|
1
|
McMullen EP, Lee Y, Lipsitz O, Lui LMW, Vinberg M, Ho R, Rodrigues NB, Rosenblat JD, Cao B, Gill H, Teopiz KM, Cha DS, McIntyre RS. Strategies to Prolong Ketamine's Efficacy in Adults with Treatment-Resistant Depression. Adv Ther 2021; 38:2795-2820. [PMID: 33929660 PMCID: PMC8189962 DOI: 10.1007/s12325-021-01732-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 03/25/2021] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Ketamine treatment is capable of significant and rapid symptom improvement in adults with treatment-resistant depression (TRD). A limitation of ketamine treatment in TRD is the relatively short duration of time to relapse (e.g., median 2-4 weeks). The objective of the systematic review herein is to identify strategies capable of prolonging the acute efficacy of ketamine in adults with TRD. METHODS PubMed/MEDLINE databases were searched from inception to December 2020 for clinical studies written in English using the following key terms: ketamine, prolong, and depression. A total of 454 articles were identified from the literature search which included all clinical studies regarding prolonging the antidepressant effects of ketamine. Twenty-two articles were included: ten randomized controlled trials (RCTs), eight prospective open-label trials, one retrospective chart review, and three case reports. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for data extraction. The primary outcome was prolonged effect, defined as statistically significant antidepressant effects following acute ketamine treatment. RESULTS A total of 454 articles were identified, and 22 articles were included. Different treatment modalites including pharmacological interventions, manualized-based psychotherapies, electroconvulsive therapy, transcranial magnetic stimulation, and intravenous monotherapy were examined to determine their impact on the prolongation of antidepressant effects following acute ketamine treatment. No treatment modality, other than repeat-dose IV ketamine, has demonstrated ability to significantly prolong the acute efficacy of IV ketamine in TRD. CONCLUSION Hitherto, available open-label data and controlled trial data support repeat administration of IV ketamine as an effective strategy to prolong the efficacy of ketamine's antidepressant effects (although not the focus of the study herein, maintenance repeat-dose esketamine treatment is proven effective in esketamine responders). There is a need to identify multimodality strategies that are safe and capable of prolonging the efficacy of ketamine in adults with TRD.
Collapse
Affiliation(s)
- Eric P McMullen
- Mood Disorder Psychopharmacology Unit, University Health Network, University of Toronto, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada
- Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Yena Lee
- Mood Disorder Psychopharmacology Unit, University Health Network, University of Toronto, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada
- Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Orly Lipsitz
- Mood Disorder Psychopharmacology Unit, University Health Network, University of Toronto, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada
- Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Leanna M W Lui
- Mood Disorder Psychopharmacology Unit, University Health Network, University of Toronto, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada
- Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Maj Vinberg
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, Psychiatric Research Unit, University of Copenhagen, Psychiatric Centre North Zealand, Hilleroed, Denmark
| | - Roger Ho
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, Singapore
- Department of Psychological Medicine, National University Hospital, Singapore, Singapore
| | - Nelson B Rodrigues
- Mood Disorder Psychopharmacology Unit, University Health Network, University of Toronto, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada
- Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Joshua D Rosenblat
- Mood Disorder Psychopharmacology Unit, University Health Network, University of Toronto, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada
- Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Bing Cao
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing, 400715, People's Republic of China
| | - Hartej Gill
- Mood Disorder Psychopharmacology Unit, University Health Network, University of Toronto, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada
- Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Kayla M Teopiz
- Mood Disorder Psychopharmacology Unit, University Health Network, University of Toronto, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada
| | - Danielle S Cha
- Mood Disorder Psychopharmacology Unit, University Health Network, University of Toronto, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada
- Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Roger S McIntyre
- Mood Disorder Psychopharmacology Unit, University Health Network, University of Toronto, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada.
- Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada.
- Brain and Cognition Discovery Foundation, Canada, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|