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J Palliat Med. 2019 Sep;22(9):1154-1161. doi: 10.1089/jpm.2018.0627. Epub 2019 May 15.

The Efficacy of Ketamine in the Palliative Care Setting: A Comprehensive Review of the Literature.

Author information

1
New York Medical College, Valhalla, New York.
2
Department of Palliative Care, New York Medical College, Westchester Medical Center, Valhalla, New York.
3
Department of Psychiatry, New York Medical College, Westchester Medical Center, Valhalla, New York.

Abstract

Background: Previous literature suggests that ketamine may be an effective drug in the palliative care population as this drug has been shown to treat multiple conditions that are common in these patients. Objective: This review examines the efficacy of ketamine for the treatment of depression and physical pain in palliative care patients. Methods: Eleven studies were included on the topic of ketamine as an antidepressant in the palliative care population. Additionally, 5 RCT studies were included on the topic of physical pain in this population. Results: All 11 studies, including one RCT, found antidepressant effects of ketamine in this patient population. Ketamine's effect on treating physical pain was mixed with the largest and most recent RCTs suggesting no significant analgesic effect. Discussion: This review suggests that starting qualified patients on intravenous (IV) ketamine and switching to oral or intranasal administration may be the most effective and convenient for treating depression, especially for patients who wish to receive treatment at home. Significant analgesia was found in patients who received epidural or intrathecal ketamine as well as in one study using intravenous administration. More research is necessary to determine which palliative care patients may benefit from ketamine treatment.

KEYWORDS:

analgesia; depression; ketamine; palliative medicine; terminal illness; total pain

PMID:
31090477
DOI:
10.1089/jpm.2018.0627

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