Efficacy of ketamine for comorbid depression and acute or chronic pain: A systematic review
Pain and depression frequently co-occur. Due to its antidepressant and analgesic properties, ketamine has been used for the management of treatment-resistant depression and pain. This systematic review examined the literature on the efficacy of sub-anesthetic doses of ketamine in individuals experie...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2022-10-01
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| Series: | Frontiers in Pain Research |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fpain.2022.1022767/full |
| _version_ | 1798030819496820736 |
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| author | Aksharra Balachandran Vanessa K. Tassone Fathima Adamsahib Anne-Marie Di Passa Sarah Kuburi Ilya Demchenko Karim S. Ladha Karim S. Ladha Venkat Bhat Venkat Bhat Venkat Bhat Venkat Bhat Venkat Bhat |
| author_facet | Aksharra Balachandran Vanessa K. Tassone Fathima Adamsahib Anne-Marie Di Passa Sarah Kuburi Ilya Demchenko Karim S. Ladha Karim S. Ladha Venkat Bhat Venkat Bhat Venkat Bhat Venkat Bhat Venkat Bhat |
| author_sort | Aksharra Balachandran |
| collection | DOAJ |
| description | Pain and depression frequently co-occur. Due to its antidepressant and analgesic properties, ketamine has been used for the management of treatment-resistant depression and pain. This systematic review examined the literature on the efficacy of sub-anesthetic doses of ketamine in individuals experiencing comorbid depression and chronic pain (CDCP), as well as comorbid depression and acute pain (CDAP). A secondary objective was to provide an assessment of dosage, route, and adverse effects of ketamine treatment for CDCP and CDAP. A literature search was conducted on MEDLINE, PsycINFO, and Embase databases, coupled with a manual screening of the bibliography sections of included articles. In addition, registered ongoing and planned trials were searched on Clinicaltrials.gov. The end date of the search was April 9th, 2022. Included studies assessed changes in depression and pain in patients receiving at least one sub-anesthetic dose of ketamine. Assessment of quality was conducted using the GRADE checklist. Of the 7 CDCP clinical trials, 3 reported a reduction in depression and pain, 3 reported a reduction in depression or pain only, and 1 reported no improvement in either comorbidity. Among the 7 CDAP clinical trials, 4 studies found improvements in depression and pain while the remaining 3 reported improvements in only one parameter. Ten of the 12 case studies and 2 of the 3 observational studies assessing CDCP and CDAP found improvements in pain and depression scores post-treatment with effects of variable duration. The planned methodologies of the registered clinical trials are in line with those of the published research. Preliminary evidence supports the efficacy of ketamine in treating CDCP and CDAP. However, the current review identified a small number of heterogeneous studies with mixed results, preventing comprehensive conclusions. More longitudinal placebo-controlled studies are needed to identify the effects of ketamine for patients with CDCP and CDAP. |
| first_indexed | 2024-04-11T19:46:26Z |
| format | Article |
| id | doaj.art-d80a74e032b24c959cf9a044a6ffc799 |
| institution | Directory Open Access Journal |
| issn | 2673-561X |
| language | English |
| last_indexed | 2024-04-11T19:46:26Z |
| publishDate | 2022-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pain Research |
| spelling | doaj.art-d80a74e032b24c959cf9a044a6ffc7992022-12-22T04:06:27ZengFrontiers Media S.A.Frontiers in Pain Research2673-561X2022-10-01310.3389/fpain.2022.10227671022767Efficacy of ketamine for comorbid depression and acute or chronic pain: A systematic reviewAksharra Balachandran0Vanessa K. Tassone1Fathima Adamsahib2Anne-Marie Di Passa3Sarah Kuburi4Ilya Demchenko5Karim S. Ladha6Karim S. Ladha7Venkat Bhat8Venkat Bhat9Venkat Bhat10Venkat Bhat11Venkat Bhat12Interventional Psychiatry Program, Mental Health and Addictions Service, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, CanadaInterventional Psychiatry Program, Mental Health and Addictions Service, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, CanadaInterventional Psychiatry Program, Mental Health and Addictions Service, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, CanadaInterventional