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Abstract
Severe depression, also known as major depression, is a mood disorder characterized by a persistent feeling of sadness or loss of interest in previously pleasurable activities, negatively affecting patients' social and professional lives. This study aimed to investigate the efficacy and safety of ketamine infusion as an emerging therapeutic option for patients with severe, treatment-resistant depression, evaluating whether ketamine can provide rapid symptom relief, especially in cases of suicidal ideation. The methodology used was based on a quantitative bibliographic review, covering the period from 2014 to 2024. Studies available in the main databases were selected, including Scielo, scientific journals, repositories and virtual libraries, in multiple languages. For data collection, strict inclusion and exclusion criteria were used, including clinical cases, case studies, meta-analyses and other forms of investigation. The data extracted from the selected studies were analyzed in order to synthesize the quantitative findings, highlighting the efficacy, safety and therapeutic results of ketamine infusion. During the literature review process, 100 studies were initially identified, of which 20 were selected for detailed analysis after applying the inclusion and exclusion criteria. The results indicated that ketamine infusion exhibits a rapid antidepressant response, often observable within hours of administration, with antidepressant effects maintained for up to seven days. Furthermore, repeated infusions increased the duration of effects. Despite the observed benefits, the limited duration of antidepressant effects and the need for repeated infusions highlight the importance of further research to establish effective and safe long-term treatment protocols. It is concluded that ketamine infusion represents a promising intervention for severe depression, especially in cases of treatment-resistant depression, providing new hope for patients who do not respond to traditional interventions.
References
BRYANT, Kelly A. et al. Effects of repeated intravenous ketamine in treatment-resistant geriatric depression: a case series. Journal of Clinical Psychopharmacology, v. 39, n. 2, p. 158-161, 2019.
CHEN, Mu-Hong et al. Maintenance of antidepressant and antisuicidal effects by D-cycloserine among patients with treatment-resistant depression who responded to low-dose ketamine infusion: a double-blind randomized placebo–control study. Neuropsychopharmacology, v. 44, n. 12, p. 2112-2118, 2019.
CHEN, Mu-Hong et al. Using classification and regression tree modelling to investigate treatment response to a single low-dose ketamine infusion: Post hoc pooled analyses of randomized placebo-controlled and open-label trials. Journal of affective disorders, v. 281, p. 865-871, 2021.
CORRIGER, Alexandrine; PICKERING, Gisèle. Ketamine and depression: a narrative review. Drug design, development and therapy, p. 3051-3067, 2019.
Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association, 2013.
DIAMOND, Peter R. et al. Ketamine infusions for treatment resistant depression: a series of 28 patients treated weekly or twice weekly in an ECT clinic. Journal of Psychopharmacology, v. 28, n. 6, p. 536-544, 2014.
FEENEY, Anna et al. The effect of single administration of intravenous ketamine augmentation on suicidal ideation in treatment-resistant unipolar depression: results from a randomized double-blind study. European Neuropsychopharmacology, v. 49, p. 122-132, 2021.
IONESCU, Dawn F. et al. Repeat-dose ketamine augmentation for treatment-resistant depression with chronic suicidal ideation: a randomized, double blind, placebo controlled trial. Journal of affective disorders, v. 243, p. 516-524, 2019.
IONESCU, Dawn F. et al. Rapid and sustained reductions in current suicidal ideation following repeated doses of intravenous ketamine: secondary analysis of an open-label study. The Journal of clinical psychiatry, v. 77, n. 6, p. 10114, 2016.
KISHIMOTO, T. et al. Single-dose infusion ketamine and non-ketamine N-methyl-d-aspartate receptor antagonists for unipolar and bipolar depression: a meta-analysis of efficacy, safety and time trajectories. Psychological medicine, v. 46, n. 7, p. 1459-1472, 2016.
LIU, Weijian et al. Repeated intravenous infusions of ketamine: neurocognition in patients with anxious and nonanxious treatment-resistant depression. Journal of affective disorders, v. 259, p. 1-6, 2019.
