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Br J Psychiatry. 2016 Feb;208(2):108-13. doi: 10.1192/bjp.bp.115.165498.

Oral ketamine for the treatment of pain and treatment-resistant depression†.

Author information

1
Robert A. Schoevers, MD PhD, Tharcila V. Chaves, MSc, Sonya M. Balukova, MSc, University of Groningen, University Medical Center Groningen, Department of Psychiatry, Research School of Behavioural and Cognitive Neurosciences (BCN), Interdisciplinary Center for Psychopathology and Emotion Regulation (ICPE), Groningen; Marije aan het Rot, PhD, Department of Psychology and Research School of Behavioral and Cognitive Neurosciences; Rudie Kortekaas, PhD, Department of Psychiatry, Interdisciplinary Center for Psychopathology and Emotion Regulation, Department of Neuroscience, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands r.a.schoevers@umcg.nl.
2
Robert A. Schoevers, MD PhD, Tharcila V. Chaves, MSc, Sonya M. Balukova, MSc, University of Groningen, University Medical Center Groningen, Department of Psychiatry, Research School of Behavioural and Cognitive Neurosciences (BCN), Interdisciplinary Center for Psychopathology and Emotion Regulation (ICPE), Groningen; Marije aan het Rot, PhD, Department of Psychology and Research School of Behavioral and Cognitive Neurosciences; Rudie Kortekaas, PhD, Department of Psychiatry, Interdisciplinary Center for Psychopathology and Emotion Regulation, Department of Neuroscience, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

Abstract

BACKGROUND:

Recent studies with intravenous (i.v.) application of ketamine show remarkable but short-term success in patients with MDD. Studies in patients with chronic pain have used different ketamine applications for longer time periods. This experience may be relevant for psychiatric indications.

AIMS:

To review the literature about the dosing regimen, duration, effects and side-effects of oral, intravenous, intranasal and subcutaneous routes of administration of ketamine for treatment-resistant depression and pain.

METHOD:

Searches in PubMed with the terms 'oral ketamine', 'depression', 'chronic pain', 'neuropathic pain', 'intravenous ketamine', 'intranasal ketamine' and 'subcutaneous ketamine' yielded 88 articles. We reviewed all papers for information about dosing regimen, number of individuals who received ketamine, number of ketamine days per study, results and side-effects, as well as study quality.

RESULTS:

Overall, the methodological strength of studies investigating the antidepressant effects of ketamine was considered low, regardless of the route of administration. The doses for depression were in the lower range compared with studies that investigated analgesic use. Studies on pain suggested that oral ketamine may be acceptable for treatment-resistant depression in terms of tolerability and side-effects.

CONCLUSIONS:

Oral ketamine, given for longer time periods in the described doses, appears to be well tolerated, but few studies have systematically examined the longer-term negative consequences. The short- and longer-term depression outcomes as well as side-effects need to be studied with rigorous randomised controlled trials.

PMID:
26834167
DOI:
10.1192/bjp.bp.115.165498
[Indexed for MEDLINE]

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