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Ketamine for Treatment-Resistant Depression or PTSD in Various Settings: A Review of Clinical Effectiveness, Safety, and Guidelines

Last updated: March 1, 2017
Project Number: RC0855-000
Product Line: Rapid Response
Research Type: Drug
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the clinical effectiveness and safety of using ketamine for treatment-resistant depression or post-traumatic stress disorder in various settings?
  2. What are the evidence-based guidelines associated with the use of ketamine for treatment-resistant depression or post-traumatic stress disorder in various settings?

Key Message

Three systematic reviews, five primary studies, and two evidence-based guidelines were found on the off-label use of ketamine for treatment-resistant depression and post-traumatic stress disorder, mostly in hospital settings. Ketamine, when administered to patients with treatment-resistant depression, was effective at reducing depressive severity within minutes or hours. It was also effective at reducing post-traumatic stress disorder severity in patients with the condition. Its antidepressant effects may taper over time but last up to two weeks and be comparable or superior to other pharmacological or somatic interventions for treatment-resistant depression. Its short-term benefits were also demonstrated in improving fatigue and suicidality, without serious adverse events or compromise in neurocognitive functioning in patients with treatment-resistant depression. Nevertheless, citing limited information on ketamine’s safety and duration of effect, both guidelines recommended restricting the off-label use of ketamine to research settings.