Efficacy and safety of ketamine and esketamine for unipolar and bipolar depression: an overview of systematic reviews with meta-analysis

作者：Alessandro Rodolico, Pierfelice Cutrufelli, Antonio Di Francesco, Andrea Aguglia, G Catania, Carmen Concerto, Alessandro Cuomo, Andrea Fagiolini, Giuseppe Lanza, Ludovico Mineo, Antimo Natale, Laura Rapisarda, Antonino Petralia, Maria Salvina Signorelli, Eugenio Aguglia · 发表于：Frontiers in Psychiatry · 年份：2024 · DOI：10.3389/fpsyt.2024.1325399 · 被引用次数：31 · 研究领域：Treatment of Major Depression、Bipolar Disorder and Treatment、Tryptophan and brain disorders

Background: Unipolar and bipolar depression present treatment challenges, with patients sometimes showing limited or no response to standard medications. Ketamine and its enantiomer, esketamine, offer promising alternative treatments that can quickly relieve suicidal thoughts. This Overview of Reviews (OoR) analyzed and synthesized systematic reviews (SRs) with meta-analysis on randomized clinical trials (RCTs) involving ketamine in various formulations (intravenous, intramuscular, intranasal, subcutaneous) for patients with unipolar or bipolar depression. We evaluated the efficacy and safety of ketamine and esketamine in treating major depressive episodes across various forms, including unipolar, bipolar, treatment-resistant, and non-resistant depression, in patient populations with and without suicidal ideation, aiming to comprehensively assess their therapeutic potential and safety profile. Methods: Following PRIOR guidelines, this OoR's protocol was registered on Implasy (ID:202150049). Searches in PubMed, Scopus, Cochrane Library, and Epistemonikos focused on English-language meta-analyses of RCTs of ketamine or esketamine, as monotherapy or add-on, evaluating outcomes like suicide risk, depressive symptoms, relapse, response rates, and side effects. We included studies involving both suicidal and non-suicidal patients; all routes and formulations of administration (intravenous, intramuscular, intranasal) were considered, as well as all available comparisons with control...