MARCANTONI, Walter S. et al. A systematic review and meta-analysis of the efficacy of intravenous ketamine infusion for treatment resistant depression: January 2009–January 2019. Journal of affective disorders, v. 277, p. 831-841, 2020.
MCGIRR, A. et al. A systematic review and meta-analysis of randomized, double-blind, placebo-controlled trials of ketamine in the rapid treatment of major depressive episodes. Psychological medicine, v. 45, n. 4, p. 693-704, 2015.
MCINTYRE, Roger S. et al. The effectiveness of repeated intravenous ketamine on depressive symptoms, suicidal ideation and functional disability in adults with major depressive disorder and bipolar disorder: results from the Canadian Rapid Treatment Center of Excellence. Journal of affective disorders, v. 274, p. 903-910, 2020.
PENNYBAKER, Steven J. et al. Symptomatology and predictors of antidepressant efficacy in extended responders to a single ketamine infusion. Journal of Affective Disorders, v. 208, p. 560-566, 2017.
RIVA-POSSE, Patricio et al. Blood pressure safety of subanesthetic ketamine for depression: a report on 684 infusions. Journal of affective disorders, v. 236, p. 291-297, 2018.
SHIROMA, Paulo R. et al. Neurocognitive performance and serial intravenous subanesthetic ketamine in treatment-resistant depression. International Journal of Neuropsychopharmacology, v. 17, n. 11, p. 1805-1813, 2014.
SINGH, Jaskaran B. et al. A double-blind, randomized, placebo-controlled, dose-frequency study of intravenous ketamine in patients with treatment-resistant depression. American Journal of Psychiatry, v. 173, n. 8, p. 816-826, 2016.
VOORT, Jennifer L. Vande et al. Continuation phase intravenous ketamine in adults with treatment-resistant depression. Journal of affective disorders, v. 206, p. 300-304, 2016.
WAN, Le-Ben et al. Ketamine safety and tolerability in clinical trials for treatment-resistant depression. The Journal of clinical psychiatry, v. 76, n. 3, p. 10121, 2014.
ZHENG, Wei et al. Investigation of medical effect of multiple ketamine infusions on patients with major depressive disorder. Journal of Psychopharmacology, v. 33, n. 4, p. 494-501, 2019.
ZHENG, Wei et al. Rapid and longer-term antidepressant effects of repeated-dose intravenous ketamine for patients with unipolar and bipolar depression. Journal of psychiatric research, v. 106, p. 61-68, 2018.
ZHENG, Wei et al. A preliminary study of adjunctive ketamine for treatment-resistant bipolar depression. Journal of affective disorders, v. 275, p. 38-43, 2020.
ZHOU, Yanling et al. Neurocognitive effects of six ketamine infusions and the association with antidepressant response in patients with unipolar and bipolar depression. Journal of Psychopharmacology, v. 32, n. 10, p. 1118-1126, 2018.
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Copyright (c) 2024 Luiz Eduardo Vilar Soares, Gabriel Valença de Siqueira Borges, Maria Luísa Alves de Andrade , Analice Maria de Luna Albuquerque, Laura Cristina Alves de Sousa , Júlia Renata Pinto Correia de Mélo, Sevana Valadão Naves , Leonardo de Andrade Vitorio , Anny Palloma Queiros Ramos, Felipe Otávio Saraiva França , Tadeu Romagnoli Neto, Maria Eduarda Viana de Araújo Munhoz , Francesca da Rocha Rosa Martins, Eduarda Richardt de Carvalho , Maria Luiza Barros Rodrigues , Emanuelle Schwab Inglês, Maria Clara Eifler Coimbra, Ali Malek Rahal , Augusto Nandi, Ana Carolina Delfino, Ana Carolina Munaro Coelho, Bruna Schmidt Leal , Isabela Facchin Bidoia , Ludmila Lemos Coelho Battisti , Ludmila Lemos Coelho Battisti , Gabriel Ferreira Fernandes , Mayara Rodrigues dos Santos Silva, Victor Ivo Crivoi Calzolari