is an overview of systematic reviews performed according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) check-list and Cochrane Collaboration recommendations, in which the literature searches were executed in Medline (via Pubmed) and Embase databases. Systematic reviews of randomized clinical trials of adults with refractory unipolar major depression were included, using other drugs as comparators. The methodological quality was evaluated according to the AMSTAR-2 tool (A measurement tool to assess systematic reviews - 2). Results: A total of 445 records, in which 73 studies were selected for full-text reading and 21 fully met the eligibility criteria. The most prevalent dosage was 0.5mg/kg in single dose and in multiple doses. Compared to control, ketamine promoted beneficial effect by reducing the depressive symptoms and suicidal ideation, and improving the depression tools scores. The effects were observed for 3-7 days after the ketamine infusion; in a single dose, these effects restricted the first hours (between 30-40 minutes). Additionally, the studies revealed that the adverse effects were predominantly mild, and only two studies showed serious events, such as bradycardia and hypotension, but did not result in discontinuation of the studies. The methodological quality was considered “critically low” in most cases (62%). Conclusion: The intravenous ketamine showed a significant improvement or non-inferiority in comparison to other treatments, and a reduction of depressive symptoms, including suicidal ideation, with an appropriate safety profile. Therefore, besides the low quality of the included systematic reviews, intravenous ketamine can represent an effective and safe option for refractory unipolar major depression. Higher quality studies about this topic are needed to guarantee more robust evidence, especially related to the ideal dosage of intravenous ketamine.
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