Psychiatry Program, Mental Health and Addictions Service, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, CanadaInterventional Psychiatry Program, Mental Health and Addictions Service, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, CanadaInterventional Psychiatry Program, Mental Health and Addictions Service, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, CanadaDepartment of Anesthesia, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, CanadaDepartment of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, CanadaInterventional Psychiatry Program, Mental Health and Addictions Service, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, CanadaInstitute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, CanadaDepartment of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, CanadaLi Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, CanadaKrembil Research Institute, University Health Network, Toronto, ON, CanadaPain and depression frequently co-occur. Due to its antidepressant and analgesic properties, ketamine has been used for the management of treatment-resistant depression and pain. This systematic review examined the literature on the efficacy of sub-anesthetic doses of ketamine in individuals experiencing comorbid depression and chronic pain (CDCP), as well as comorbid depression and acute pain (CDAP). A secondary objective was to provide an assessment of dosage, route, and adverse effects of ketamine treatment for CDCP and CDAP. A literature search was conducted on MEDLINE, PsycINFO, and Embase databases, coupled with a manual screening of the bibliography sections of included articles. In addition, registered ongoing and planned trials were searched on Clinicaltrials.gov. The end date of the search was April 9th, 2022. Included studies assessed changes in depression and pain in patients receiving at least one sub-anesthetic dose of ketamine. Assessment of quality was conducted using the GRADE checklist. Of the 7 CDCP clinical trials, 3 reported a reduction in depression and pain, 3 reported a reduction in depression or pain only, and 1 reported no improvement in either comorbidity. Among the 7 CDAP clinical trials, 4 studies found improvements in depression and pain while the remaining 3 reported improvements in only one parameter. Ten of the 12 case studies and 2 of the 3 observational studies assessing CDCP and CDAP found improvements in pain and depression scores post-treatment with effects of variable duration. The planned methodologies of the registered clinical trials are in line with those of the published research. Preliminary evidence supports the efficacy of ketamine in treating CDCP and CDAP. However, the current review identified a small number of heterogeneous studies with mixed results, preventing comprehensive conclusions. More longitudinal placebo-controlled studies are needed to identify the effects of ketamine for patients with CDCP and CDAP.https://www.frontiersin.org/articles/10.3389/fpain.2022.1022767/fullmood disorderspainglutamatedissociative anestheticscomorbidityketamine |
| spellingShingle | Aksharra Balachandran Vanessa K. Tassone Fathima Adamsahib Anne-Marie Di Passa Sarah Kuburi Ilya Demchenko Karim S. Ladha Karim S. Ladha Venkat Bhat Venkat Bhat Venkat Bhat Venkat Bhat Venkat Bhat Efficacy of ketamine for comorbid depression and acute or chronic pain: A systematic review Frontiers in Pain Research mood disorders pain glutamate dissociative anesthetics comorbidity ketamine |
| title | Efficacy of ketamine for comorbid depression and acute or chronic pain: A systematic review |
| title_full | Efficacy of ketamine for comorbid depression and acute or chronic pain: A systematic review |
| title_fullStr | Efficacy of ketamine for comorbid depression and acute or chronic pain: A systematic review |
| title_full_unstemmed | Efficacy of ketamine for comorbid depression and acute or chronic pain: A systematic review |
| title_short | Efficacy of ketamine for comorbid depression and acute or chronic pain: A systematic review |
| title_sort | efficacy of ketamine for comorbid depression and acute or chronic pain a systematic review |
| topic | mood disorders pain glutamate dissociative anesthetics comorbidity ketamine |
| url | https://www.frontiersin.org/articles/10.3389/fpain.2022.1022767/full |
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