Revolutionizing Depression Treatment: A Paradigm Shift of Ketamine Therapy- A Systematic Review
Keywords:
Ketamine, Major depressive disorder (MDD), Treatment-resistant depression (TRD)Abstract
Aim: This systematic review aims to evaluate the pharmacokinetic effects, safety, and efficacy of ketamine therapy in patients with major depressive disorders, including TRD, bipolar disorder, and postpartum depression (PPD).
Methodology: Fourteen primary clinical trials and randomized controlled trials (RCTs) were systematically reviewed following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Databases such as PubMed, MEDLINE, and Google Scholar were searched for relevant articles. Inclusion criteria encompassed studies involving adult patients diagnosed with MDD, bipolar disorder, or PPD, receiving ketamine therapy via intranasal esketamine or intravenous infusion. Data extraction and risk of bias assessment were performed independently by multiple reviewers, with discrepancies resolved through consensus.
Results: Primary outcome measures included scores on the Montgomery-Åsberg Depression Rating Scale (MADRS), with secondary outcomes encompassing various other depression and anxiety scales. Ketamine therapy demonstrated significant reductions in MADRS scores across multiple studies, with effects observed as early as 40 minutes post-infusion and persisting up to seven days. Additionally, ketamine showed efficacy in improving anxiety symptoms and self-reported depression measures, with some studies indicating sustained effects over time. The safety profile of ketamine was generally favorable, with most adverse events resolving on the same day of administration.
Discussion: The findings suggest that ketamine therapy holds promise as a rapid and effective treatment for depressive disorders, particularly in TRD patients. Its rapid onset of action and sustained efficacy make it a potential candidate for replacing or augmenting current treatment strategies. However, further research is needed to elucidate optimal dosing regimens, long-term safety, and potential adverse effects, especially concerning cognitive function and relapse rates.
Conclusion: Ketamine therapy represents a paradigm shift in the treatment of depression, offering rapid and robust antidepressant effects with a favorable safety profile. While current evidence supports its efficacy as a standalone therapy, more research is warranted to optimize its clinical use and explore its long-term effects. Nonetheless, ketamine's potential to address the unmet needs of TRD patients underscores its significance in revolutionizing depression treatment paradigms.
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