PDF(Pubmed)
Abstract：
UNASSIGNED: Unipolar and bipolar depression present treatment challenges, with patients sometimes showing limited or no response to standard medications. Ketamine and its enantiomer, esketamine, offer promising alternative treatments that can quickly relieve suicidal thoughts. This Overview of Reviews (OoR) analyzed and synthesized systematic reviews (SRs) with meta-analysis on randomized clinical trials (RCTs) involving ketamine in various formulations (intravenous, intramuscular, intranasal, subcutaneous) for patients with unipolar or bipolar depression. We evaluated the efficacy and safety of ketamine and esketamine in treating major depressive episodes across various forms, including unipolar, bipolar, treatment-resistant, and non-resistant depression, in patient populations with and without suicidal ideation, aiming to comprehensively assess their therapeutic potential and safety profile.
UNASSIGNED: Following PRIOR guidelines, this OoR\'s protocol was registered on Implasy (ID:202150049). Searches in PubMed, Scopus, Cochrane Library, and Epistemonikos focused on English-language meta-analyses of RCTs of ketamine or esketamine, as monotherapy or add-on, evaluating outcomes like suicide risk, depressive symptoms, relapse, response rates, and side effects. We included studies involving both suicidal and non-suicidal patients; all routes and formulations of administration (intravenous, intramuscular, intranasal) were considered, as well as all available comparisons with control interventions. We excluded meta-analysis in which the intervention was used as anesthesia for electroconvulsive therapy or with a randomized ascending dose design. The selection, data extraction, and quality assessment of studies were carried out by pairs of reviewers in a blinded manner. Data on efficacy, acceptability, and tolerability were extracted.
UNASSIGNED: Our analysis included 26 SRs and 44 RCTs, with 3,316 subjects. The intervention is effective and well-tolerated, although the quality of the included SRs and original studies is poor, resulting in low certainty of evidence.
UNASSIGNED: This study is limited by poor-quality SRs and original studies, resulting in low certainty of the evidence. Additionally, insufficient available data prevents differentiation between the effects of ketamine and esketamine in unipolar and bipolar depression.
UNASSIGNED: While ketamine and esketamine show promising therapeutic potential, the current evidence suffers from low study quality. Enhanced methodological rigor in future research will allow for a more informed application of these interventions within the treatment guidelines for unipolar and bipolar depression.
UNASSIGNED: [https://inplasy.com/inplasy-2021-5-0049/], identifier (INPLASY202150049).
UNASSIGNED: Following PRIOR guidelines, this OoR\'s protocol was registered on Implasy (ID:202150049). Searches in PubMed, Scopus, Cochrane Library, and Epistemonikos focused on English-language meta-analyses of RCTs of ketamine or esketamine, as monotherapy or add-on, evaluating outcomes like suicide risk, depressive symptoms, relapse, response rates, and side effects. We included studies involving both suicidal and non-suicidal patients; all routes and formulations of administration (intravenous, intramuscular, intranasal) were considered, as well as all available comparisons with control interventions. We excluded meta-analysis in which the intervention was used as anesthesia for electroconvulsive therapy or with a randomized ascending dose design. The selection, data extraction, and quality assessment of studies were carried out by pairs of reviewers in a blinded manner. Data on efficacy, acceptability, and tolerability were extracted.
UNASSIGNED: Our analysis included 26 SRs and 44 RCTs, with 3,316 subjects. The intervention is effective and well-tolerated, although the quality of the included SRs and original studies is poor, resulting in low certainty of evidence.
UNASSIGNED: This study is limited by poor-quality SRs and original studies, resulting in low certainty of the evidence. Additionally, insufficient available data prevents differentiation between the effects of ketamine and esketamine in unipolar and bipolar depression.
UNASSIGNED: While ketamine and esketamine show promising therapeutic potential, the current evidence suffers from low study quality. Enhanced methodological rigor in future research will allow for a more informed application of these interventions within the treatment guidelines for unipolar and bipolar depression.
