REVOLUTIONIZING DEPRESSION TREATMENT: A PARADIGM SHIFT OF KETAMINE THERAPY – A SYSTEMATIC REVIEW

Abstract

Objectives: Primary Objective: (1) The objectives of the study are as follows: assessment of the effectiveness of ketamine-based treatment in known patients of various subtypes of depression and (2) assessment of time of onset and duration along with routes of administration and safety of ketamine therapy. Secondary Objective: The objectives of the study are as follows: (1) evaluate changes in secondary outcomes in scales of depression and anxiety reporting improvement in overall mood and (2) emphasizing the need for extensive research and patient-based data collection for the future. Methods: The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and the literature analysis included fourteen primary clinical studies including randomized controlled trials (RCTs), using electronic databases such as Google Scholar, MEDLINE, or PubMed for our search for relevant literature. RCTs and open-label case reports of adult patients with bipolar illness, major depressive disorder, or postpartum depression receiving ketamine through intravenous infusions or intranasal esketamine were included in the inclusion criteria. Potential review bias and data extraction were done independently by many reviewers with any discrepancies discussed by the team. Results: MADRS was used as first-order outcomes and other depression and anxiety scales as second-order outcomes. Multiple studies revealed that ketamine therapy reduced the MADRS score, and this reduction occurred 40 min after the infusion and lasted up to 1 week. Moreover, the use of ketamine has proved helpful in addressing anxiety disorders and self-assessed depression, and some studies have demonstrated long-lasting effects of the drug. The safety findings indicated that ketamine was generally safe, as many of the side effects were reported on the same day of administration. Discussion: This shows that ketamine therapy, especially for patients with treatment-resistant depression (TRD), can be a fast and effective biological treatment for depressive disorders. It could complement or even become a new treatment option due to its immediate onset and prolonged duration of action. Further studies should be conducted to determine the optimal administration intervals, side effects including cognitive impairment, and the frequency of relapses. Conclusion: Ketamine has emerged as a new class of intervention for the management of depression due to its rapid and sustained antidepressant efficacy with lower risk of side effects. Although it is effective on its own for treating various conditions, there is a need for further research to determine how best to apply it clinically and to establish its side effects in the long run. However, given that ketamine holds the promise of filling the gaps for TRD patients, the substance plays a crucial role in changing the landscape of psychopharmacological management of depression.