TDNet Discover

Background: Around 322 million people battle with depression worldwide. There are no current guidelines or a standard of care to help treat patients with treatment resistant depression. The recent FDA approval of esketamine aims to help these treatment resistant patients. However, with how novel ketamine and esketamine are in this use, most providers are unaware of how and when to implement ketamine in this patient population. Objective: The aim of this systematic review is to evaluate whether the lack of guidelines and a standard of care with ketamine administration ultimately hurts patient outcomes. Methods: Three databases were utilized to conduct this systematic review, Google Scholar, PubMed, and CORE. Articles were selected based on specific inclusion and exclusion criteria. Data extraction was performed on the selected articles and quality assessment was performed using the National Heart, Lung and Blood Institute quality assessment tool. Articles of good and fair quality were utilized to discern whether patients improved in their depression rating based on MADRS and HAMD scores as well as symptomology when given ketamine/esketamine treatment. Results: Google Scholar, PubMed, and CORE searches with specific inclusion and exclusion criteria revealed 11 articles which focused on ketamine/esketamine treatment of patients with treatment resistant depression. Eight articles found statistically significant decreases in mean MADRS/HAMD scores with IV ketamine. Three articles found statistically significant decreases in mean MADRS/HAMD scores with intranasal esketamine. Conclusion: Any ketamine administration has shown promise in the treatment of TRD. The majority of the articles in this systematic review show statistically significant improvements in mean MADRS and HAMD scores with any ketamine administration, IV or intranasal, and with iv varying dosages. Further research is warranted on long term cognitive effects and an ideal dose. Research with oral formulations also needs to be expedited as this can increase patient compliance.