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Ketamine for the Treatment of Psychiatric Disorders: A Systematic Review and Meta-Analysis

Published online by Cambridge University Press:  20 November 2024

Angela T.H. Kwan ,
Moiz Lakhani ,
Gurkaran Singh ,
Gia Han Le ,
Sabrina Wong ,
Kayla M. Teopiz ,
Donovan A. Dev ,
Arshpreet Singh Manku ,
Gurnoor Sidhu  and
Roger S. McIntyre Open the ORCID record for Roger S. McIntyre [Opens in a new window]
Angela T.H. Kwan
Affiliation:
Brain and Cognition Discovery Foundation, Toronto, ON M5S 1M2, Canada Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
Moiz Lakhani
Affiliation:
Brain and Cognition Discovery Foundation, Toronto, ON M5S 1M2, Canada Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
Gurkaran Singh
Affiliation:
Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
Gia Han Le
Affiliation:
Brain and Cognition Discovery Foundation, Toronto, ON M5S 1M2, Canada Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada Institute of Medical Science, University of Toronto, Toronto, ON, Canada
Sabrina Wong
Affiliation:
Brain and Cognition Discovery Foundation, Toronto, ON M5S 1M2, Canada Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
Kayla M. Teopiz
Affiliation:
Brain and Cognition Discovery Foundation, Toronto, ON M5S 1M2, Canada
Donovan A. Dev
Affiliation:
Brain and Cognition Discovery Foundation, Toronto, ON M5S 1M2, Canada Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada School of Medicine, University College Dublin, Dublin, Ireland
Arshpreet Singh Manku
Affiliation:
Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
Gurnoor Sidhu
Affiliation:
Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
Roger S. McIntyre*
Affiliation:
Department of Psychiatry, University of Toronto, Toronto, ON, Canada
*
Corresponding author: Roger S. McIntyre; Email: roger.mcintyre@bcdf.org
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Abstract

Background

Inadequate response to first- and second-line pharmacological treatments for psychiatric disorders is commonly observed. Ketamine has demonstrated efficacy in treating adults with treatment-resistant depression (TRD), with additional off-label benefits reported for various psychiatric disorders. Herein, we performed a systematic review and meta-analysis to examine the therapeutic applications of ketamine across multiple mental disorders, excluding mood disorders.

Methods

We conducted a multidatabase literature search of randomized controlled trials and open-label trials investigating the therapeutic use of ketamine in treating mental disorders. Studies utilizing the same psychological assessments for a given disorder were pooled using the generic inverse variance method to generate a pooled estimated mean difference.

Results

The search in OVID (MedLine, Embase, AMED, PsychINFO, JBI EBP Database), EBSCO CINAHL Plus, Scopus, and Web of Science yielded 44 studies. Ketamine had a statistically significant effect on PTSD Checklist for DSM-5 (PCL-5) scores (pooled estimate = ‒28.07, 95% CI = [‒40.05, ‒16.11], p < 0.001), Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) scores (pooled estimate = ‒14.07, 95% CI = [‒26.24, ‒1.90], p = 0.023), and Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores (pooled estimate = ‒8.08, 95% CI = [‒13.64, ‒2.52], p = 0.004) in individuals with PTSD, treatment-resistant PTSD (TR-PTSD), and obsessive compulsive disorder (OCD), respectively. For alcohol use disorders and at-risk drinking, there was disproportionate reporting of decreased urge to drink, increased rate of abstinence, and longer time to relapse following ketamine treatment.

Conclusions

Extant literature supports the potential use of ketamine for the treatment of PTSD, OCD, and alcohol use disorders with significant improvement of patient symptoms. However, the limited number of randomized controlled trials underscores the need to further investigate the short- and long-term benefits and risks of ketamine for the treatment of psychiatric disorders.

Keywords

ketamineAnxiety disordersBorderline personality disorder (BPD)Eating disordersObsessive compulsive disorder (OCD)Post-traumatic stress disorder (PTSD)Substance/alcohol use disordersSchizophrenia

Information

Type
Review
Information
CNS Spectrums , Volume 29 , Issue 5 , October 2024 , pp. 354 - 361
Copyright
© The Author(s), 2024. Published by Cambridge University Press

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Footnotes

†

Denotes co-first authorship

This article has been updated since it was originally published. A notice detailing this has been published.

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