UNASSIGNED: [https://inplasy.com/inplasy-2021-5-0049/], identifier (INPLASY202150049).
摘要：
■单相和双相抑郁症提出了治疗挑战，患者有时对标准药物反应有限或没有反应。氯胺酮及其对映体，艾氯胺酮,提供有希望的替代疗法，可以迅速缓解自杀念头。本综述（OoR）分析和综合了系统评价（SRs），并对涉及各种制剂氯胺酮的随机临床试验（RCTs）进行了荟萃分析（静脉注射，肌肉内，鼻内,皮下）适用于单相或双相抑郁患者。我们评估了氯胺酮和艾氯胺酮治疗各种形式的重度抑郁发作的疗效和安全性，包括单极,双极,抗治疗，和非抗性抑郁症，在有和没有自杀意念的患者人群中，旨在全面评估其治疗潜力和安全性。
■遵循先前的准则，这个OoR的协议在Implasy上注册(ID:202150049)。在PubMed中搜索,Scopus,科克伦图书馆,Epistemonikos专注于氯胺酮或艾氯胺酮RCT的英语荟萃分析，作为单一疗法或附加疗法，评估自杀风险等结果，抑郁症状,复发,反应率，和副作用。我们纳入了涉及自杀和非自杀患者的研究；所有给药途径和制剂（静脉内，肌肉内，鼻内)被考虑，以及与控制干预措施的所有可用比较。我们排除了荟萃分析，其中干预被用作电惊厥治疗的麻醉或随机递增剂量设计。的选择，数据提取,研究的质量评估是由成对的审稿人以盲目的方式进行的。疗效数据，可接受性,提取了耐受性。
■我们的分析包括26个SR和44个RCT，有3316个科目。干预措施有效且耐受性良好，尽管纳入的SR和原始研究的质量很差，导致证据的确定性低。
■这项研究受到质量差的SR和原始研究的限制，导致证据的确定性低。此外,现有数据不足,无法区分氯胺酮和艾氯胺酮在单相和双相型抑郁症中的作用.
■虽然氯胺酮和艾氯胺酮显示出很有希望的治疗潜力，目前的证据存在研究质量低的问题.在未来的研究中，方法学上的严谨性将使这些干预措施在单相和双相抑郁的治疗指南中得到更明智的应用。
■[https://inplasy.com/inplasy-2021-5-0049/],标识符(INPLASY202150049)。
■遵循先前的准则，这个OoR的协议在Implasy上注册(ID:202150049)。在PubMed中搜索,Scopus,科克伦图书馆,Epistemonikos专注于氯胺酮或艾氯胺酮RCT的英语荟萃分析，作为单一疗法或附加疗法，评估自杀风险等结果，抑郁症状,复发,反应率，和副作用。我们纳入了涉及自杀和非自杀患者的研究；所有给药途径和制剂（静脉内，肌肉内，鼻内)被考虑，以及与控制干预措施的所有可用比较。我们排除了荟萃分析，其中干预被用作电惊厥治疗的麻醉或随机递增剂量设计。的选择，数据提取,研究的质量评估是由成对的审稿人以盲目的方式进行的。疗效数据，可接受性,提取了耐受性。
■我们的分析包括26个SR和44个RCT，有3316个科目。干预措施有效且耐受性良好，尽管纳入的SR和原始研究的质量很差，导致证据的确定性低。
■这项研究受到质量差的SR和原始研究的限制，导致证据的确定性低。此外,现有数据不足,无法区分氯胺酮和艾氯胺酮在单相和双相型抑郁症中的作用.
■虽然氯胺酮和艾氯胺酮显示出很有希望的治疗潜力，目前的证据存在研究质量低的问题.在未来的研究中，方法学上的严谨性将使这些干预措施在单相和双相抑郁的治疗指南中得到更明智的应用。
■[https://inplasy.com/inplasy-2021-5-0049/],标识符(INPLASY202150049)。
